List Archives

Fri Apr 24 10:43:51 BST 2009

Tim,

The reason to use DPL to R/O diaphragmatic injuries is that you avoid  
the OR/anesthesia event, if there is in fact no injury.

For the tracts of penetrating injuries perhaps we're agreeing? If the  
information you get from the CT is unclear or you're not confident of  
it because of the mechanism, then a DPL will answer the question of  
penetration. This assumes that you will operate on a SW to the back  
with a positive DPL indicating the missile has passed through the  
retroperitoneum into the peritoneal cavity.

Rob

On Apr 24, 2009, at 4:45 AM, Dr Timothy Hardcastle wrote:

> 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
>
>
> --
> 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