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

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Rob and Rob

For the ?-penetrated diaphragm the Laparoscope is probably the way to go,
but if this is not fairly easily accessible then DPL certainly is a viable
option.

For the other two scenarios you sketch I will agree that CT is the best
option to follow the tract in the bullet injury group. It is not the best
for stabs, however, with a higher "miss rate", particularly if there is
not enteric contrast, which is not routine in most places anymore.

Cheers
Tim
Dr T C Hardcastle
M.B., Ch.B. (Stell); M. Med. (Chir) (Stell); FCS (SA)
Principal Specialist Trauma Surgeon /
Honorary Lecturer University of KwaZulu-Natal Dept Surgery
Deputy Director - IALCH Trauma Service
Durban - South Africa

> Rob,
>
> No not unstable. We have FAST. CT isn't good for picking up
> penetrating injuries to the diaphragm which, unlike blunt injuries,
> may often have no other signs. Fast isn't sensitive enough to pick up
> what would be the equivalent of a few cc of blood to give 10k rbc
> indicating penetration. The other two scenarios are when CT didn't
> answer the question of penetration.
>
> Rob
> On Apr 23, 2009, at 6:55 PM, Rob Ojala wrote:
>
>> Dr Smith,
>> Fortunately we don't see a huge amount of penetrating trauma, so my
>> expertise for the DPL indications you quote is limited. I wonder for
>> the
>> scenarios you quote....are we talking about patients who are too
>> unstable to get a CT? [while I realise that CT has limited sensitivity
>> for Diaphragmatic penetration- it can usually pick up secondary
>> features
>> of injury [stranding /free fluid etc]].
>> Do you have rapid bedside ultrasound available at your institution?
>> If too unstable AND no FAST...perhaps DPA...but DPL??
>>
>> Regards,
>> Rob Ojala

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