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Mon May 12 15:31:05 BST 2008

I would just like to add a cautionary note here, stemming from a recent untoward incident in our place.  "Hemodynamically stable" has various interpretations depending on who is looking at the patient. In the case I am referring to we decided to emobo a grade four spleen that had been reported as stable.  But once you go down that road the pt needs to be constantly reassessed for even the hint of trouble. There were nursing issues in the IR suite and overzealous attempts to complete the procedure despite a dynamap that was malfunctioning ( read unable to obtain BP-read there was no BP).
	So my point is the OR is the best place to "Nurse" a patient with a bad spleen, and if your anywhere else-the effort ( in the first 24 hours) to make sure that the patient is truly, truly stable needs to be an extraordinary one.  With folks that will re-steer the ship to the OR at the first hint of trouble.  In particular the wait for the IR suite in the ER, the transport to and from the IR suite and the initial (getting to know you) in the Surgical ICU (we have found) are points of failure)...Shel 

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Today's Topics:

   1. RE: Blunt splenic injuries (Matt Oliver)
   2. Blunt Splenic Injuries (Matthew Reeds)
   3. Re: Blunt Splenic Injuries (nappio at aol.com)
   4. Stab Mouth (Matthew Reeds)
   5. Re: Blunt Splenic Injuries (Ronald Gross)
   6. Re: Blunt splenic injuries (julie miller)
   7. Re: interesting zone I GSW (sjasmd at aol.com)
   8. Re: Blunt Splenic Injuries (sjasmd at aol.com)
   9. Trauma books (harthy1973 at yahoo.ca)
  10. RE: Trauma books (Timothy Craig Hardcastle)
  11. RE: Trauma books (Dr Ross Hofmeyr)
  12. RE: Trauma books (Timothy Craig Hardcastle)

----------------------------------------------------------------------

Message: 1
Date: Wed, 7 May 2008 22:29:53 +1000
From: Matt Oliver <moliverzw at gmail.com>
Subject: RE: Blunt splenic injuries
To: "'Trauma &amp; Critical Care mailing list'"
	<trauma-list at trauma.org>
Message-ID:
	<!&!AAAAAAAAAAAYAAAAAAAAABSuF9bDeuNNmltoZ7nEVuZChQAAEAAAAN6mKK+m6V9KlRkNMMx9ZjgBAAAAAA==@googlemail.com>

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Ian

ICU for 24 hours.

Matt Oliver
Bendigo
Australia

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of Ian Seppelt
Sent: Wednesday, 7 May 2008 4:50 PM
To: trauma-list at trauma.org
Subject: Blunt splenic injuries

Quick and dirty survey:

Where do you nurse haemodynamically stable patients with an isolated spleen injury being managed conservatively, and no other injuries? ICU?
General ward? Higher acuity ward?
What acuity of nursing? What monitors? 
Does the exact CT grade of injury matter, or merely the fact that the patient is stable and the trauma surgeon is comfortable to watch?

Many thanks,

Ian

correspondence to: seppelt at med.usyd.edu.au

Ian Seppelt FANZCA FJFICM
Senior Staff Specialist
Dept of Intensive Care Medicine
The Nepean Hospital, PO Box 63 Penrith NSW 2751 Director of Clinical Research, Sydney West AHS Clinical Lecturer, University of Sydney

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Message: 2
Date: Wed, 7 May 2008 19:29:20 +0100
From: "Matthew Reeds" <mgreeds at reeds.uk.com>
Subject: Blunt Splenic Injuries
To: "'Trauma &amp; Critical Care mailing list'"
	<trauma-list at trauma.org>
Message-ID:
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If the patient is "stable" (translated to mean that the patient is not having their "spleen preserved in a bucket") then, at least in our hospital, they would be observed on the HDU for the first 24-48 hours. Like what used to happen with Tim previously, grade is not a factor as to where they go as there is not a "normal" dedicated trauma ward. If the patient shows no clinical change after this time (they will have check Hb with HCT 12 hourly
- not 4 hourly like Tim's previous unit) and other vital signs remain unchanged, then they get transferred to a general ward. I would not get obsessed with specific observational readings such as BP & HR etc. - as it is the patient's clinical condition that counts (treat the patient not the numbers etc.) It is a change in the patient's vital signs that would warrant reassessment of conservative management and not absolute values. After 2-4 days, if the patient remains well, they would be discharged home. Like Tim, there is no further imaging or follow-up.

I agree with Ron that if transferring the patient to ITU is being considered, then the patient is not "stable" and cannot be managed conservatively (as the old saying goes - stable = a place for horses with mess on the floor!!) In that case, I question the role for preserving the spleen with angio rather than in a bucket. I also agree with Ron in that the patient should not be transferred straight from the ED to ITU.

Matthew

-----Original Message-----
From: Ian Seppelt [mailto:seppeli at wahs.nsw.gov.au]
Sent: 07 May 2008 07:50
To: trauma-list at trauma.org
Subject: Blunt splenic injuries

Quick and dirty survey:

Where do you nurse haemodynamically stable patients with an isolated

spleen injury being managed conservatively, and no other injuries? ICU?

General ward? Higher acuity ward?

What acuity of nursing? What monitors? 

Does the exact CT grade of injury matter, or merely the fact that the

patient is stable and the trauma surgeon is comfortable to watch?

Many thanks,

Ian

correspondence to: seppelt at med.usyd.edu.au

Ian Seppelt FANZCA FJFICM

Senior Staff Specialist

Dept of Intensive Care Medicine

The Nepean Hospital, PO Box 63 Penrith NSW 2751

Director of Clinical Research, Sydney West AHS

Clinical Lecturer, University of Sydney

____________________________________________________________________________
__

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Message: 3
Date: Wed, 7 May 2008 18:39:20 +0000
From: nappio at aol.com
Subject: Re: Blunt Splenic Injuries
To: "Trauma &amp; Critical Care mailing list" <trauma-list at trauma.org>
Message-ID:
	<1091908188-1210185646-cardhu_decombobulator_blackberry.rim.net-226540075- at bxe136.bisx.prod.on.blackberry>

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What activities can they pursue and when?  Including rough sports.  Do you give vaccines?  DN Sent from my Verizon Wireless BlackBerry

-----Original Message-----
From: "Matthew Reeds" <mgreeds at reeds.uk.com>

Date: Wed, 7 May 2008 19:29:20
To:"'Trauma &amp; Critical Care mailing list'" <trauma-list at trauma.org>
Subject: Blunt Splenic Injuries

If the patient is "stable" (translated to mean that the patient is not
having their "spleen preserved in a bucket") then, at least in our hospital,
they would be observed on the HDU for the first 24-48 hours. Like what used
to happen with Tim previously, grade is not a factor as to where they go as
there is not a "normal" dedicated trauma ward. If the patient shows no
clinical change after this time (they will have check Hb with HCT 12 hourly
- not 4 hourly like Tim's previous unit) and other vital signs remain
unchanged, then they get transferred to a general ward. I would not get
obsessed with specific observational readings such as BP & HR etc. - as it
is the patient's clinical condition that counts (treat the patient not the
numbers etc.) It is a change in the patient's vital signs that would warrant
reassessment of conservative management and not absolute values. After 2-4
days, if the patient remains well, they would be discharged home. Like Tim,
there is no further imaging or follow-up.

I agree with Ron that if transferring the patient to ITU is being
considered, then the patient is not "stable" and cannot be managed
conservatively (as the old saying goes - stable = a place for horses with
mess on the floor!!) In that case, I question the role for preserving the
spleen with angio rather than in a bucket. I also agree with Ron in that the
patient should not be transferred straight from the ED to ITU.

Matthew

-----Original Message-----
From: Ian Seppelt [mailto:seppeli at wahs.nsw.gov.au] 
Sent: 07 May 2008 07:50
To: trauma-list at trauma.org
Subject: Blunt splenic injuries

Quick and dirty survey:

Where do you nurse haemodynamically stable patients with an isolated

spleen injury being managed conservatively, and no other injuries? ICU?

General ward? Higher acuity ward?

What acuity of nursing? What monitors? 

Does the exact CT grade of injury matter, or merely the fact that the

patient is stable and the trauma surgeon is comfortable to watch?

Many thanks,

Ian

correspondence to: seppelt at med.usyd.edu.au

Ian Seppelt FANZCA FJFICM

Senior Staff Specialist

Dept of Intensive Care Medicine

The Nepean Hospital, PO Box 63 Penrith NSW 2751

Director of Clinical Research, Sydney West AHS

Clinical Lecturer, University of Sydney

____________________________________________________________________________
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------------------------------

Message: 4
Date: Wed, 7 May 2008 19:46:38 +0100
From: "Matthew Reeds" <mgreeds at reeds.uk.com>
Subject: Stab Mouth
To: "'Trauma &amp; Critical Care mailing list'"
	<trauma-list at trauma.org>
Message-ID:
	<!&!AAAAAAAAAAAYAAAAAAAAAEyQlkqev8pIuYu+oSSXTyvCgAAAEAAAAHfg0Ug0QTRIsTKc5tCUa+QBAAAAAA==@reeds.uk.com>

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Doug,

I know of a number of situations where the use of haemostatic agents has
proved lifesaving and I also know that the military use them regularly to
save both life and limb. Whilst I fully agree that their use would certainly
not be the preferred option, if all other options have failed, you should
not waste time repeatedly trying methods that have already failed but
instead move one quickly and try a different method which may work. I
recognise your comment about antiseptic dressing use for dry sockets - but
that is a completely different subject. The HemCon dressings have worked for
me in the past with good effect - in fact our local Max-Fax unit confirmed
that they were a good idea! Given what you have said though, I shall
certainly await your practical tips with keen interest.

Matthew 

-----Original Message-----
From: DWGKENNEDY at aol.com [mailto:DWGKENNEDY at aol.com] 
Sent: 05 May 2008 19:18
To: trauma-list at trauma.org
Subject: Re: stab mouth

Stop this now!

Alvogyl is an antiseptic dressing used for post extraction 'dry sockets' -  

NOTHING ELSE.

I'll write some practical tips later when people stop stuffing things in  

this wound!

Doug

------------------------------

Message: 5
Date: Wed, 07 May 2008 15:38:05 -0400
From: "Ronald Gross" <Rgross at harthosp.org>
Subject: Re: Blunt Splenic Injuries
To: "Trauma &amp; Critical Care mailing list" <trauma-list at trauma.org>
Message-ID: <4821CCDD.7FF1.00B9.0 at harthosp.org>
Content-Type: text/plain; charset=US-ASCII

If non-operative management is successful, I allow the Grade I patients back to regular activity at 2-3 months, including contact sports if they so choose, remembering, however, that there was no post injury RE-scanning.  Any higher grade I will not allow back to anything other than sedentary activity for 6 months.  I admit that this is purely arbitrary, with not a shred of good evidence to support this practice -  other than what these patients' spleens used to look like on followup scans when I did scan them to follow the "healing process" (and that was a very long time ago!).

As to vaccines, I do vaccinate all patients that have been angio-embolized, regardless of whether the gelfoam and/or coils were placed "selectively" or proximally.  Given the variance of "opinion/evidence" about the correct timing of post-splenectomy vaccination, I give the vaccines to the  patient in the recovery room, lest I (or someone else) forget to give it to them on discharge!

Just my 2 cents,
Ron

>>> <nappio at aol.com> 5/7/2008 2:39 PM >>>
What activities can they pursue and when?  Including rough sports.  Do you give vaccines?  DN
Sent from my Verizon Wireless BlackBerry

-----Original Message-----
From: "Matthew Reeds" <mgreeds at reeds.uk.com>

Date: Wed, 7 May 2008 19:29:20 
To:"'Trauma &amp; Critical Care mailing list'" <trauma-list at trauma.org>
Subject: Blunt Splenic Injuries

If the patient is "stable" (translated to mean that the patient is not
having their "spleen preserved in a bucket") then, at least in our hospital,
they would be observed on the HDU for the first 24-48 hours. Like what used
to happen with Tim previously, grade is not a factor as to where they go as
there is not a "normal" dedicated trauma ward. If the patient shows no
clinical change after this time (they will have check Hb with HCT 12 hourly
- not 4 hourly like Tim's previous unit) and other vital signs remain
unchanged, then they get transferred to a general ward. I would not get
obsessed with specific observational readings such as BP & HR etc. - as it
is the patient's clinical condition that counts (treat the patient not the
numbers etc.) It is a change in the patient's vital signs that would warrant
reassessment of conservative management and not absolute values. After 2-4
days, if the patient remains well, they would be discharged home. Like Tim,
there is no further imaging or follow-up.

I agree with Ron that if transferring the patient to ITU is being
considered, then the patient is not "stable" and cannot be managed
conservatively (as the old saying goes - stable = a place for horses with
mess on the floor!!) In that case, I question the role for preserving the
spleen with angio rather than in a bucket. I also agree with Ron in that the
patient should not be transferred straight from the ED to ITU.

Matthew

-----Original Message-----
From: Ian Seppelt [mailto:seppeli at wahs.nsw.gov.au] 
Sent: 07 May 2008 07:50
To: trauma-list at trauma.org 
Subject: Blunt splenic injuries

Quick and dirty survey:

Where do you nurse haemodynamically stable patients with an isolated

spleen injury being managed conservatively, and no other injuries? ICU?

General ward? Higher acuity ward?

What acuity of nursing? What monitors? 

Does the exact CT grade of injury matter, or merely the fact that the

patient is stable and the trauma surgeon is comfortable to watch?

Many thanks,

Ian

correspondence to: seppelt at med.usyd.edu.au 

Ian Seppelt FANZCA FJFICM

Senior Staff Specialist

Dept of Intensive Care Medicine

The Nepean Hospital, PO Box 63 Penrith NSW 2751

Director of Clinical Research, Sydney West AHS

Clinical Lecturer, University of Sydney

____________________________________________________________________________
__

This electronic message and any attachments may be confidential.  If you

are not the intended recipient of this message would you please delete the

message and any attachments and advise the sender. Sydney West

Area Health Service (SWAHS) uses virus scanning software but excludes 

any liability for viruses contained in any email or attachment.

This email may contain privileged and confidential information intended

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------------------------------

Message: 6
Date: Wed, 7 May 2008 14:04:43 -0700 (PDT)
From: julie miller <jamiller444 at yahoo.com>
Subject: Re: Blunt splenic injuries
To: "Trauma &amp; Critical Care mailing list" <trauma-list at trauma.org>
Message-ID: <443482.75921.qm at web56909.mail.re3.yahoo.com>
Content-Type: text/plain; charset=iso-8859-1

Dear Ian,
We send patients with grade IV or V to ICU for the first day (we don't have an HDU), as our ward nurses are stretched somewhat thin. We know then that a new tachycardia or drop in urine output will be picked up earlier than if they are on the ward. I also like to vaccinate the high grade spleens just in case the spleen will be taking a walk.  If there is a  contrast blush on CT, or a drop in Hb in the first day with markedly increased blood on a repeat CT (obtained only if drop in Hb), we have recently begun requesting angioembolization from our very accommodating interventional radiologists.All things being equal, it's better to have  your spleen than not (many patients retain splenic function after embolization), and it is better not to have a laparotomy than to have one (no incisional hernias, shorter LOS, etc). 
We typically keep patients 3 days if they have stable Hb and have no ileus. I recently saw some great data from the NTDB with many thousands of patients, that 95% of failures occur in the first 72 hours, then the curve flattens completely and you would have to keep patients 30 days to capture 99% of failures. (published J Trauma 2008) The main thing is to encourage patients to take it easy, and to return if they feel unwell, dizzy, etc. after discharge. I cannot recall any readmissions for spleens, but we had one renal injury return with collapse from a ruptured psuedoaneurysm that was successfully embolized. 
Julie Miller
Royal Melbourne Hospital
Australia

----- Original Message ----
From: Matt Oliver <moliverzw at gmail.com>
To: "Trauma & Critical Care mailing list" <trauma-list at trauma.org>
Sent: Wednesday, May 7, 2008 10:29:53 PM
Subject: RE: Blunt splenic injuries

Ian

ICU for 24 hours.

Matt Oliver
Bendigo
Australia

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of Ian Seppelt
Sent: Wednesday, 7 May 2008 4:50 PM
To: trauma-list at trauma.org
Subject: Blunt splenic injuries

Quick and dirty survey:

Where do you nurse haemodynamically stable patients with an isolated
spleen injury being managed conservatively, and no other injuries? ICU?
General ward? Higher acuity ward?
What acuity of nursing? What monitors? 
Does the exact CT grade of injury matter, or merely the fact that the
patient is stable and the trauma surgeon is comfortable to watch?

Many thanks,

Ian

correspondence to: seppelt at med.usyd.edu.au

Ian Seppelt FANZCA FJFICM
Senior Staff Specialist
Dept of Intensive Care Medicine
The Nepean Hospital, PO Box 63 Penrith NSW 2751
Director of Clinical Research, Sydney West AHS
Clinical Lecturer, University of Sydney

____________________________________________________________________________
__

This electronic message and any attachments may be confidential.  If you
are not the intended recipient of this message would you please delete the
message and any attachments and advise the sender. Sydney West
Area Health Service (SWAHS) uses virus scanning software but excludes 
any liability for viruses contained in any email or attachment.

This email may contain privileged and confidential information intended
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intended recipient of this email, you are hereby notified that any use,
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you have received this email in error, please notify SWAHS
immediately. 

Any views expressed in this email are those of the individual sender 
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Message: 7
Date: Thu, 08 May 2008 01:59:00 -0400
From: sjasmd at aol.com
Subject: Re: interesting zone I GSW
To: trauma-list at trauma.org
Message-ID: <8CA7EE7BE8AF007-11C4-1B75 at WEBMAIL-DF03.sysops.aol.com>
Content-Type: text/plain; charset="us-ascii"

haim
in this case CT did not show the trajectory, did show known hematoma in mediastinum as well as retained hemothorax. AND IT SHOWED AN INJURY NOT SEEN ON ANGIO

with regard to the experience derved from this case:
1. don't over hydrate. it causes the aorta to bleed.
2. plus one for CT: i think it better visualized the injury

sal

-----Original Message-----
From: Dr. Haim Paran <paran620 at green.co.il>
To: 'Trauma &amp; Critical Care mailing list' <trauma-list at trauma.org>
Sent: Mon, 5 May 2008 11:38 pm
Subject: RE: interesting zone I GSW

No evidence yet, but CTA in this case could show the tract, unseen hematomas
missed by the angio and also the damage to other structures. If the CTA
would show a suspected vessel damage, then depending of the kind of injury
either go directly to surgery or, as Dr. Mattox probably would want, confirm
with angio.

Haim Paran

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of sjasmd at aol.com
Sent: Tuesday, May 06, 2008 3:29 AM
To: trauma-list at trauma.org
Subject: Re: interesting zone I GSW

haim
sorry,let me try again

what is the evidence concerning accuracy of CTA compared to the gold
standard catheter based angiography for penetrating trauma of the great
vessels?

sal

-----Original Message-----
From: Dr. Haim Paran <paran620 at green.co.il>
To: 'Trauma & Critical Care mailing list' <trauma-list at trauma.org>
Sent: Mon, 5 May 2008 1:40 pm
Subject: RE: interesting zone I GSW

I think I would have started with a CT-angio in the first place.

Haim Paran

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of SJASMD at aol.com
Sent: Monday, May 05, 2008 3:05 PM
To: trauma-list at trauma.org
Subject: Re: interesting zone I GSW

In a message dated 5/4/2008 11:27:57 P.M. Eastern Standard Time,  
shebrain1 at yahoo.com writes:

I would  do very careful exam to R/O any other GSW to abd, to help explain 
his  hypotension which i think is due to hemorrhage and possible initial 
neurogenic  origin.

how about his LU pulse exam, any  difference? any bruit over supraclavicular

region , any arm swelling, that  might suggest AVF with Hyperdynamic state 
that can explain his increased  BP.

the Chest Tube out put is 1600 ml Over how long  time? or better how  much 
over the last 2-3 hours?

if patient remained stable with decreasing CT out put, I would  obesrve, if 
any Q about integrity of aorta I would have IVUS to  evlaute.
I would admit to ICU, get EKG and possible TEE and  observe.unless become 
unstable.

ss

no other injuries
pulses symetrical
no bruit
no arm swelling
possibly over resuscitated to cause bp increase?
output was over about six hours. by end of angio, output stopped. still  
residual blood in the chest
ekg normal
currently being observed

would ken mattox do a CT of the chest after a negative angiogram?

sal

**************Wondering what's for Dinner Tonight? Get new twists on family 
favorites at AOL Food.      
(http://food.aol.com/dinner-tonight?NCID=aolfod00030000000001)
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Message: 8
Date: Thu, 08 May 2008 02:29:54 -0400
From: sjasmd at aol.com
Subject: Re: Blunt Splenic Injuries
To: trauma-list at trauma.org
Message-ID: <8CA7EEC0FEFDA08-11C4-1BA6 at WEBMAIL-DF03.sysops.aol.com>
Content-Type: text/plain; charset="us-ascii"

matthew
what are you questioning about angio. Do you think that splenectomy is preferable to splenic salvage? Do you have difficulties with angio or are your interventionalists not particularly useful, interested, adept at trauma care?

sal

-----Original Message-----
From: Matthew Reeds <mgreeds at reeds.uk.com>
To: 'Trauma &amp; Critical Care mailing list' <trauma-list at trauma.org>
Sent: Wed, 7 May 2008 2:29 pm
Subject: Blunt Splenic Injuries

If the patient is "stable" (translated to mean that the patient is not
having their "spleen preserved in a bucket") then, at least in our hospital,
they would be observed on the HDU for the first 24-48 hours. Like what used
to happen with Tim previously, grade is not a factor as to where they go as
there is not a "normal" dedicated trauma ward. If the patient shows no
clinical change after this time (they will have check Hb with HCT 12 hourly
- not 4 hourly like Tim's previous unit) and other vital signs remain
unchanged, then they get transferred to a general ward. I would not get
obsessed with specific observational readings such as BP & HR etc. - as it
is the patient's clinical condition that counts (treat the patient not the
numbers etc.) It is a change in the patient's vital signs that would warrant
reassessment of conservative management and not absolute values. After 2-4
days, if the patient remains well, they would be discharged home. Like Tim,
there is no further imaging or follow-up.

I agree with Ron that if transferring the patient to ITU is being
considered, then the patient is not "stable" and cannot be managed
conservatively (as the old saying goes - stable = a place for horses with
mess on the floor!!) In that case, I question the role for preserving the
spleen with angio rather than in a bucket. I also agree with Ron in that the
patient should not be transferred straight from the ED to ITU.

Matthew

-----Original Message-----
From: Ian Seppelt [mailto:seppeli at wahs.nsw.gov.au] 
Sent: 07 May 2008 07:50
To: trauma-list at trauma.org
Subject: Blunt splenic injuries

Quick and dirty survey:

Where do you nurse haemodynamically stable patients with an isolated

spleen injury being managed conservatively, and no other injuries? ICU?

General ward? Higher acuity ward?

What acuity of nursing? What monitors? 

Does the exact CT grade of injury matter, or merely the fact that the

patient is stable and the trauma surgeon is comfortable to watch?

Many thanks,

Ian

correspondence to: seppelt at med.usyd.edu.au

Ian Seppelt FANZCA FJFICM

Senior Staff Specialist

Dept of Intensive Care Medicine

The Nepean Hospital, PO Box 63 Penrith NSW 2751

Director of Clinical Research, Sydney West AHS

Clinical Lecturer, University of Sydney

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Message: 9
Date: Thu, 8 May 2008 07:25:29 +0000
From: harthy1973 at yahoo.ca
Subject: Trauma books
To: "Trauma &amp; Critical Care mailing list" <trauma-list at trauma.org>
Message-ID:
	<1152746169-1210231604-cardhu_decombobulator_blackberry.rim.net-1486920504- at bxe050.bisx.produk.on.blackberry>

Content-Type: text/plain; charset="Windows-1252"

Our surgical department is forming a mini library. I'm looking for title suggestions (other than Trauma and Top Knife by mattox).
Thank you,
Abdullah Al-Harthy
Sent from my BlackBerry® smartphone from Oman Mobile!

------------------------------

Message: 10
Date: Thu, 8 May 2008 10:12:19 +0200
From: "Timothy Craig Hardcastle" <TimothyHar at ialch.co.za>
Subject: RE: Trauma books
To: "Trauma &amp; Critical Care mailing list" <trauma-list at trauma.org>
Message-ID:
	<C37E73C1CBE7BE4B80591B319EC849BA208E4B0A at ALSEX.ialch.co.za>
Content-Type: text/plain;	charset="US-ASCII"

If you can get it:
Oxford Handbook of trauma for Southern Africa, edited by Nicol and Steyn
is good for a developing country scenario. ISBN 019578809

"Manual of DSTC" edited by Boffard is also worthwhile. Sorry don't have
the ISBN, but published by Arnold.

CRISP Course manual deals with surgical critical care, mainly trauma.
Also published by Arnold.

Regards,
Tim
Dr Timothy C Hardcastle
M.B., Ch.B. (Stell); M. Med (Chir) (Stell); FCS (SA)
Principal Surgeon-Lecturer / Sub-specialist: Trauma and Critical Care
Deputy director: Trauma Unit and Trauma ICU
Inkosi Albert Luthuli Central Hospital / UKZN
800 Bellair Road
Mayville, Durban

Postal: PostNet Suite 27
Private Bag X05
Malvern, 4055
KwaZulu Natal

timothyhar at ialch.co.za 

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of harthy1973 at yahoo.ca
Sent: 08 May 2008 09:25
To: Trauma &amp; Critical Care mailing list
Subject: Trauma books

Our surgical department is forming a mini library. I'm looking for title
suggestions (other than Trauma and Top Knife by mattox).
Thank you,
Abdullah Al-Harthy
Sent from my BlackBerry(r) smartphone from Oman Mobile!

------------------------------

Message: 11
Date: Thu, 8 May 2008 10:15:30 -0000
From: "Dr Ross Hofmeyr" <wildmedic at gmail.com>
Subject: RE: Trauma books
To: "'Trauma &amp; Critical Care mailing list'"
	<trauma-list at trauma.org>
Message-ID: <443DABD20DE34F5D80BBB00B1551F5F7 at WildMedicPavillion>
Content-Type: text/plain;	charset="us-ascii"

> "Manual of DSTC" edited by Boffard is also worthwhile. Sorry don't have
> the ISBN, but published by Arnold.

[Dr Ross Hofmeyr] 
Manual of Definitive Surgical Trauma Care, Second Edition.  ISBN
978-0-340-94764-7, Hodder Arnold (www.hoddereducation.com)

Close enough that I didn't need to get out of my chair ;)

R.

------------------------------

Message: 12
Date: Thu, 8 May 2008 12:46:34 +0200
From: "Timothy Craig Hardcastle" <TimothyHar at ialch.co.za>
Subject: RE: Trauma books
To: "Trauma &amp; Critical Care mailing list" <trauma-list at trauma.org>
Message-ID:
	<C37E73C1CBE7BE4B80591B319EC849BA208E43DD at ALSEX.ialch.co.za>
Content-Type: text/plain;	charset="US-ASCII"

Ross

Thanks - mine is still in storage with the relocation! (Will be for a
few more months!!!!)

Tim
Dr Timothy C Hardcastle
M.B., Ch.B. (Stell); M. Med (Chir) (Stell); FCS (SA)
Principal Surgeon-Lecturer / Sub-specialist: Trauma and Critical Care
Deputy director: Trauma Unit and Trauma ICU
Inkosi Albert Luthuli Central Hospital / UKZN
800 Bellair Road
Mayville, Durban

Postal: PostNet Suite 27
Private Bag X05
Malvern, 4055
KwaZulu Natal

timothyhar at ialch.co.za 

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of Dr Ross Hofmeyr
Sent: 08 May 2008 12:16
To: 'Trauma &amp; Critical Care mailing list'
Subject: RE: Trauma books

> "Manual of DSTC" edited by Boffard is also worthwhile. Sorry don't
have
> the ISBN, but published by Arnold.

[Dr Ross Hofmeyr] 
Manual of Definitive Surgical Trauma Care, Second Edition.  ISBN
978-0-340-94764-7, Hodder Arnold (www.hoddereducation.com)

Close enough that I didn't need to get out of my chair ;)

R.

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trauma-list Digest, Vol 59, Issue 11/Conservative management of the injured spleen