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Sat May 23 13:02:09 BST 2009

If the limb is viable and the CT does not show extravasation then I would
leave well alone.  I would duplex the arm in a couple of weeks to make sure
there is no pseudoaneurysm formation.  I would intervene only if the patient
developed disabling claudication symptoms or the vertebral was involved.  I
would angio & ?stent an ischaemic limb only, recognizing that the stent is
probably only going to be a temporising device.
Karim

2009/5/23 Sanjay Gupta <sanjaygupta99_91 at yahoo.com>

>
> No angio.  Only CT angio. Patient asymptomatic.  Is a formal angiogram
> warranted at all if everyone on the trauma list thinks it is VOMIT?  Why
> expose the patient to an invasive procedure with a significant risk of
> complications - specially as she has no symptoms?
>
>
> Sanjay Gupta
> Tel: 207 576 3296
>
>
> --- On Fri, 5/22/09, Gross, Ronald <Ronald.Gross at baystatehealth.org>
> wrote:
>
> > From: Gross, Ronald <Ronald.Gross at baystatehealth.org>
> > Subject: RE: Subclavian artery intimal injury
> > To: "'Trauma and Critical Care mailing list'" <trauma-list at trauma.org>
> > Date: Friday, May 22, 2009, 5:15 AM
> > VOMIT?  What did the angio look
> > like?
> >
> > Ron
> > -----Original Message-----
> > From: trauma-list-bounces at trauma.org
> > [mailto:trauma-list-bounces at trauma.org]
> > On Behalf Of Sanjay Gupta
> > Sent: Thursday, May 21, 2009 5:10 PM
> > To: Trauma and Critical Care mailing list
> > Subject: Subclavian artery intimal injury
> >
> >
> > 30 yrs old healthy motor cycle rider, slipped and went over
> > a guard rail.  Came in complaining of pain in right
> > shoulder and some numbness in rt upper extremity.
> > Objectively, all sensory and motor function in this
> > extremity was normal.  Blood pressure in this extremity
> > was equal to the opposite side.  Had some swelling in
> > posterior triangle of neck on the right side very low down
> > in the neck.  Transverse non-displaced fracture of
> > right clavicle in the mid-portion.
> >
> > CT angio was done because of the swelling in posterior
> > triangle.  Showed an intimal flap with thrombus with no
> > proximal dilation, good distal flow and approximately 50%
> > compromise of the lumen. Injury was distal to origin of
> > thyrocervical trunk.  No extra-vasation of
> > contrast.  I will post pictures soon.
> >
> > Any advice on management of this patient.  I have
> > anticoagulated her and given her a sling for the clavicle.
> >
> >
> > Sanjay Gupta
> > Tel: 207 576 3296
> >
> >
> >
> >
> > --- On Thu, 5/21/09, khumar huseynova <khumarhuse at yahoo.ca>
> > wrote:
> >
> > > From: khumar huseynova <khumarhuse at yahoo.ca>
> > > Subject: Re: Australian doctor uses household drill to
> > save boy
> > > To: trauma-list at trauma.org
> > > Date: Thursday, May 21, 2009, 11:50 AM
> > > absolutely amazing. I know from
> > > experience that this is also part of practice in
> > developing
> > > countries-use whatever in hand to help out.
> > > KH
> > >
> > > Message: 4
> > > Date: Wed, 20 May 2009 15:58:33 -0700 (PDT)
> > > From: Charles Brault <c_brault at yahoo.com>
> > > Subject: Australian doctor uses household drill to
> > save
> > > boy
> > > To: Trauma and Critical Care mailing list <trauma-list at trauma.org>
> > > Message-ID: <872592.21536.qm at web36507.mail.mud.yahoo.com>
> > > Content-Type: text/plain; charset=iso-8859-1
> > >
> > >
> > > ?
> > > ?
> > > Australian doctor uses household drill to save boy
> > > Provided by: The Canadian Press
> > > Written by: THE ASSOCIATED PRESS
> > > May. 19, 2009
> > > MELBOURNE, Australia- A doctor in rural Australiaused
> > a
> > > household drill to bore a hole into the skull of a boy
> > with
> > > a severe head injury, saving his life.
> > > Nicholas Rossi fell off his bike on Friday in
> > Maryborough,
> > > hitting his head on the pavement, his family told The
> > > Australian newspaper in a story published Wednesday.
> > > By the time Rossi got to the hospital, he was slipping
> > in
> > > and out of consciousness.
> > > The doctor on duty, Rob Carson, quickly recognized
> > the
> > > 13-year-old was experiencing potentially fatal
> > bleeding on
> > > the brain and knew he had only minutes to drill a
> > hole
> > > through the boy's skull to relieve the pressure.
> > > But the small hospital was not equipped with
> > neurological
> > > drills - so Carsongrabbed a household drill from the
> > > maintenance room.
> > > A Melbourneneurosurgeon talked Carsonthrough the
> > procedure
> > > by telling him where to aim the drill and how deep to
> > go and
> > > soon, a blood clot fell out, relieving the pressure on
> > the
> > > boy's brain.
> > > "Dr. Carson came over to us and said, 'I am going to
> > have
> > > to drill into (Nicholas) to relieve the pressure on
> > the
> > > brain - we've got one shot at this and one shot
> > only,"' said
> > > the boy's father, Michael Rossi.
> > > Rossi was airlifted to a larger hospital in
> > Melbourneand
> > > released Tuesday - his 13th birthday.
> > > Carsonwas modest about his feat.
> > > "It is not a personal achievement, it is just a part
> > of the
> > > job and I had a very good team of people helping me,"
> > he
> > > told the newspaper.
> > > Michael Rossi was more effusive.
> > > "He saved our son's life," he said.
> > > ?
> > > ?
> > > ?
> > >
> http://health.lifestyle.yahoo.ca/channel_health_news_details.asp?news_id=18129&news_channel_id=1008&channel_id=1008
> > >
> > >
> > > ------------------------------
> > >
> > >
> > >
> > >
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Subclavian artery intimal injury