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Thu Aug 20 12:01:14 BST 2009

Jeeez - I was really behind on e-mail I guess.  Sent out a response when I got back to the office earlier - and now am catching up on all of these.  Good news is I guess I am in good company with my thinking!!
Ron

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] On Behalf Of Dr Timothy Hardcastle
Sent: Thursday, August 20, 2009 2:26 AM
To: Trauma-List [TRAUMA.ORG]
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