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Sat Jun 27 16:42:30 BST 2009

Yup 12 hours later.  Mechanism was blunt trauma (car crash as I remember).
 Complete fracture-dislocation of the cord at T7/8.  *lots* of inotropes.
 Is this situs inversus/dextrocardia???  Can you tell from this X-ray?Karim

2009/6/27 <nappio at aol.com>

> This was twelve hrs later?dn
> Sent from my Verizon Wireless BlackBerry
>
> -----Original Message-----
> From: Mary Lumpkin <docmarance at yahoo.com>
>
> Date: Sat, 27 Jun 2009 08:16:24
> To: Trauma-List [TRAUMA.ORG]<trauma-list at trauma.org>
> Subject: Re: Very cool case
>
>
> doubt if ultrasound would change your management- examine via median
> sternotomy.  reverse trendelenburg position might help vitals en route to
> the OR.  without the spinal injury, would try sitting the patient up.
>
> Mary Foster Lumpkin MD
>
>
>
>
> ________________________________
> From: Stephen Richey <stephen.richey at gmail.com>
> To: Trauma-List [TRAUMA.ORG] <trauma-list at trauma.org>
> Sent: Friday, June 26, 2009 6:38:24 PM
> Subject: Re: Very cool case
>
> Also the cardiac show looks rather enlarged so could there be a cardiac
> injury?  How about a quick ultrasound exam to check that out?
>
> On Fri, Jun 26, 2009 at 7:37 PM, Stephen Richey <stephen.richey at gmail.com
> >wrote:
>
> > Situs inversus/dextrocardia?
> >
> >
> > On Fri, Jun 26, 2009 at 7:20 PM, Karim Brohi <karimbrohi at gmail.com>
> wrote:
> >
> >> Great case a couple of weeks ago.  Patient secondarily transferred to us
> >> for
> >> management of a thoracic spinal fracture-dislocation with associated
> >> spinal
> >> cord injury.  Re-trauma called on arrival as is our protocol.   He
> arrived
> >> 12 hours or so following the injury on very large doses on inotropes to
> >> support his blood pressure.  I've posted the chest-Xray to one of the
> new
> >> blogs on the website
> >> http://www.trauma.org/index.php/community/blog_post/karim_brohi/882/
> >>
> >> What's going on?  We might have a blog comment discussion on this one
> :-)
> >>
> >> K
> >> --
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> >
> >
> >
> > --
> > Stephen Richey, CRT
> >
> > "It is not unreasonable that we grapple with problems....Our
> responsibility
> > is to do what we can, learn what we can, improve the solutions, and pass
> > them on."- Richard Feynman
> >
>
>
>
> --
> Stephen Richey, CRT
>
> "It is not unreasonable that we grapple with problems....Our responsibility
> is to do what we can, learn what we can, improve the solutions, and pass
> them on."- Richard Feynman
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> trauma-list : TRAUMA.ORG
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Very cool case