Technology and Trauma Laparoscopy

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I apologize for any perception that I might have meant to insult Dr. Norman McSwain, for whom I have great respect.   We in private practice have pressures and traditions that are not always seen in a social service or public hospital.    We do what works for us.    In the long run, I suspect that our costs and Dr. McSwain's costs are very similiar.   I am working at a quite large private hospital in a city with several public hospitals.     Our results are comparable to those in the social service sector of our city.     We also have private patients who are more aware of the advanced and emerging technologies than those in the social service side.     I do try to apply all advance technology when I can.   Like many we are exclusively using the CTA and the reconstructions of the aorta on the computer to diagnosis thoracic aortic injury and are using endografts almost exclusively to open procedures.    Dr. Demetriades of our city recommended CTA and endografts in the literature this year.    Our hospital is always one of the first to buy the very fast multicut helical CT scanners.     
 
Mohammed



From: rfsmithmd at comcast.netTo: trauma-list at trauma.orgSubject: RE: Trauma Screening LaparoscopyDate: Mon, 24 Nov 2008 07:01:30 -0500



Sorry; No diaphragmatic injury would heal…. and therefore needed to be repaired. As Tim says, some because of their anatomic location, like over the back of the liver, seem resistant to this.
 


From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] On Behalf Of Robert SmithSent: Monday, November 24, 2008 6:52 AMTo: 'Trauma & Critical Care mailing list'Cc: Kknagy at aol.comSubject: RE: Trauma Screening Laparoscopy
 

Dr. McSwain,
 
Of course I agree with everything you said in your response. 
 
Except:
 
You are saying that you do a laparoscopy to look for perforation of the peritoneum “We merely look for signs of> peritoneal penetration, as you did with DPL.”
            (DPL is NOT an indicator of perforation of the peritoneum. I do not use it for this reason)
 
I realize everything I once knew is either wrong or forgotten. But this must really be the end. I certainly labored under the belief the this was exactly what DPL was used for. Kim Nagy at Cook County Hospital and others have published extensively on its use. For instance: A method of determining peritoneal penetration in gunshot wounds to the abdomen. Nagy KK, Krosner SM, Joseph KT, Roberts RR, Smith RF, Barrett J. J Trauma. 1997 Aug;43(2):242-5; discussion 245-6. We also used it to R/U diaphragmatic penetration and I would think it is much less invasive than a scope of any kind. In Cymbas’ text on Cardiothoracic Trauma he was clear that he believed his work showed that not diaphragmatic penetration would heal, and that all, over time enough time would develop hernias and needed to be repaired. In general, this was the approach at County Hospital as I understood it.
Rob Smith
 
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