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Mon Mar 16 13:19:07 GMT 2009

Our ICU admission order set is computerized, and demands a distinct selection of VTE prophylaxis.  The default order is LMWH, but in cases such as this, with contraindications, the modality automatically reverts to sequentials.  For whatever they're worth.

I suppose the conversation then turns to filters.  But in a blunt trauma with unsedated GCS of 3 in an elderly male with unlisted comorbidities, unspecified vertebral column (i.e. potential cord) injuries, multiple intraabdominal traumas, multiple extremity traumas, and presumably a very precarious path to survival -- much less functional return -- I think we'd be talking to the family before adding to his procedure bills.

Interested in seeing what others would do.

Pret Bjorn, RN
Bangor, ME USA.

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] On Behalf Of Gad Shaked
Sent: Monday, March 16, 2009 9:06 AM
To: Trauma &amp; Critical Care mailing list
Subject: More on TE prophylaxis

Having now in our ICU: 74-y-old male, ped. vs. vehicle. Diffuse SAHs, GCS 3 (no sedation for the last 24 hours), grade 3 splenic laceration, cervical and thoracic vertebra fractures, radial bone and bil. tib-fib fractures, AND abdominal aortic laceration with contained hematoma. How would you prevent DVT/PE in this patient?

Gadi Shaked, MD
Department of Surgery
Trauma Unit
Soroka University Medical Center
Beer Sheva
Israel‎
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More on TE prophylaxis