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Thu Apr 23 15:53:35 BST 2009

In short there is no role for DPL- lets expunge it from the record books and delete it from ATLS.  We spend much more time talking about it and then actually doing it. In the last 10 years at this Level one center we have used it twice.  Both times was to use the Catheter to warm a Hypothermic Pt until they were "warm" and dead.  Shel 

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Today's Topics:

   1. RE: The role of DPA in 2009 and beyond (Gross, Ronald)
   2. RE: The role of DPA in 2009 and beyond (McSwain, Norman E Jr.)
   3. The role of DPA in 2009 and beyond (Bevan Lowe) (navin goyal)
   4. Re: The role of DPA in 2009 and beyond (Bevan Lowe) (Karim Brohi)

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Message: 1
Date: Wed, 22 Apr 2009 07:10:48 -0400
From: "Gross, Ronald" <Ronald.Gross at baystatehealth.org>
Subject: RE: The role of DPA in 2009 and beyond
To: "'Trauma and Critical Care mailing list'" <trauma-list at trauma.org>
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	<FD2BE6867A90F543AAD02E429F878633013B1FBC0B27 at bhsexc11.bhs.org>
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Since 1995, when I began to use the FAST as a part of my primary survey I have done no DPL's........

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] On Behalf Of Bevan Lowe
Sent: Wednesday, April 22, 2009 2:47 AM
To: trauma-list at trauma.org
Subject: The role of DPA in 2009 and beyond

Is there any role of Diagnostic Peritoneal tap (DPA) or for that matter DPL in the ED in the hypotensive blunt trauma pt when we have FAST available these days?
Our approach is:- do a FAST, +ve OT, -ve repeat & look for other cause, if still ? abdo bleed go to OT. Equivocal FAST go to OT. Some surgeons are advocating DPA. Thoughts?

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Message: 2
Date: Wed, 22 Apr 2009 11:04:32 -0500
From: "McSwain, Norman E Jr." <nmcswai at tulane.edu>
Subject: RE: The role of DPA in 2009 and beyond
To: "Trauma and Critical Care mailing list" <trauma-list at trauma.org>
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Please do not confuse principles with preferences. 

I like DPL and use it but others may not. this does not mean that I am wrong and that they are right or visa versa.  DPL is a test like all tests. It has its good points and bad. The good is that it is very accurate (~98% ). the bad is that it is very accurate (~98%). It is so accurate in identifying the presence of blood it is overly sensitive. If it is followed closely many patients with a small amount of blood will get an operation that is not needed because the hemorrhage has stopped. The is true of the latest generation of CT. Many radiologists will identify things on the scan that do not require surgery. All of these tests require clinical judgment. They CANNOT be used in isolation of other physical examination and laboratory findings.

You should use the one the works best for YOU.

the eye scan - looking at the patient, and the finger scan. - physical examination with the fingers are both still a very important part of patient assessment.

Principle. determine what is going on in the abdomen
Preferences: 
Situation - where are you and the patient Condition - what is the current condition of the patient acute?, in shock? just needs to R/O intraabdominal injury. What does the physical examination show?
Skill and experience. what the experience in your hospital with the various tests? Example what is your %  accuracy with FAST. Not how good in Dr Rozychi in Grady Hospital but how good are the sonographies in YOUR hospital Resources - what tests does your hospital have quickly available DPL? FAST? CT?

Norman

Norman McSwain MD
Trauma Director, Charity Hospital
Professor of Surgery, Tulane University
New Orleans LA
504 988 5111
norman.mcswain at tulane.edu <mailto:norman.mcswain at tulane.edu> 

________________________________

From: trauma-list-bounces at trauma.org on behalf of Bevan Lowe
Sent: Wed 4/22/2009 1:47 AM
To: trauma-list at trauma.org
Subject: The role of DPA in 2009 and beyond

Is there any role of Diagnostic Peritoneal tap (DPA) or for that matter DPL in the ED in the hypotensive blunt trauma pt when we have FAST available these days?
Our approach is:- do a FAST, +ve OT, -ve repeat & look for other cause, if still ? abdo bleed go to OT. Equivocal FAST go to OT. Some surgeons are advocating DPA. Thoughts?

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If you are not the intended recipient(s), or if you have received this email in error, you are asked to immediately notify the sender by telephone collect on Australia +61 1800 198 175 or by return email.  You should also delete this email, and any copies, from your computer system network and destroy any hard copies produced.
If not an intended recipient of this email, you must not copy, distribute or take any action(s) that relies on it; any form of disclosure, modification, distribution and/or publication of this email is also prohibited.
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Message: 3
Date: Thu, 23 Apr 2009 10:15:13 +0530 (IST)
From: navin goyal <drnavingoyal at yahoo.co.in>
Subject: The role of DPA in 2009 and beyond (Bevan Lowe)
To: trauma-list at trauma.org
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Dear Bevan ,
I am sorry I may be missing something but I could understand what do you mean by equivocal FAST. We rarely use DPL . Last time I used it was for an pelvic injury patient when my sonologist was unable to tell me whether fluid is intra or extraperitoneal. We perform CT in all FAST positive patients if feasible before shifting to OT to rule out solid organ injury.
Thanks.
Dr. Navin Goyal
Trauma Surgeon
India

      From Chandigarh to Chennai - find friends all over India. Go to http://in.promos.yahoo.com/groups/citygroups/

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Message: 4
Date: Thu, 23 Apr 2009 08:55:56 +0100
From: Karim Brohi <karimbrohi at gmail.com>
Subject: Re: The role of DPA in 2009 and beyond (Bevan Lowe)
To: Trauma and Critical Care mailing list <trauma-list at trauma.org>
Message-ID:
	<b8b351510904230055u3fed1fb5s2e8976f420d2e7a2 at mail.gmail.com>
Content-Type: text/plain; charset=ISO-8859-1

Lots of places still do not have ultrasound in the resuscitation room.
Surely then, the continuing role for DPA is for the same indications as FAST but where ultrasound is not readily available?

(The converse of course is that FAST should be used when you would previously have used DPA.  Otherwise these days it's going to be CT.
There's a lot of un-substantiated mission-creep with FAST)

Karim

2009/4/23 navin goyal <drnavingoyal at yahoo.co.in>:
> Dear Bevan ,
> I am sorry I may be missing something but I could understand what do you mean by equivocal FAST. We rarely use DPL . Last time I used it was for an pelvic injury patient when my sonologist was unable to tell me whether fluid is intra or extraperitoneal. We perform CT in all FAST positive patients if feasible before shifting to OT to rule out solid organ injury.
> Thanks.
> Dr. Navin Goyal
> Trauma Surgeon
> India
>
>
> ? ? ?From Chandigarh to Chennai - find friends all over India. Go to 
> http://in.promos.yahoo.com/groups/citygroups/
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> trauma-list : TRAUMA.ORG
> To change your settings or unsubscribe visit:
> http://www.trauma.org/index.php?/community/
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