List Archives

Sat Jun 20 03:51:36 BST 2009

Thanks.   First I have concern for the CTA.    Increasingly we are being 
burned by CTAs, as are many hospitals.   The  results are often misleading.   
A negative CTA does not rule out a  vascular injury.   IF YOU ARE CONCERNED 
ABOUT A VASCULAR INJURY GET A  FORMAL REAL ARTERIOGRAM.     

Second.    The wound should have been explored, extensively  within the 
hour of presentation to the EC.    The possibility of  a foreign body still 
being present is huge.   

Third.    Several infectious conditions are real  possibilities, even 
without any dishwater.     It is  too soon for tetanus, but this is a tetanus 
prone wound and should have been  treated accordingly.      Clostridia 
infection is a  real possibility, even in the absence of gas in the tissue.   

To the OR.   Open widely and to the base of the  penetration.   
Intraoperative cultures and immediate  SMEARS.   Surgeon to go look at the slides of 
the immediate gram  stains of the deep tissue.   Look for gram positive rods 
with spores  at one end.     

Until proven otherwise, this is a sepsis from a virulent  organism.   Call 
ID and treat with your best BIG GUN.   

Put on your surgery QA meeting .   CLOSE THE DOOR and do a real  analysis 
as to why this case was not in the OR immediately after arrival at the  
hospital.    The purpose of the ER in this patient's care was to  wave to the 
patient on the way from the way from the ambulance dock to the  OR.    
Determine why a CTA was done.    It did not  really add anything to the known 
information or to the decision, but added risks  and costs.    

Get an immediate blood culture.     

k

In a message dated 6/19/2009 9:36:44 P.M. Central Standard Time,  
SSherry at LHS.ORG writes:

CTA neg.  CXR clear

concern for wound. wound explored in or no "dishwater"  appearance no 
fevers. taken back. later that afternoon. the wbc drops from 9  to 3. plts drop. 
redness in L arm. 

what next? thoughts...   

**************Dell Inspiron 15: Now starting at $349 
(http://pr.atwola.com/promoclk/100126575x1222435718x1201460505/aol?redir=http:%2F%2Fad.doubleclick.
net%2Fclk%3B215748553%3B38126199%3Bs)

List Archives

For your convenience, find the Trauma List Archive Below

A trauma case...impaled branch