List Archives

Sat Jan 31 14:10:31 GMT 2009

We take the ICU vent into the OR if necessary. K

2009/1/31 Gross, Ronald <Ronald.Gross at bhs.org>

> 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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