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Sun Feb 1 12:07:50 GMT 2009

Hi all

Suggest you all look at the WJS January issue - nice review

Tim

Dr T C Hardcastle
M.B., Ch.B. (Stell); M. Med. (Chir) (Stell); FCS (SA)
Principal Specialist Trauma Surgeon /
Honorary Lecturer UKZN Dept Surgery
Deputy Director - IALCH Trauma Service
> Karim,
>
> I agree with most all that you said - the really bad contusions often
> don't do well for the reasons you cited, but none the less, changing vents
> DOES impact these folks' ability to tolerate surgical procedures.
>
> Having said that, I would LOVE any input from the group as to what y'all
> think is the appropriate patient for early rib fixation.  As Karim said,
> it probably should be done later (towards the 5-7 post admission day), and
> perhaps earlier on the "stoved-in" (is that really the correct way to say
> that??) chest.
>
> Ron
>
> -----Original Message-----
> From: trauma-list-bounces at trauma.org
> [mailto:trauma-list-bounces at trauma.org] On Behalf Of Karim Brohi
> Sent: Saturday, January 31, 2009 7:48 AM
> To: Trauma &amp, Critical Care mailing list
> Subject: Re: Lung Contusion
>
> I've always liked the idea of such a study - but it needs to be a
> long-term
> study looking at things like lung function @ 1 yr, not just immediate ICU
> response etc.
> I disagree that patients with massive lung injury tolerate the procedure
> poorly.  It's essentially a body wall procedure.  The chest cavity is not
> opened, it's relatively quick and there's minimal blood loss.   The main
> concern is transfer from an ICU ventilator on an OR ventilator, which they
> don't tolerate well.  We tend to do it later in the course prior to or
> during weaning attempts, but have done it for severely stoved-in chests
> earlier.  Having said that we don't do it very often at all (because of a
> lack of clear indications)
>
> Karim
>
> 2009/1/30 Gross, Ronald <Ronald.Gross at bhs.org>
>
>> Bill,
>>
>> I heard you and Gage on the RibLoc webinar that one of my partners was
>> also
>> on.  I missed it live but got the link.  I am meeting with them in the
>> next
>> month, and I am hoping to gather a number (if not all!) of the Level I
>> Trauma Centers in New England to move the study forward.  Gonna take a
>> bunch
>> of time AND MONEY, but I do think we could get this done!!!
>>
>> "Talk" to you soon, I hope!
>> Ron
>>
>> -----Original Message-----
>> From: trauma-list-bounces at trauma.org [mailto:
>> trauma-list-bounces at trauma.org] On Behalf Of William Bromberg
>> Sent: Friday, January 30, 2009 2:55 PM
>> To: 'Trauma &amp; Critical Care mailing list'
>> Subject: RE: Lung Contusion
>>
>> We have recently put in a purchase request for the Ribloc (TM) plates
>> just
>> for this very reason. We'd be very interested in participating in a
>> multi-institutional trial on this subject.
>>
>> Bill Bromberg
>>
>>
>> William J. Bromberg, MD, FACS
>> Savannah Surgical Group
>> 912 350-7412
>>
>> >>> "Gross, Ronald" <Ronald.Gross at bhs.org> 1/30/2009 2:35 PM >>>
>> Terrific!  I look forward to hearing from y'all - and just maybe working
>> on
>> this together!
>> Ron
>>
>> -----Original Message-----
>> From: trauma-list-bounces at trauma.org [mailto:
>> trauma-list-bounces at trauma.org] On Behalf Of Errington Thompson
>> Sent: Friday, January 30, 2009 2:32 PM
>> To: 'Trauma &amp; Critical Care mailing list'
>> Subject: RE: Lung Contusion
>>
>> Ron -
>>
>> I think that it is a good idea.  We have a large elderly population.
>> They
>> fell in the shower or down steps and get 4 - 8 rib fractures and are in
>> the
>> hospital for 10 days or more.  Stabilizing the chest maybe helpful.  Let
>> me
>> run it by the guys.
>>
>> E
>>
>> Errington C. Thompson, MD, FACS, FCCM
>> Trauma/Surgical Critical Care
>> Radio Talk Host - WPEK 880 AM
>> Author - Letter to America
>> Asheville, NC
>>
>> -----Original Message-----
>> From: trauma-list-bounces at trauma.org [mailto:
>> trauma-list-bounces at trauma.org]
>> On Behalf Of Gross, Ronald
>> Sent: Friday, January 30, 2009 8:37 AM
>> To: 'Trauma &amp; Critical Care mailing list'
>> Subject: RE: Lung Contusion
>>
>> Sure - the INITIAL damage has been done, but I am convinced that in the
>> really nasty flails, or even in the really nasty multiple fractures with
>> severe displacement of the fracture edges, (1) continued lung injury
>> from
>> markedly displaced fracture edges, (2) persistent abnormal chest wall
>> mechanics, and (3) persistent and poorly managed PAIN!!! end up keeping
>> a
>> lot of people on vents for a whole lot longer than they should/need to
>> be....
>>
>> Ron
>> -----Original Message-----
>> From: trauma-list-bounces at trauma.org [mailto:
>> trauma-list-bounces at trauma.org]
>> On Behalf Of thomas konig
>> Sent: Friday, January 30, 2009 8:06 AM
>> To: trauma list
>> Subject: RE: Lung Contusion
>>
>>
>> Hasn't the damage to lung parenchyma already been done?
>> I understand that continued abnormal force from fractured rib may
>> continue
>> to injure lung is this damage as severe as the initial insult?
>>
>> Tom> From: Ronald.Gross at bhs.org> To: trauma-list at trauma.org> Date: Fri,
>> 30
>> Jan 2009 07:42:27 -0500> Subject: RE: Lung Contusion> > How 'bout repair
>> of
>> the fractures? Looks like this "antiquated" procedure is coming back
>> into
>> use - with initial results appearing to be impressive. Anecdotal but
>> impressive. No LARGE studies to date, to my knowledge and this is why we
>> are
>> looking to put together a multicenter PRT to look at this very issue.> >
>> Any
>> takers?> > Ron> > Ronald I. Gross, MD, FACS> Chief of Trauma & Emergency
>> Surgery Services> Baystate Medical Center> 759 Chestnut Street>
>> Springfield,
>> MA 01199> 413-794-4022 phone> 413-794-0142 fax>
>> ronald.gross at baystatehealth.org> -----Original Message-----> From:
>> trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
>> On
>> Behalf Of Jose Luis Danguilan> Sent: Thursday, January 29, 2009 6:19 PM>
>> To:
>> Trauma &amp, Critical Care mailing list> Subject: Re: Lung Contusion> >
>> Dear
>> Karim,> > Anything new in treating flail chest wi
>>  th pulmonary contusion? Mechanical> ventilator (internal splinting),
>> etc.?>
>> > Thanks.> > Jose Luis J. Danguilan, MD> Manila, Philippines> > > On
>> 1/29/09, Karim Brohi <karimbrohi at gmail.com> wrote:> >> > While I would
>> agree
>> with minimizing crystalloids and maintaining euvolaemia> > I don't think
>> there's any evidence to support fluid restriction in these> > patients.
>> A
>> normal enteral fluid requirement should be adequate. No> > diuretics.> >
>> Karim> >> >> > On 01/29/2009, KMATTOX at aol.com <KMATTOX at aol.com> wrote:>
>> >
>> >>
>> > > You are correct. Lasix is probably contraindicated in> > > pulmonary
>> contusion.> > > We would use fluid RESTRICTION to even almost no
>> crystalloid
>> fluid at> > > all. AVOID ALBUMIN at all cost. ONE doctor, not a team of
>> multiple> > > consultants writing orders> > >> > > k> > >> > >> > >> > >
>> In
>> a message dated 1/28/2009 8:32:21 P.M. Central Standard Time,> > >
>> errington at erringtonthompson.com writes:> > >> > > As a rule we don't use
>> Lasix in pulmonary contusions. T
>>  he goal in> > > caring for patients with pulmonary contusions is> > >
>> euvolemia. Intubate early> > > if necessary. Head of the bed should be
>> elevated. No prophylactic> > > antibiotics. Early tracheostomy.> > >> >
>> >
>> Guys, am I missing anything?> > >> > >> > > **************From Wall
>> Street
>> to Main Street and everywhere in between,> > > stay> > > up-to-date with
>> the
>> latest news. (> > http://aol.com?ncid=emlcntaolcom00000023> > > )> > >
>> -->
>> >
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Lung Contusion - rib fixation