List Archives

Sun Jun 28 23:18:23 BST 2009

The patient also came with a CT scan.  Do these images help you with the
situs inversus question?Would you have gone to CT with this patient?

http://www.trauma.org/index.php/community/blog_post/karim_brohi/884/

Karim

2009/6/28 Rob Ojala <Rob.Ojala at cdhb.govt.nz>

> Ron - while I think ultimately your assertion may be correct, I've taken
> the liberty of flipping the image to illustrate that technical error
> remains a possibility that would be prudent in the heat of resus to
> discount...[see attachment]
>
>
>
> Rob
>
>
>
>
>
>
>
> -----Original Message-----
> From: trauma-list-bounces at trauma.org
> [mailto:trauma-list-bounces at trauma.org] On Behalf Of Gross, Ronald
> Sent: Sunday, 28 June 2009 11:18 p.m.
> To: 'Trauma-List [TRAUMA.ORG]'
> Subject: RE: Very cool case
>
>
>
> Nope - Dr. Mattox is absolutely correct.  Look at the aortic
> knob.........its on the left and the heart is on the right.
>
>
>
> Ron
>
> ________________________________
>
> From: trauma-list-bounces at trauma.org
> [mailto:trauma-list-bounces at trauma.org] On Behalf Of Rob Ojala
>
> Sent: Sunday, June 28, 2009 4:29 AM
>
> To: Trauma-List [TRAUMA.ORG]
>
> Subject: RE: Very cool case
>
>
>
> While Dextrocardia and herniation are interesting calls - isn't the
> commonest cause of this appearence purely technical [inverted CXR,
> mislabelled]? - Yes the labelled 'right' hemi-diaphram is higher, but
> his is not a reliable distinction.....would suggest either repeat film
> or Ultrasound to confirm orientation before getting too excited!!
>
> Rob
>
>
>
> ________________________________
>
> From: trauma-list-bounces at trauma.org on behalf of Karim Brohi
>
> Sent: Sun 28/06/2009 3:42 a.m.
>
> To: Trauma-List [TRAUMA.ORG]
>
> Subject: Re: Very cool case
>
>
>
> 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
>
> > >> --
>
> > >> trauma-list : TRAUMA.ORG
>
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> > >> http://www.trauma.org/index.php?/community/
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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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Very cool case