List Archives

Wed Feb 4 18:14:14 GMT 2009

 If the skin and Subq tissues don't look all that different then when you first opened 24 or 48hrs later, I would say that my partners and I , on the Average, are closing the skin.  BTW -Mike-getting the Vac out in that time frame-a very, very good thing...Shel

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] On Behalf Of trauma-list-request at trauma.org
Sent: Tuesday, February 03, 2009 8:48 PM
To: trauma-list at trauma.org
Subject: trauma-list Digest, Vol 68, Issue 4

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Today's Topics:

   1. Re: trauma-list Digest, Vol 67, Issue 43 (McSwain, Norman E Jr.)
   2. Re: trauma-list Digest, Vol 67, Issue 43 (jduchesne1)
   3. Re: trauma-list Digest, Vol 67, Issue 43 (Karim Brohi)
   4. RE: trauma-list Digest, Vol 67, Issue 43 (Dr Timothy Hardcastle)
   5. Point of Care urine HCG or lab processed blood HCG (Tracy Rogers)
   6. Re: Point of Care urine HCG or lab processed blood HCG
      (Krin135 at aol.com)
   7. Re: Point of Care urine HCG or lab processed blood HCG
      (William Bromberg)
   8. RE: Point of Care urine HCG or lab processed blood HCG
      (Marc Matthews - MedPro MMC X)
   9. Re: Point of Care urine HCG or lab processed blood HCG
      (jduchesne1)
  10. Re: Point of Care urine HCG or lab processed blood HCG
      (Krin135 at aol.com)
  11. Re: Point of Care urine HCG or lab processed blood HCG
      (William Bromberg)
  12. Re: Lung Contusion (Robert Smith)
  13. Re: trauma-list Digest, Vol 67, Issue 43 (Richard Wigle MD FACS)
  14. Re: Point of Care urine HCG or lab processed blood HCG
      (Larry Torrey)
  15. Re: Point of Care urine HCG or lab processed blood HCG
      (Larry Torrey)
  16. RE: trauma-list Digest, Vol 67, Issue 43 (tina)
  17. R: trauma-list Digest, Vol 67, Issue 43 (Peter)
  18. Re: trauma-list Digest, Vol 67, Issue 43 (Bradley Morris)
  19. RE: trauma-list Digest, Vol 67, Issue 43 (Duchesne, Juan C )

----------------------------------------------------------------------

Message: 1
Date: Tue, 3 Feb 2009 06:39:42 -0600
From: "McSwain, Norman E Jr." <nmcswai at tulane.edu>
Subject: Re: trauma-list Digest, Vol 67, Issue 43
To: <trauma-list at trauma.org>
Message-ID:
        <B79C02DCC4FA074DB02381DF1C5D60BA0168F006 at EX07.ad.tulane.edu>
Content-Type: text/plain;       charset="UTF-8"

This "older surgeon" would likely close the skin.

Preferences & principles again...

principle: skin needs to closed sometime.

Preference - when?.........What is the condition of the wound. It is less than 72 hours; no bowel injury; was the patient overloaded with fluid?; how much pull on the skin to close?.

Typed by the thumbs of
Norman on his BlackBerry

Norman McSwain, MD
Tulane Univ Surgery
504 988-5111

________________________________

From: trauma-list-bounces at trauma.org
To: trauma-list at trauma.org
Sent: Mon Feb 02 22:39:54 2009
Subject: RE: trauma-list Digest, Vol 67, Issue 43

To all trauma-listers, a question from one of my partners:

You have a damage control closure with a vac closure after a laparotomy for trauma without bowel injury (ie just spleen or liver, mesentery, whatever) - you take back in 24 to 48 hours and are able to close the fascia.  What do you do with the skin?  Leave open or staple closed?

We're having a debate over this in our group. Older surgeons pack skin and subQ open, younger surgeons frequently close skin.

Mike Sise
San Diego

________________________________

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Sent: Tue 1/27/2009 12:35 AM
To: trauma-list at trauma.org
Subject: trauma-list Digest, Vol 67, Issue 43

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------------------------------

Message: 2
Date: Tue, 3 Feb 2009 15:31:31 +0000
From: "jduchesne1" <jduchesn at tulane.edu>
Subject: Re: trauma-list Digest, Vol 67, Issue 43
To: "Trauma &amp" <trauma-list at trauma.org>
Message-ID:
        <303248937-1233675093-cardhu_decombobulator_blackberry.rim.net-628520888- at bxe157.bisx.prod.on.blackberry>

Content-Type: text/plain; charset="Windows-1252"

Mike- Good to hear from you.
I try my best here at Charity not to close skin in the presence of any enteric injury in damage control patients. I personally leave the wound open with delay closure prior to discharge. My rationale is the following: by post-trauma day 5-7 when the patient start spiking fever then u have too many variables to rule out the source of sepsis, which will increase the need for unnecessary CT scans and VOMIT's. Keep it simple :)
Juan
CharityOne-NO
Sent via BlackBerry by AT&T

-----Original Message-----
From: "Sise, Mike MD" <Sise.Mike at scrippshealth.org>

Date: Mon, 2 Feb 2009 22:39:54
To: <trauma-list at trauma.org>
Subject: RE: trauma-list Digest, Vol 67, Issue 43

To all trauma-listers, a question from one of my partners:?
?
You have a damage control closure with a vac closure after a laparotomy?for trauma without bowel injury (ie just spleen or liver, mesentery, whatever) - you take back in 24 to 48 hours and are able to close the fascia.? What do you do with the skin?? Leave open or staple closed??
?
We're having a debate over this in?our group. Older surgeons pack skin and subQ open, younger surgeons frequently close skin.
?
Mike Sise
San Diego

----------------

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Sent: Tue 1/27/2009 12:35 AM
To: trauma-list at trauma.org
Subject: trauma-list Digest, Vol 67, Issue 43

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------------------------------

Message: 3
Date: Tue, 3 Feb 2009 16:04:56 +0000
From: Karim Brohi <karimbrohi at gmail.com>
Subject: Re: trauma-list Digest, Vol 67, Issue 43
To: "Trauma &amp, Critical Care mailing list" <trauma-list at trauma.org>
Message-ID:
        <b8b351510902030804u4a6371a5n96932ccdad52a7f2 at mail.gmail.com>
Content-Type: text/plain; charset=ISO-8859-1

Staple closed.

On 02/03/2009, jduchesne1 <jduchesn at tulane.edu> wrote:
>
> Mike- Good to hear from you.
> I try my best here at Charity not to close skin in the presence of any
> enteric injury in damage control patients. I personally leave the wound open
> with delay closure prior to discharge. My rationale is the following: by
> post-trauma day 5-7 when the patient start spiking fever then u have too
> many variables to rule out the source of sepsis, which will increase the
> need for unnecessary CT scans and VOMIT's. Keep it simple :)
> Juan
> CharityOne-NO
> Sent via BlackBerry by AT&T
>
> -----Original Message-----
> From: "Sise, Mike MD" <Sise.Mike at scrippshealth.org>
>
> Date: Mon, 2 Feb 2009 22:39:54
> To: <trauma-list at trauma.org>
> Subject: RE: trauma-list Digest, Vol 67, Issue 43
>
>
> To all trauma-listers, a question from one of my partners:
>
> You have a damage control closure with a vac closure after a laparotomy for
> trauma without bowel injury (ie just spleen or liver, mesentery, whatever) -
> you take back in 24 to 48 hours and are able to close the fascia.  What do
> you do with the skin?  Leave open or staple closed?
>
> We're having a debate over this in our group. Older surgeons pack skin and
> subQ open, younger surgeons frequently close skin.
>
> Mike Sise
> San Diego
>
>
> ----------------
>
> From: trauma-list-bounces at trauma.org on behalf of
> trauma-list-request at trauma.org
> Sent: Tue 1/27/2009 12:35 AM
> To: trauma-list at trauma.org
> Subject: trauma-list Digest, Vol 67, Issue 43
>
>
>
> Send trauma-list mailing list submissions to
>         trauma-list at trauma.org
>
> To subscribe or unsubscribe via the World Wide Web, visit
>         http://list.mistral.net/mailman/listinfo/trauma-list <
> http://list.mistral.net/mailman/listinfo/trauma-list>
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------------------------------

Message: 4
Date: Tue, 3 Feb 2009 19:46:08 +0200 (SAST)
From: "Dr Timothy Hardcastle" <dr.tchardcastle at absamail.co.za>
Subject: RE: trauma-list Digest, Vol 67, Issue 43
To: "Trauma &amp; Critical Care mailing list" <trauma-list at trauma.org>
Message-ID:
        <50494.41.9.195.100.1233683168.squirrel at aiamail.lantic.net>
Content-Type: text/plain;charset=iso-8859-1

Mike wrote:
> To all trauma-listers, a question from one of my partners:
>
> You have a damage control closure with a vac closure after a laparotomy
> for trauma without bowel injury (ie just spleen or liver, mesentery,
> whatever) - you take back in 24 to 48 hours and are able to close the
> fascia.  What do you do with the skin?  Leave open or staple closed?
>
> We're having a debate over this in our group. Older surgeons pack skin and
> subQ open, younger surgeons frequently close skin.
>
> Mike Sise
> San Diego
>
> ________________________________
>
> From: trauma-list-bounces at trauma.org on behalf of
> trauma-list-request at trauma.org
> Sent: Tue 1/27/2009 12:35 AM
> To: trauma-list at trauma.org
> Subject: trauma-list Digest, Vol 67, Issue 43
>
>
>
> Send trauma-list mailing list submissions to
>         trauma-list at trauma.org
>
> To subscribe or unsubscribe via the World Wide Web, visit
>         http://list.mistral.net/mailman/listinfo/trauma-list
> or, via email, send a message with subject or body 'help' to
>         trauma-list-request at trauma.org
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Dear Mike

I close skin - as do most South African surgeons to my knowledge; the idea
of leaving skin open is a very American thing, certainly never advocated
in this country and to my knowledge not in the UK or Australia either.

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
Durban - South Africa

------------------------------

Message: 5
Date: Tue, 03 Feb 2009 12:35:42 -0600
From: "Tracy Rogers" <trogers at kumc.edu>
Subject: Point of Care urine HCG or lab processed blood HCG
To: <trauma-list at trauma.org>
Message-ID: <49883A1F.C017.0048.0 at kumc.edu>
Content-Type: text/plain; charset=US-ASCII

Which method for screening does your facility use on trauma activations:
point of Care urine HCG or lab processed blood HCG?

Tracy Rogers, MSN, RN, CCRN
Trauma and Burn Program Manager
The University of Kansas Hospital
Office phone: 913-945-6853
Pager: 913-917-4391
email: trogers at kumc.edu
Mail stop Delp 1011

------------------------------

Message: 6
Date: Tue, 3 Feb 2009 13:57:00 EST
From: Krin135 at aol.com
Subject: Re: Point of Care urine HCG or lab processed blood HCG
To: trauma-list at trauma.org
Message-ID: <c82.398a56cc.36b9ed7c at aol.com>
Content-Type: text/plain; charset="US-ASCII"

at the trauma centers I have worked at in the past, the lab returns serum  or
urine hCG results in near real time. Interestingly enough, at least two non
trauma centers (both less than 8K visits a year) did do urine hCG testing in
the  department, as lab was often on call, not in house.

ck
Charles S. Krin, DO

In a message dated 2/3/2009 12:36:27 Central Standard Time,  trogers at kumc.edu
writes:

Which  method for screening does your facility use on trauma activations:
point of  Care urine HCG or lab processed blood  HCG?

**************Stay up to date on the latest news - from sports scores to
stocks and so much more. (http://aol.com?ncid=emlcntaolcom00000022)

------------------------------

Message: 7
Date: Tue, 03 Feb 2009 14:11:01 -0500
From: "William Bromberg" <brombwi1 at memorialhealth.com>
Subject: Re: Point of Care urine HCG or lab processed blood HCG
To: <trauma-list at trauma.org>
Message-ID: <49885075.85AB.003A.0 at memorialhealth.com>
Content-Type: text/plain; charset=UTF-8

Our lab has recently banned POC urine HCGs because they are "not
calibrated" ? see also POC urine dipsticks and Hemocrits

William J. Bromberg, MD, FACS
Savannah Surgical Group
912 350-7412

>>> <Krin135 at aol.com> 2/3/2009 1:57 PM >>>
at the trauma centers I have worked at in the past, the lab returns
serum  or
urine hCG results in near real time. Interestingly enough, at least two
non
trauma centers (both less than 8K visits a year) did do urine hCG
testing in
the  department, as lab was often on call, not in house.

ck
Charles S. Krin, DO

In a message dated 2/3/2009 12:36:27 Central Standard Time,
trogers at kumc.edu
writes:

Which  method for screening does your facility use on trauma
activations:
point of  Care urine HCG or lab processed blood  HCG?

**************Stay up to date on the latest news - from sports scores
to
stocks and so much more. (http://aol.com?ncid=emlcntaolcom00000022)
--
trauma-list : TRAUMA.ORG
To change your settings or unsubscribe visit:
http://www.trauma.org/index.php?/community/

------------------------------

Message: 8
Date: Tue, 3 Feb 2009 12:19:29 -0700
From: "Marc Matthews - MedPro MMC X" <Marc_Matthews at medprodoctors.com>
Subject: RE: Point of Care urine HCG or lab processed blood HCG
To: "Trauma &amp; Critical Care mailing list"
        <trauma-list at trauma.org>,       <trauma-list at trauma.org>
Message-ID:
        <28907859B728CA469FCD77AB2DBB10EA47D2B4 at mpmail1.medprodoctors.com>
Content-Type: text/plain;       charset="iso-8859-1"

Tracy,

MIHS uses lab only for HCG's. The only POC is in the NICU.

Respectfully,

MRM

________________________________

From: trauma-list-bounces at trauma.org on behalf of Tracy Rogers
Sent: Tue 2/3/2009 11:35 AM
To: trauma-list at trauma.org
Subject: Point of Care urine HCG or lab processed blood HCG

Which method for screening does your facility use on trauma activations:
point of Care urine HCG or lab processed blood HCG?

Tracy Rogers, MSN, RN, CCRN
Trauma and Burn Program Manager
The University of Kansas Hospital
Office phone: 913-945-6853
Pager: 913-917-4391
email: trogers at kumc.edu
Mail stop Delp 1011

--
trauma-list : TRAUMA.ORG
To change your settings or unsubscribe visit:
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------------------------------

Message: 9
Date: Tue, 3 Feb 2009 19:30:32 +0000
From: "jduchesne1" <jduchesn at tulane.edu>
Subject: Re: Point of Care urine HCG or lab processed blood HCG
To: "Trauma &amp; Critical Care mailing list" <trauma-list at trauma.org>
Message-ID:
        <2004891693-1233689435-cardhu_decombobulator_blackberry.rim.net-1827629555- at bxe157.bisx.prod.on.blackberry>

Content-Type: text/plain

Tracy- we start with bedside urine dip if positive then we proceed with quantitative.
J
CharityOne-NO
Sent via BlackBerry by AT&T

-----Original Message-----
From: "Marc Matthews - MedPro MMC X" <Marc_Matthews at medprodoctors.com>

Date: Tue, 3 Feb 2009 12:19:29
To: Trauma &amp; Critical Care mailing list<trauma-list at trauma.org>; <trauma-list at trauma.org>
Subject: RE: Point of Care urine HCG or lab processed blood HCG

Tracy,

MIHS uses lab only for HCG's. The only POC is in the NICU.

Respectfully,

MRM

________________________________

From: trauma-list-bounces at trauma.org on behalf of Tracy Rogers
Sent: Tue 2/3/2009 11:35 AM
To: trauma-list at trauma.org
Subject: Point of Care urine HCG or lab processed blood HCG

Which method for screening does your facility use on trauma activations:
point of Care urine HCG or lab processed blood HCG?

Tracy Rogers, MSN, RN, CCRN
Trauma and Burn Program Manager
The University of Kansas Hospital
Office phone: 913-945-6853
Pager: 913-917-4391
email: trogers at kumc.edu
Mail stop Delp 1011

--
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To change your settings or unsubscribe visit:
http://www.trauma.org/index.php?/community/

------------------------------

Message: 10
Date: Tue, 3 Feb 2009 14:36:39 EST
From: Krin135 at aol.com
Subject: Re: Point of Care urine HCG or lab processed blood HCG
To: trauma-list at trauma.org
Message-ID: <cd0.37223eba.36b9f6c7 at aol.com>
Content-Type: text/plain; charset="UTF-8"

I find this interesting, as all three of the test were considered  'waivered'
tests under CLIA, and can be done in any clinic office with little or  no
oversight. Add in the relatively inexpensive automated dipstick readers, and
what this seems to be is a billing protection issue, not a 'patient  safety
issue.' It's bad enough that some labs are trying to claim fingerstick  blood
glucose measurements, but at least that requires periodic control  samples...with
the modern urine hCG dipsticks, there is a built in control on  every test.

In a message dated 2/3/2009 13:12:16 Central Standard Time,
brombwi1 at memorialhealth.com writes:

Our lab  has recently banned POC urine HCGs because they are "not
calibrated" ? see  also POC urine dipsticks and Hemocrits

William J. Bromberg, MD,  FACS
Savannah Surgical Group
912  350-7412

**************Stay up to date on the latest news - from sports scores to
stocks and so much more. (http://aol.com?ncid=emlcntaolcom00000022)

------------------------------

Message: 11
Date: Tue, 03 Feb 2009 14:39:45 -0500
From: "William Bromberg" <brombwi1 at memorialhealth.com>
Subject: Re: Point of Care urine HCG or lab processed blood HCG
To: <trauma-list at trauma.org>
Message-ID: <49885731.85AB.003A.0 at memorialhealth.com>
Content-Type: text/plain; charset=UTF-8

Ha, YOU try talking to our clipboard carriers. They are a totally
different breed of stubborn.

William J. Bromberg, MD, FACS
Savannah Surgical Group
912 350-7412

>>> <Krin135 at aol.com> 2/3/2009 2:36 PM >>>
I find this interesting, as all three of the test were considered
'waivered'
tests under CLIA, and can be done in any clinic office with little or
no
oversight. Add in the relatively inexpensive automated dipstick
readers, and
what this seems to be is a billing protection issue, not a 'patient
safety
issue.' It's bad enough that some labs are trying to claim fingerstick
blood
glucose measurements, but at least that requires periodic control
samples...with
the modern urine hCG dipsticks, there is a built in control on  every
test.

In a message dated 2/3/2009 13:12:16 Central Standard Time,
brombwi1 at memorialhealth.com writes:

Our lab  has recently banned POC urine HCGs because they are "not
calibrated" ? see  also POC urine dipsticks and Hemocrits

William J. Bromberg, MD,  FACS
Savannah Surgical Group
912  350-7412

**************Stay up to date on the latest news - from sports scores
to
stocks and so much more. (http://aol.com?ncid=emlcntaolcom00000022)
--
trauma-list : TRAUMA.ORG
To change your settings or unsubscribe visit:
http://www.trauma.org/index.php?/community/

------------------------------

Message: 12
Date: Tue, 3 Feb 2009 15:10:23 -0500
From: Robert Smith <rfsmithmd at comcast.net>
Subject: Re: Lung Contusion
To: "Trauma &amp; Critical Care mailing list" <trauma-list at trauma.org>
Message-ID: <99A75EE7-DFBB-4D1B-B4EE-D569A01F6007 at comcast.net>
Content-Type: text/plain; charset=US-ASCII; format=flowed; delsp=yes

Hi Ron,

I"m listing you as someone who has knowledge of my clinical abilities
for my credentials reappointment if that's OK. Can you send me your
mailing address?

Rob
On Feb 1, 2009, at 8:01 AM, Gross, Ronald wrote:

> Tim,
>
> For what it is worth, I am hoping to get the study funded - not sure
> how that is gonna affect my international colleagues (IF this is
> funded by some govt agency), but lets see how it plays out.....
>
> Ron
>
> -----Original Message-----
> From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org
> ] On Behalf Of Dr Timothy Hardcastle
> Sent: Sunday, February 01, 2009 7:26 AM
> To: Trauma &amp; Critical Care mailing list
> Subject: Re: Lung Contusion
>
> Charles wrote
>> well, with at least six outfits involved, that only means 50 patients
>> each....considering how busy Charity and Ben Taub are (not to
>> mention the
>> folks
>> down in ZA...Dr. Hardcastle?), that should take about a year to
>> enroll
>> enough...
>>
>> ck
>>
>>
> Charles
>
> The only catch is getting the study to have sponsored gadgets to
> use. The
> unit I work at now has seen just under 200 major chest injuries in the
> first 18 months since opening; we are about to embark on an extensive
> review of these. I can off-hand think of 4 or 5 patients we
> discussed that
> we would like to fix - if we had access to these gadgets, which we
> don't
> as we are a public hospital wth out equipment dependant upone the
> national
> health tender,\.
>
> 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
> Durban - South Africa
>
> --
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------------------------------

Message: 13
Date: Tue, 3 Feb 2009 12:39:18 -0800 (PST)
From: Richard Wigle MD FACS <rlwigle at yahoo.com>
Subject: Re: trauma-list Digest, Vol 67, Issue 43
To: "Trauma &amp; Critical Care mailing list" <trauma-list at trauma.org>
Message-ID: <317197.10357.qm at web111505.mail.gq1.yahoo.com>
Content-Type: text/plain; charset=us-ascii

Mike

I have in the past on many occasions closed the skin after damage control fascial closure without any problem and I'm an old surgeon. I also in the past have closed over a catheter and intimately irrigated and sucked with good results. Now days though if I'm the least little bit unsure I'll put a wound vac in and come back in a couple of days and close it. The one thing I don't like although I've done it in the remote past is  a "loose closure" with packing between the stitches.

R. Wigle MD FACS

----- Original Message ----
From: jduchesne1 <jduchesn at tulane.edu>
To: Trauma & <trauma-list at trauma.org>
Sent: Tuesday, February 3, 2009 9:31:31 AM
Subject: Re: trauma-list Digest, Vol 67, Issue 43

Mike- Good to hear from you.
I try my best here at Charity not to close skin in the presence of any enteric injury in damage control patients. I personally leave the wound open with delay closure prior to discharge. My rationale is the following: by post-trauma day 5-7 when the patient start spiking fever then u have too many variables to rule out the source of sepsis, which will increase the need for unnecessary CT scans and VOMIT's. Keep it simple :)
Juan
CharityOne-NO
Sent via BlackBerry by AT&T

-----Original Message-----
From: "Sise, Mike MD" <Sise.Mike at scrippshealth.org>

Date: Mon, 2 Feb 2009 22:39:54
To: <trauma-list at trauma.org>
Subject: RE: trauma-list Digest, Vol 67, Issue 43

To all trauma-listers, a question from one of my partners:

You have a damage control closure with a vac closure after a laparotomy for trauma without bowel injury (ie just spleen or liver, mesentery, whatever) - you take back in 24 to 48 hours and are able to close the fascia.  What do you do with the skin?  Leave open or staple closed?

We're having a debate over this in our group. Older surgeons pack skin and subQ open, younger surgeons frequently close skin.

Mike Sise
San Diego

----------------

From: trauma-list-bounces at trauma.org on behalf of trauma-list-request at trauma.org
Sent: Tue 1/27/2009 12:35 AM
To: trauma-list at trauma.org
Subject: trauma-list Digest, Vol 67, Issue 43

Send trauma-list mailing list submissions to
        trauma-list at trauma.org

To subscribe or unsubscribe via the World Wide Web, visit
        http://list.mistral.net/mailman/listinfo/trauma-list <http://list.mistral.net/mailman/listinfo/trauma-list>
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        trauma-list-request at trauma.org

You can reach the person managing the list at
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When replying, please edit your Subject line so it is more specific
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Message: 14
Date: Tue, 3 Feb 2009 20:54:21 +0000
From: "Larry Torrey" <ltorrey at maine.rr.com>
Subject: Re: Point of Care urine HCG or lab processed blood HCG
To: "Trauma &amp; Critical Care mailing list" <trauma-list at trauma.org>
Message-ID:
        <1703222425-1233694454-cardhu_decombobulator_blackberry.rim.net-406138186- at bxe153.bisx.prod.on.blackberry>

Content-Type: text/plain; charset="utf-8"

We do them in the ER, as an extention of the lab.  In short, we do them using devices provided by the lab.

Saves a lot of time, and it's quick and easy enough not to be a workload issue for the ER staff.

LT

Sent from my Verizon Wireless BlackBerry

-----Original Message-----
From: "William Bromberg" <brombwi1 at memorialhealth.com>

Date: Tue, 03 Feb 2009 14:11:01
To: <trauma-list at trauma.org>
Subject: Re: Point of Care urine HCG or lab processed blood HCG

Our lab has recently banned POC urine HCGs because they are "not
calibrated" ? see also POC urine dipsticks and Hemocrits

William J. Bromberg, MD, FACS
Savannah Surgical Group
912 350-7412

>>> <Krin135 at aol.com> 2/3/2009 1:57 PM >>>
at the trauma centers I have worked at in the past, the lab returns
serum  or
urine hCG results in near real time. Interestingly enough, at least two
non
trauma centers (both less than 8K visits a year) did do urine hCG
testing in
the  department, as lab was often on call, not in house.

ck
Charles S. Krin, DO

In a message dated 2/3/2009 12:36:27 Central Standard Time,
trogers at kumc.edu
writes:

Which  method for screening does your facility use on trauma
activations:
point of  Care urine HCG or lab processed blood  HCG?

**************Stay up to date on the latest news - from sports scores
to
stocks and so much more. (http://aol.com?ncid=emlcntaolcom00000022)
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Message: 15
Date: Tue, 3 Feb 2009 20:56:24 +0000
From: "Larry Torrey" <ltorrey at maine.rr.com>
Subject: Re: Point of Care urine HCG or lab processed blood HCG
To: "Trauma &amp; Critical Care mailing list" <trauma-list at trauma.org>
Message-ID:
        <1162326281-1233694570-cardhu_decombobulator_blackberry.rim.net-597656027- at bxe153.bisx.prod.on.blackberry>

Content-Type: text/plain

Same at my hospital in Boston.

LT

Sent from my Verizon Wireless BlackBerry

-----Original Message-----
From: "jduchesne1" <jduchesn at tulane.edu>

Date: Tue, 3 Feb 2009 19:30:32
To: Trauma &amp; Critical Care mailing list<trauma-list at trauma.org>
Subject: Re: Point of Care urine HCG or lab processed blood HCG

Tracy- we start with bedside urine dip if positive then we proceed with quantitative.
J
CharityOne-NO
Sent via BlackBerry by AT&T

-----Original Message-----
From: "Marc Matthews - MedPro MMC X" <Marc_Matthews at medprodoctors.com>

Date: Tue, 3 Feb 2009 12:19:29
To: Trauma &amp; Critical Care mailing list<trauma-list at trauma.org>; <trauma-list at trauma.org>
Subject: RE: Point of Care urine HCG or lab processed blood HCG

Tracy,

MIHS uses lab only for HCG's. The only POC is in the NICU.

Respectfully,

MRM

________________________________

From: trauma-list-bounces at trauma.org on behalf of Tracy Rogers
Sent: Tue 2/3/2009 11:35 AM
To: trauma-list at trauma.org
Subject: Point of Care urine HCG or lab processed blood HCG

Which method for screening does your facility use on trauma activations:
point of Care urine HCG or lab processed blood HCG?

Tracy Rogers, MSN, RN, CCRN
Trauma and Burn Program Manager
The University of Kansas Hospital
Office phone: 913-945-6853
Pager: 913-917-4391
email: trogers at kumc.edu
Mail stop Delp 1011

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Message: 16
Date: Tue, 3 Feb 2009 22:47:43 +0100
From: "tina" <tinagaar at online.no>
Subject: RE: trauma-list Digest, Vol 67, Issue 43
To: "'Trauma &amp; Critical Care mailing list'"
        <trauma-list at trauma.org>
Message-ID: <004d01c98649$0e39e6a0$2aadb3e0$@no>
Content-Type: text/plain;       charset="us-ascii"

Tim

...you can add this part of Scandinavia to the "closing skin"
tradition...staples or suture..

Tina Gaarder
Trauma and GI Surgery
Head of Trauma Unit
Oslo University Hospital, Norway
(list lurker)

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of Dr Timothy Hardcastle
Sent: 03 February 2009 18:46
To: Trauma &amp; Critical Care mailing list
Subject: RE: trauma-list Digest, Vol 67, Issue 43

Mike wrote:
> To all trauma-listers, a question from one of my partners:
>
> You have a damage control closure with a vac closure after a laparotomy
> for trauma without bowel injury (ie just spleen or liver, mesentery,
> whatever) - you take back in 24 to 48 hours and are able to close the
> fascia.  What do you do with the skin?  Leave open or staple closed?
>
> We're having a debate over this in our group. Older surgeons pack skin and
> subQ open, younger surgeons frequently close skin.
>
> Mike Sise
> San Diego
>
> ________________________________
>
> From: trauma-list-bounces at trauma.org on behalf of
> trauma-list-request at trauma.org
> Sent: Tue 1/27/2009 12:35 AM
> To: trauma-list at trauma.org
> Subject: trauma-list Digest, Vol 67, Issue 43
>
>
>
> Send trauma-list mailing list submissions to
>         trauma-list at trauma.org
>
> To subscribe or unsubscribe via the World Wide Web, visit
>         http://list.mistral.net/mailman/listinfo/trauma-list
> or, via email, send a message with subject or body 'help' to
>         trauma-list-request at trauma.org
>
> You can reach the person managing the list at
>         trauma-list-owner at trauma.org
>
> When replying, please edit your Subject line so it is more specific
> than "Re: Contents of trauma-list digest..."
>
>
>
> "Scripps Information Security"
>
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> This e-mail and any files transmitted with it may contain privileged and
> confidential information and are intended solely for the use of the
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> the intended recipient, you are hereby notified that any dissemination or
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Dear Mike

I close skin - as do most South African surgeons to my knowledge; the idea
of leaving skin open is a very American thing, certainly never advocated
in this country and to my knowledge not in the UK or Australia either.

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
Durban - South Africa

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Message: 17
Date: Tue, 3 Feb 2009 23:51:48 +0100
From: "Peter" <taliente at tiscalinet.it>
Subject: R: trauma-list Digest, Vol 67, Issue 43
To: "'Trauma &amp; Critical Care mailing list'"
        <trauma-list at trauma.org>
Message-ID: <FBCMCL01B05GCIFoPkG00096cd5 at FBCMCL01B05.fbc.local>
Content-Type: text/plain; charset="iso-8859-1"

I much prefer to close the skin, I keep a close watch on the wound and any
sign of an important infection, open up the wound again. I am rarely
disappointed( I am not that young!!)

Peter

  _____

Da: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
Per conto di Sise, Mike MD
Inviato: marted? 3 febbraio 2009 5.40
A: trauma-list at trauma.org
Oggetto: RE: trauma-list Digest, Vol 67, Issue 43

To all trauma-listers, a question from one of my partners:

You have a damage control closure with a vac closure after a laparotomy for
trauma without bowel injury (ie just spleen or liver, mesentery, whatever) -
you take back in 24 to 48 hours and are able to close the fascia.  What do
you do with the skin?  Leave open or staple closed?

We're having a debate over this in our group. Older surgeons pack skin and
subQ open, younger surgeons frequently close skin.

Mike Sise

San Diego

  _____

From: trauma-list-bounces at trauma.org on behalf of
trauma-list-request at trauma.org
Sent: Tue 1/27/2009 12:35 AM
To: trauma-list at trauma.org
Subject: trauma-list Digest, Vol 67, Issue 43

Send trauma-list mailing list submissions to
        trauma-list at trauma.org

To subscribe or unsubscribe via the World Wide Web, visit
        http://list.mistral.net/mailman/listinfo/trauma-list
or, via email, send a message with subject or body 'help' to
        trauma-list-request at trauma.org

You can reach the person managing the list at
        trauma-list-owner at trauma.org

When replying, please edit your Subject line so it is more specific
than "Re: Contents of trauma-list digest..."

"Scripps Information Security"
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Message: 18
Date: Wed, 4 Feb 2009 10:34:39 +1000
From: Bradley Morris <bradleypmorris at gmail.com>
Subject: Re: trauma-list Digest, Vol 67, Issue 43
To: "Trauma &amp, Critical Care mailing list" <trauma-list at trauma.org>
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        <70996400902031634h64e77ff0v70dca6c86047006 at mail.gmail.com>
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Dear Dr Juan,

In query and interest of your statement:

"I try my best here at Charity not to close skin in the presence of any
enteric injury in damage control patients. I personally leave the wound open
with delay closure prior to discharge. My rationale is the following: by
post-trauma day 5-7 when the patient start spiking fever then u have too
many variables to rule out the source of sepsis, which will increase the
need for unnecessary CT scans and VOMIT's. "

I am not particularly experienced in this area, but I would think bed-side
USS sufficient to rule out a subcutaneous collection if no external evidence
of wound infection/cellulitis? Do you extend this approach to other 'dirty'
procedures, emergency or otherwise?

I also humbly propose that a patient with sepsis day 5-7 post-damage control
laparotomy with enteric injury receiving a CT scan is most likely not a
VOMIT? :)

Kind regards,

Brad Morris
Surgical Registrar
Australia

On Wed, Feb 4, 2009 at 7:47 AM, tina <tinagaar at online.no> wrote:

> Tim
>
> ...you can add this part of Scandinavia to the "closing skin"
> tradition...staples or suture..
>
> Tina Gaarder
> Trauma and GI Surgery
> Head of Trauma Unit
> Oslo University Hospital, Norway
> (list lurker)
>
> -----Original Message-----
> From: trauma-list-bounces at trauma.org [mailto:
> trauma-list-bounces at trauma.org]
> On Behalf Of Dr Timothy Hardcastle
> Sent: 03 February 2009 18:46
> To: Trauma &amp; Critical Care mailing list
> Subject: RE: trauma-list Digest, Vol 67, Issue 43
>
> Mike wrote:
> > To all trauma-listers, a question from one of my partners:
> >
> > You have a damage control closure with a vac closure after a laparotomy
> > for trauma without bowel injury (ie just spleen or liver, mesentery,
> > whatever) - you take back in 24 to 48 hours and are able to close the
> > fascia.  What do you do with the skin?  Leave open or staple closed?
> >
> > We're having a debate over this in our group. Older surgeons pack skin
> and
> > subQ open, younger surgeons frequently close skin.
> >
> > Mike Sise
> > San Diego
> >
> > ________________________________
> >
> > From: trauma-list-bounces at trauma.org on behalf of
> > trauma-list-request at trauma.org
> > Sent: Tue 1/27/2009 12:35 AM
> > To: trauma-list at trauma.org
> > Subject: trauma-list Digest, Vol 67, Issue 43
> >
> >
> >
> > Send trauma-list mailing list submissions to
> >         trauma-list at trauma.org
> >
> > To subscribe or unsubscribe via the World Wide Web, visit
> >         http://list.mistral.net/mailman/listinfo/trauma-list
> > or, via email, send a message with subject or body 'help' to
> >         trauma-list-request at trauma.org
> >
> > You can reach the person managing the list at
> >         trauma-list-owner at trauma.org
> >
> > When replying, please edit your Subject line so it is more specific
> > than "Re: Contents of trauma-list digest..."
> >
> >
> >
> > "Scripps Information Security"
> >
>
> ----------------------------------------------------------------------------
> --
> > This e-mail and any files transmitted with it may contain privileged and
> > confidential information and are intended solely for the use of the
> > individual or entity to which they are addressed. If you are not the
> > intended recipient or the person responsible for delivering the e-mail to
> > the intended recipient, you are hereby notified that any dissemination or
> > copying of this e-mail or any of its attachment(s) is strictly
> prohibited.
> > If you have received this e-mail in error, please immediately notify the
> > sending individual or entity by e-mail and permanently delete the
> original
> > e-mail and attachment(s) from your computer system. Thank you for your
> > cooperation.
> >
> >
> >
>
> ============================================================================
> ==
> > --
> > trauma-list : TRAUMA.ORG <http://trauma.org/>
> > To change your settings or unsubscribe visit:
> > http://www.trauma.org/index.php?/community/
> Dear Mike
>
> I close skin - as do most South African surgeons to my knowledge; the idea
> of leaving skin open is a very American thing, certainly never advocated
> in this country and to my knowledge not in the UK or Australia either.
>
> 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
> Durban - South Africa
>
> --
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> To change your settings or unsubscribe visit:
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>
>
> --
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>

------------------------------

Message: 19
Date: Tue, 3 Feb 2009 19:45:36 -0600
From: "Duchesne, Juan C " <jduchesn at tulane.edu>
Subject: RE: trauma-list Digest, Vol 67, Issue 43
To: "Trauma &amp; Critical Care mailing list" <trauma-list at trauma.org>
Message-ID:
        <93F431B4ABF11C43BDB776B643B691BCA2E57F at EX04.ad.tulane.edu>
Content-Type: text/plain; charset="iso-8859-1"

Dear Brad:

Regarding your important questions:

1)I am not particularly experienced in this area, but I would think bed-side
USS sufficient to rule out a subcutaneous collection if no external evidence
of wound infection/cellulitis? Do you extend this approach to other 'dirty'
procedures, emergency or otherwise?

yes- Physical exam is definitively essential to rule out SSI, unfortunately not all this complications read surgical textbooks, nor they are clearly evident on physical exam. US will tell you if there is a fluid collection between the tissue planes......a finding common to most of our surgical patients (seroma) not useful in this scenario. My preference is not to close the wound in this group of patients because of multifactorial etiologies that will add to poor wound healing: shock state, hypoxia, need of blood transfusions, gross contamination, tissue edema and hypothermia. Remember the damage control laparotomy patient already had an the first hit insult.......why we need to give them the second hit with surgical wound infection?..........In elective cases were most of this variables are well controlled, the presence of enteric spillage due to iatrogenic causes will not make me leave the wound open. This is my preference.

2)I also humbly propose that a patient with sepsis day 5-7 post-damage control
laparotomy with enteric injury receiving a CT scan is most likely not a
VOMIT? :)

Great point.............Nor they needed to have their wound closed to begin with........that's why your patient will be in the CT scanner and mine not =0>

Hope this helps
j

Juan C. Duchesne MD, FACS, FCCP
Director Surgical Hospital Center
Director Tulane Surgical Intensive Care Unit
AMR Regional Director Louisiana Emergency Response Network

Division of Trauma and Critical Care Surgery
Tulane & LSU Department of Surgery and Anesthesiology
1430 Tulane Ave., SL-22
New Orleans LA 70112-2699
Tel. 504-988-5111
Fax. 504-988-3683

________________________________

From: trauma-list-bounces at trauma.org on behalf of Bradley Morris
Sent: Tue 2/3/2009 6:34 PM
To: Trauma &amp, Critical Care mailing list
Subject: Re: trauma-list Digest, Vol 67, Issue 43

Dear Dr Juan,

In query and interest of your statement:

"I try my best here at Charity not to close skin in the presence of any
enteric injury in damage control patients. I personally leave the wound open
with delay closure prior to discharge. My rationale is the following: by
post-trauma day 5-7 when the patient start spiking fever then u have too
many variables to rule out the source of sepsis, which will increase the
need for unnecessary CT scans and VOMIT's. "

I am not particularly experienced in this area, but I would think bed-side
USS sufficient to rule out a subcutaneous collection if no external evidence
of wound infection/cellulitis? Do you extend this approach to other 'dirty'
procedures, emergency or otherwise?

I also humbly propose that a patient with sepsis day 5-7 post-damage control
laparotomy with enteric injury receiving a CT scan is most likely not a
VOMIT? :)

Kind regards,

Brad Morris
Surgical Registrar
Australia

On Wed, Feb 4, 2009 at 7:47 AM, tina <tinagaar at online.no> wrote:

> Tim
>
> ...you can add this part of Scandinavia to the "closing skin"
> tradition...staples or suture..
>
> Tina Gaarder
> Trauma and GI Surgery
> Head of Trauma Unit
> Oslo University Hospital, Norway
> (list lurker)
>
> -----Original Message-----
> From: trauma-list-bounces at trauma.org [mailto:
> trauma-list-bounces at trauma.org]
> On Behalf Of Dr Timothy Hardcastle
> Sent: 03 February 2009 18:46
> To: Trauma &amp; Critical Care mailing list
> Subject: RE: trauma-list Digest, Vol 67, Issue 43
>
> Mike wrote:
> > To all trauma-listers, a question from one of my partners:
> >
> > You have a damage control closure with a vac closure after a laparotomy
> > for trauma without bowel injury (ie just spleen or liver, mesentery,
> > whatever) - you take back in 24 to 48 hours and are able to close the
> > fascia.  What do you do with the skin?  Leave open or staple closed?
> >
> > We're having a debate over this in our group. Older surgeons pack skin
> and
> > subQ open, younger surgeons frequently close skin.
> >
> > Mike Sise
> > San Diego
> >
> > ________________________________
> >
> > From: trauma-list-bounces at trauma.org on behalf of
> > trauma-list-request at trauma.org
> > Sent: Tue 1/27/2009 12:35 AM
> > To: trauma-list at trauma.org
> > Subject: trauma-list Digest, Vol 67, Issue 43
> >
> >
> >
> > Send trauma-list mailing list submissions to
> >         trauma-list at trauma.org
> >
> > To subscribe or unsubscribe via the World Wide Web, visit
> >         http://list.mistral.net/mailman/listinfo/trauma-list
> > or, via email, send a message with subject or body 'help' to
> >         trauma-list-request at trauma.org
> >
> > You can reach the person managing the list at
> >         trauma-list-owner at trauma.org
> >
> > When replying, please edit your Subject line so it is more specific
> > than "Re: Contents of trauma-list digest..."
> >
> >
> >
> > "Scripps Information Security"
> >
>
> ----------------------------------------------------------------------------
> --
> > This e-mail and any files transmitted with it may contain privileged and
> > confidential information and are intended solely for the use of the
> > individual or entity to which they are addressed. If you are not the
> > intended recipient or the person responsible for delivering the e-mail to
> > the intended recipient, you are hereby notified that any dissemination or
> > copying of this e-mail or any of its attachment(s) is strictly
> prohibited.
> > If you have received this e-mail in error, please immediately notify the
> > sending individual or entity by e-mail and permanently delete the
> original
> > e-mail and attachment(s) from your computer system. Thank you for your
> > cooperation.
> >
> >
> >
>
> ============================================================================
> ==
> > --
> > trauma-list : TRAUMA.ORG <http://trauma.org/>
> > To change your settings or unsubscribe visit:
> > http://www.trauma.org/index.php?/community/
> Dear Mike
>
> I close skin - as do most South African surgeons to my knowledge; the idea
> of leaving skin open is a very American thing, certainly never advocated
> in this country and to my knowledge not in the UK or Australia either.
>
> 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
> Durban - South Africa
>
> --
> trauma-list : TRAUMA.ORG <http://trauma.org/>
> To change your settings or unsubscribe visit:
> http://www.trauma.org/index.php?/community/
>
>
> --
> trauma-list : TRAUMA.ORG <http://trauma.org/>
> To change your settings or unsubscribe visit:
> http://www.trauma.org/index.php?/community/
>
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List Archives

For your convenience, find the Trauma List Archive Below

trauma-list Digest, Vol 68, Issue 4-open abdomen -skin closure