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Thu Aug 20 10:22:00 BST 2009

Indeed !

Deep Africa
But it's light now

... it must be day ! ! ?

Pt has been transfered to closest acceptable hospital
Pt had a good night
Flank contusion is somewhat painful (as level to be expected)
No increased abdominial pain reported or on exam
Definitive notion of internal event (pain when patient laughs)

Vitals signs normal with the exception for a labile pulse
50's to 70's NSR ! ?
No postural changes or discomfort

Will eventually get an update on his condition ! ?

Thanks for the feedback

Charles

________________________________
From: Dr Timothy Hardcastle <dr.tchardcastle at absamail.co.za>
To: Trauma-List [TRAUMA.ORG] <trauma-list at trauma.org>
Sent: Thursday, August 20, 2009 7:26:00 AM
Subject: Re: Some field prehospital stuff

Charles

Would help to know what jungle (country) you are in - is this rural Canada
or deepest darkest Africa?

The likely injury is one of two things - renal parenchymal injury or
myonephropathic syndrome.

The treatment for either is the same - judicious fluid therapy (to flush
out the kidney) and bed rest. Get him out to where a CK / Urea and Creat
can be done prior to CT scan - if the myonephropathic is the problem the
contrast will knock his kidney! If his parameters change you may need to
move him earlier!

Keep us updated
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
> OK
>
>
> Patient  got a liter and a half of saline
> put out half of it in urine (darken) (+++) pn urine stix)
>
> Pt vitals signs are good and no postural cahnges
>
>
> Now J U N G L E
>
> We do not do night transport due to security reason
> CAT-SCAN ? there is one in town but we have'nt been able to confirm thatt
> it is working this week
> Would have to transport to the capital for more appropriate care
>
> Will keep you updated
>
> Charles
>
>
>  
>
>
>
> ________________________________
> From: Larry Torrey <ltorrey at maine.rr.com>
> To: Trauma-List [TRAUMA.ORG] <trauma-list at trauma.org>
> Sent: Thursday, August 20, 2009 1:56:44 AM
> Subject: Re: Some field prehospital stuff
>
> Charles,
>
> Give him a liter or two of NS to see if you can flush out some of the
> hematuria and increase output. Then evac to the closest facility for a CT
> on the next available. 
>
> Doesn't sound like you can do much else.
>
> LT
>
> -----Original Message-----
> From: "Bill Mastrianni" <BMastrianni at charlestoncounty.org>
>
> Date: Wed, 19 Aug 2009 19:29:40
> To: Trauma-List [TRAUMA.ORG]<trauma-list at trauma.org>
> Subject: RE: Some field prehospital stuff
>
>
> Charles,
> Why can't he go for the 2 hour ambulance ride this evening?
>
> Maj. Bill Mastrianni, EMT-P
> Charleston County (SC) EMS
>
> -----Original Message-----
> From: Charles Brault <c_brault at yahoo.com>
> Sent: 19 August, 2009 16:11
> To: Trauma-List [TRAUMA.ORG] <trauma-list at trauma.org>
> Subject: Re: Some field prehospital stuff
>
> 2 hour ambulance ride
> And unsure about the potential night helicoper there to a third rate
> clinique
> And nothing else after that
>
> Charles
>
>
>
>
> ________________________________
> From: "Krin135 at aol.com" <Krin135 at aol.com>
> To: trauma-list at trauma.org
> Sent: Wednesday, August 19, 2009 8:56:56 PM
> Subject: Re: Some field prehospital stuff
>
> how far out in the field, and what IV fluids do you have available?
> ck
>
>
>
> In a message dated 8/19/2009 13:54:43 Central Standard Time, 
> c_brault at yahoo.com writes:
>
> Out in  nowhere jungle
>
> 25 year old received a falling branch from aprox  30 feet (6" diam)
> Hitting flank
> Small abrasion
> Considering the trauma  there is very littl pain to report or illicited by
> deep palpation
> ABD soft  non-tender, no guarding, no kidney tenderness
> Does remark a discomfortable  pain when bringing back down the leg on the
> affected side
> (no proble  leifitng the leg
>
> Anyway not much to read  about
>
> But
>
> put out aprox40cc post incident and a 60cc  1hr post
> of burgundy colored urine (blood +++ )
>
>
> No  relevant PMHx (no urinary  problems)
>
>
> Now
>
> What is the likely mecanism  ?
>
>
> Can't ship him out till the morning
>
> Keep  you posted
>
> Charles
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Some field prehospital stuff