List Archives

Thu Apr 23 21:23:48 BST 2009

let's not write off the DPL quite so fast. Remember not all initial trauma is seen in a trauma center nor is everyone facile with FAST, something which is exceptionally operator dependent. ATLS is still aimed at the fellow in the small facility who still has to make decisions, most of whom don't even have an ultrasound in the ED let alone know how to use it.

Techniques taught in ATLS still revolve around things that are simple to do with minimal equipment although we have seen a tendency recently to try to be all things to all people. For that reason I think the cutdown is also still a useful technique to teach, certainly there are all sorts of access kits available on the market but to use them one actually has to have the kit in hand.

So while it's been a bit since I've actually done a DPL( and indeed when I went to one the other day I found the basic equipment was no longer readily available) I think there is still time and place for it and it still deserves to be taught.

RL Wigle MD FACS
LSUHSC Shreveport

--- On Thu, 4/23/09, Teperman, Sheldon <Sheldon.Teperman at nbhn.net> wrote:

> From: Teperman, Sheldon <Sheldon.Teperman at nbhn.net>
> Subject: RE: trauma-list Digest, Vol 70, Issue 20-DPL
> To: "'trauma-list at trauma.org'" <trauma-list at trauma.org>
> Date: Thursday, April 23, 2009, 9:53 AM
> 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 
> 
> -----Original Message-----
> From: trauma-list-bounces at trauma.org
> [mailto:trauma-list-bounces at trauma.org]
> On Behalf Of trauma-list-request at trauma.org
> Sent: Thursday, April 23, 2009 7:00 AM
> To: trauma-list at trauma.org
> Subject: trauma-list Digest, Vol 70, Issue 20
> 
> Send trauma-list mailing list submissions to
>     trauma-list at trauma.org
> 
> To subscribe or unsubscribe via the World Wide Web, visit
>     http://list.mistral.net/mailman/listinfo/trauma-list
> or, via email, send a message with subject or body 'help'
> to
>     trauma-list-request at trauma.org
> 
> You can reach the person managing the list at
>     trauma-list-owner at trauma.org
> 
> When replying, please edit your Subject line so it is more
> specific than "Re: Contents of trauma-list digest..."
> 
> 
> 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)
> 
> 
> ----------------------------------------------------------------------
> 
> 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>
> Message-ID:
>     <FD2BE6867A90F543AAD02E429F878633013B1FBC0B27 at bhsexc11.bhs.org>
> Content-Type: text/plain; charset="us-ascii"
> 
> 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?
> 
> ********************************************************************************
> This email, including any attachments sent with it, is
> confidential and for the sole use of the intended
> recipient(s). This confidentiality is not waived or lost, if
> you receive it and you are not the intended recipient(s), or
> if it is transmitted/received in error.
> Any unauthorised use, alteration, disclosure, distribution
> or review of this email is strictly prohibited.  The
> information contained in this email, including any
> attachment sent with it, may be subject to a statutory duty
> of confidentiality if it relates to health service matters.
> 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.
> Although Queensland Health takes all reasonable steps to
> ensure this email does not contain malicious software,
> Queensland Health does not accept responsibility for the
> consequences if any person's computer inadvertently suffers
> any disruption to services, loss of information, harm or is
> infected with a virus, other malicious computer programme or
> code that may occur as a consequence of receiving this
> email.
> Unless stated otherwise, this email represents only the
> views of the sender and not the views of the Queensland
> Government.
> **********************************************************************************
> 
> --
> trauma-list : TRAUMA.ORG
> To change your settings or unsubscribe visit:
> http://www.trauma.org/index.php?/community/
> 
> ----------------------------------------------------------------------
> CONFIDENTIALITY NOTICE: This email communication and any
> attachments may contain confidential and privileged
> information for the use of the designated recipients named
> above. If you are not the intended recipient, you are hereby
> notified that you have received this communication in error
> and that any review, disclosure, dissemination, distribution
> or copying of it or its contents is prohibited. If you have
> received this communication in error, please reply to the
> sender immediately or by telephone at (413) 794-0000 and
> destroy all copies of this communication and any
> attachments. For further information regarding Baystate
> Health's privacy policy, please visit our Internet web site
> at http://www.baystatehealth.com.
> 
> 
> ------------------------------
> 
> 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>
> Message-ID:
>     <B79C02DCC4FA074DB02381DF1C5D60BA01D28503 at EX07.ad.tulane.edu>
> Content-Type: text/plain; charset="iso-8859-1"
> 
> 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?
> 
> ********************************************************************************
> This email, including any attachments sent with it, is
> confidential and for the sole use of the intended
> recipient(s). This confidentiality is not waived or lost, if
> you receive it and you are not the intended recipient(s), or
> if it is transmitted/received in error.
> Any unauthorised use, alteration, disclosure, distribution
> or review of this email is strictly prohibited.  The
> information contained in this email, including any
> attachment sent with it, may be subject to a statutory duty
> of confidentiality if it relates to health service matters.
> 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.
> Although Queensland Health takes all reasonable steps to
> ensure this email does not contain malicious software,
> Queensland Health does not accept responsibility for the
> consequences if any person's computer inadvertently suffers
> any disruption to services, loss of information, harm or is
> infected with a virus, other malicious computer programme or
> code that may occur as a consequence of receiving this
> email.
> Unless stated otherwise, this email represents only the
> views of the sender and not the views of the Queensland
> Government.
> **********************************************************************************
> 
> --
> trauma-list : TRAUMA.ORG
> To change your settings or unsubscribe visit:
> http://www.trauma.org/index.php?/community/
> 
> 
> -------------- next part --------------
> A non-text attachment was scrubbed...
> Name: not available
> Type: application/ms-tnef
> Size: 7267 bytes
> Desc: not available
> URL: <http://list.mistral.net/pipermail/trauma-list/attachments/20090422/c9f18434/attachment-0001.bin>
> 
> ------------------------------
> 
> 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
> Message-ID: <110064.63554.qm at web94908.mail.in2.yahoo.com>
> Content-Type: text/plain; charset=utf-8
> 
> 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/
> 
> ------------------------------
> 
> 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/
> > --
> > trauma-list : TRAUMA.ORG
> > To change your settings or unsubscribe visit:
> > http://www.trauma.org/index.php?/community/
> >
> 
> 
> ------------------------------
> 
> --
> trauma-list : TRAUMA.ORG
> To change your settings or unsubscribe visit:
> http://www.trauma.org/index.php?/community/
> 
> End of trauma-list Digest, Vol 70, Issue 20
> *******************************************
> -----------------------------------------
> Visit www.nyc.gov/hhc
> 
> CONFIDENTIALITY NOTICE: The information in this E-Mail may
> be
> confidential and may be legally privileged. It is intended
> solely
> for the addressee(s). If you are not the intended
> recipient, any
> disclosure, copying, distribution or any action taken or
> omitted to
> be taken in reliance on this e-mail, is prohibited and may
> be
> unlawful. If you have received this E-Mail message in
> error, notify
> the sender by reply E-Mail and delete the message. 
> --
> trauma-list : TRAUMA.ORG
> To change your settings or unsubscribe visit:
> http://www.trauma.org/index.php?/community/
> 

List Archives

For your convenience, find the Trauma List Archive Below

trauma-list Digest, Vol 70, Issue 20-DPL