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Mon Feb 23 14:29:27 GMT 2009

Sheila Lopez RN, BSN 
Director of Trauma and EMS 
Memorial Hermann Texas Medical Center 

Office Phone 713-704-5297
Cell Phone 832-205-0592
Fax 713-704-5659 
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Today's Topics:

   1. Re: Neostigmine for Post operative Illeus (Krin135 at aol.com)
   2. to Northern European listmembers (Rainer Gatz)
   3. Have you seen such a case before? (rm khattar)
   4. (no subject) (navin goyal)
   5. Sequencing of complex ortho in major multisystem injury
      (Bjorn, Pret)
   6. Re: Spam: Sequencing of complex ortho in major multisystem
      injury (Zsolt Balogh)
   7. Re: Sequencing of complex ortho in major multisystem injury
      (Robert Schulze)

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

Message: 1
Date: Wed, 11 Feb 2009 07:09:17 EST
From: Krin135 at aol.com
Subject: Re: Neostigmine for Post operative Illeus
To: trauma-list at trauma.org
Message-ID: <c10.53181437.36c419ed at aol.com>
Content-Type: text/plain; charset="US-ASCII"

understood...my reservation about it as well, but with the loss of
Cisapride 
some years ago, we are limited here in the States.

ck
Charles S. Krin, DO

In a message dated 2/11/2009 04:30:30 Central Standard Time,  
dr.tchardcastle at absamail.co.za writes:

Have  done in the past - don't like it in the ICU setting regarding
resistance  etc.

**************The year's hottest artists on the red carpet at the Grammy

Awards.  AOL Music takes you there. 
(http://music.aol.com/grammys?ncid=emlcntusmusi00000002)

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

Message: 2
Date: Wed, 11 Feb 2009 14:14:45 +0100
From: Rainer Gatz <rainer.gatz at vgregion.se>
Subject: to Northern European listmembers
To: Discussion of Critical Care Medicine <ccm-l at ccm-l.org>
Cc: Anesthesiologists and Anesthetists Pass The Gas
	<gasnet at ccm-l.org>,	Trauma and Critical Care mailing list
	<trauma-list at trauma.org>,	Anesthideas at yahoogroups.com
Message-ID: <200902111414.45312.rainer.gatz at vgregion.se>
Content-Type: text/plain;  charset="iso-8859-1"

hello all and good day,

you may have heard about the Winfocus group, an international society of

people who use and promote focussed ultrasound in emergency and
intensive 
care medicine:
<http://www.winfocus.org>

last year we could organise the first Scandinavian regional meeting, and

believe it to have been a success.

now i should like to announce the next Scandinavian meeting, to be held
in 
Aarhus, Danmark, on the 19th to 21st of october:
<http://www.acidbase.org/echo/announcement-scandinavia-2009.html>
this page is still preliminary, but i will keep it updated.

best regards,
Rainer Gatz

-- 
happily using linux and kmail!
Rainer Gatz   anaesthesiologist
KSS (K?rnsjukhuset i Skaraborg / Skaraborg Central Hospital)
54185  Sk?vde /  Sweden
http://www.acidbase.org/phpscripts6/start_pe.php
http://www.acidbase.org/echo
rainer.gatz at t-online.de
rainer.gatz at vgregion.se

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

Message: 3
Date: Wed, 11 Feb 2009 19:24:27 +0530 (IST)
From: rm khattar <dr_rm_khattar at yahoo.co.in>
Subject: Have you seen such a case before?
To: trauma-list at trauma.org
Message-ID: <225517.23094.qm at web95208.mail.in2.yahoo.com>
Content-Type: text/plain; charset=utf-8

On opening peritoneum gas equivalent to amount of gas created by pneumo
peritoneum at Lap Chole escapes,hardly 500 cc of exudate escapes. At
first glance all luminal structures appear normal.When stomach is
separated from under surface of Liver.a 6-7 cm  transverse perforation
comes into view, situated at body of stomach ,more towards lesser
curvature,the margins,of perf are blackish,but bleed furiously on
debridement.No definite growth is felt in the stomach.Pylorus is
normal.A small patch,  3-4cm in diameter, of brownish blackish
discolouration is seen at fundus but is not perforated,I debride and
close the involved area ,do a peritoneal toilet,put wide drains and
close.The debrided margins I sent for histology.
Will the Bx turn out to be NHL or Adenoca?Or there is a vascular
explanation for this.Should I have done surgically any thing for the
area of discoloration at fundus which I fear may give way and lead to
gastrocutaneous fistula? Your inputs will be highly appreciated.
R.M.Khattar.
Delhi.

      Unlimited freedom, unlimited storage. Get it now, on
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------------------------------

Message: 4
Date: Wed, 11 Feb 2009 19:27:11 +0530 (IST)
From: navin goyal <drnavingoyal at yahoo.co.in>
To: trauma-list at trauma.org
Message-ID: <341195.98196.qm at web94913.mail.in2.yahoo.com>
Content-Type: text/plain; charset=utf-8

Robert ,
Thank you. You use erythromycin IV or peroral( Through Ryles tube).
Dr. Navin Goyal
India

Re: Neostigmine for Post operative Illeus
Wednesday, 11 February, 2009 4:27 PM
From:
"Robert Schulze" <Robert.Schulze at nychhc.org>
To:
trauma-list at trauma.org
I use Erythromycin frequently in the ICU, I don't like metoclopramide
anymore. I have had a pretty good success with the Emycin.

Robert Schulze MD FACS
SUNY Downstate/Kings County Hospita

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

Message: 5
Date: Wed, 11 Feb 2009 14:30:17 -0500
From: "Bjorn, Pret" <pbjorn at emh.org>
Subject: Sequencing of complex ortho in major multisystem injury
To: "Trauma &amp; Critical Care mailing list" <trauma-list at trauma.org>
Message-ID:
	<9CCE32ECAAFDEB4DA01EC771B6AD951B036A7CAE at VALIER.me.emh.org>
Content-Type: text/plain;	charset="us-ascii"

Adult female, pedestrian vs train.  

Arrives in extremis, shocky.  Looks like she's been hit by a train.  

Injuries will be found to include flail chest with tension pneumothorax
and pulmonary contusion; high-grade splenic injury with active bleeding
and clinically evident hemoperitoneum; a left renal disruption with
retroperitoneal hematoma; stable pelvic rami fractures; and two open,
angulated, mangled extremities with diminished pulses (one arm, one
leg).

Airway control, ED thoracostomy, massive transfusion initiated and taken
promptly to OR for damage-control procedures (splenectomy and packing,
extremity debridement, reapproximations and ex-fixes).  

To ICU post op, recovers nicely over a few hours: warm, no acidosis,
normotensive, predictably anemic and thrombocytopenic but without
coagulopathy.  She is moving all extremities and has a negative brain
CT.  All the surgeons are considering her survival unexpected, and her
stable condition just short of astonishing.  She has good apparent
circulatory, sensory and motor function in her fixators.

The orthopedists are anxious to have a more methodical crack at her arm
and leg: multiple complicated surgeries taking several hours.  

How long should she rest in the ICU before definitive extremity repairs?

Pret Bjorn, RN
Bangor, ME USA

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

Message: 6
Date: Thu, 12 Feb 2009 08:16:16 +1100
From: "Zsolt Balogh" <Zsolt.Balogh at hnehealth.nsw.gov.au>
Subject: Re: Spam: Sequencing of complex ortho in major multisystem
	injury
To: "Trauma &amp; Critical Care mailing list" <trauma-list at trauma.org>
Message-ID: <4993DAD0.D0AC.00B7.0 at hnehealth.nsw.gov.au>
Content-Type: text/plain; charset=US-ASCII

Dear Bjorn,

There is no good recipe for this.The best to have orthopaedic trauma
surgeons with good understanding of physiology. There are few
indicators, which we use when to go and what extent but it really
depends on what surgery needs to be done. Generally between 3-7 days we
just recommend to do relatively small interventions: repeated wash-outs,
soft tissue closures, nerve repairs (these get difficult after a week),
but even for this there is no golden rule if the patient tolerate you
can go further. A general rule is that earlier fixation is better if you
do not make the patient sicker (Second hit) and the local environment
has the ability to heal (this is sometimes problematic during the immune
paralysis phase). Sometimes you need to take the risk in the wrong time
window to help the patient positioning and to help scratching off the
ventilator with the help of pelvic/acetabular/long bone fixation. Immune
monitoring might help in this in the future. Currently we do not have
relia
 ble indicators. Generally we like to go ahead when the patient has
circulating PMN, platelets, not grossly edematous (fortunately we do not
see this as frequently as in the past). Best Regards, Zsolt Balogh

>>> "Bjorn, Pret" <pbjorn at emh.org> 12/02/2009 6:30 am >>>
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WARNING! 

The message below has been identified as possible spam. 
If you do not know the sender delete this message immediately.
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Adult female, pedestrian vs train.  

Arrives in extremis, shocky.  Looks like she's been hit by a train.  

Injuries will be found to include flail chest with tension pneumothorax
and pulmonary contusion; high-grade splenic injury with active bleeding
and clinically evident hemoperitoneum; a left renal disruption with
retroperitoneal hematoma; stable pelvic rami fractures; and two open,
angulated, mangled extremities with diminished pulses (one arm, one
leg).

Airway control, ED thoracostomy, massive transfusion initiated and taken
promptly to OR for damage-control procedures (splenectomy and packing,
extremity debridement, reapproximations and ex-fixes).  

To ICU post op, recovers nicely over a few hours: warm, no acidosis,
normotensive, predictably anemic and thrombocytopenic but without
coagulopathy.  She is moving all extremities and has a negative brain
CT.  All the surgeons are considering her survival unexpected, and her
stable condition just short of astonishing.  She has good apparent
circulatory, sensory and motor function in her fixators.

The orthopedists are anxious to have a more methodical crack at her arm
and leg: multiple complicated surgeries taking several hours.  

How long should she rest in the ICU before definitive extremity repairs?

Pret Bjorn, RN
Bangor, ME USA

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

Message: 7
Date: Thu, 12 Feb 2009 06:44:44 -0500
From: "Robert Schulze" <Robert.Schulze at nychhc.org>
Subject: Re: Sequencing of complex ortho in major multisystem injury
To: "Trauma &amp; Critical Care mailing list" <trauma-list at trauma.org>
Message-ID: <4993C55C.91FA.009C.0 at nychhc.org>
Content-Type: text/plain;    charset="US-ASCII"

We know that early fixation of fractures is a good thing. I would
suggest if you have a stable patient and have met the routine end points
of resucitation, (lactate, urine output, good gasses, etc)  then you let
the ortho guys do their thing. we frequently stop in the OR ourselves
though and make sure things are going okay and if things are not, have
pulled people off the table before everything gets done in patients like
this. 

Robert Schulze MD FACS
Clin Asst Dean, 
Trauma and Critical Care Surgery,]
SUNY Downstate/Kings County Hospital

>>> "Bjorn, Pret" <pbjorn at emh.org> 2/11/2009 2:30 PM >>>
Adult female, pedestrian vs train.  

Arrives in extremis, shocky.  Looks like she's been hit by a train.  

Injuries will be found to include flail chest with tension pneumothorax
and pulmonary contusion; high-grade splenic injury with active bleeding
and clinically evident hemoperitoneum; a left renal disruption with
retroperitoneal hematoma; stable pelvic rami fractures; and two open,
angulated, mangled extremities with diminished pulses (one arm, one
leg).

Airway control, ED thoracostomy, massive transfusion initiated and taken
promptly to OR for damage-control procedures (splenectomy and packing,
extremity debridement, reapproximations and ex-fixes).  

To ICU post op, recovers nicely over a few hours: warm, no acidosis,
normotensive, predictably anemic and thrombocytopenic but without
coagulopathy.  She is moving all extremities and has a negative brain
CT.  All the surgeons are considering her survival unexpected, and her
stable condition just short of astonishing.  She has good apparent
circulatory, sensory and motor function in her fixators.

The orthopedists are anxious to have a more methodical crack at her arm
and leg: multiple complicated surgeries taking several hours.  

How long should she rest in the ICU before definitive extremity repairs?

Pret Bjorn, RN
Bangor, ME USA

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