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Mon May 25 18:12:10 BST 2009

I'm currently looking after a patient who had angiography for a
carotid/cavernous sinus fistula-she had a retroperitoneal bleed resulting in
>2L blood loss and requiring surgical intervention to stop the bleeding.
Subsequently developed abdominal compartment syndrome, perforated her cecum,
got ARDS and an infected pleaural effusion requiring chest tubes. And an MCA
stroke resulting in partial hemiplegia. She's about 50 years old...

On Sat, May 23, 2009 at 6:33 PM, Sanjay Gupta <sanjaygupta99_91 at yahoo.com>wrote:

>
> Well.... I have been involved in at least 3 femoral artery injuries /
> pseudoaneurysms in the last 4 years after angiogram.  I have also seen two
> massive retroperitoneal bleeds after femoral arterial lines.  It is too much
> to say that angiograms have no complications. Of these 5 femoral artery
> iatrogenic injuries, I saw two at one of the top hospitals in US and another
> one at a center of excellence for cardiovascular disease!
>
>
> I do a fair amount of general surgery and this sounds like a common phrase
> that I hear from my colleagues - "just a colonoscopy".
>
>
> Sanjay Gupta
> Tel: 207 576 3296
>
>
>
>
> --- On Sat, 5/23/09, sjasmd at aol.com <sjasmd at aol.com> wrote:
>
> > From: sjasmd at aol.com <sjasmd at aol.com>
> > Subject: Re: Subclavian artery intimal injury
> > To: trauma-list at trauma.org
> > Date: Saturday, May 23, 2009, 10:34 AM
> >
> >  sanjay
> >
> > I continually hear about the significant risk of
> > angiography.
> >
> > j would dispute that significant risk and cannot find it in
> > the modern literature, especially related to trauma in young
> > patients. . Even as a fledgling inexperienced interventional
> > radiologist, i never had? complications of a subclavian
> > arteriogram. Angiography is a very safe procedure and does
> > not have significant risk of complications.
> >
> > A vomit is a potential situation when one manages the
> > patient on the basis of an imaging study such as mri, ct,
> > ultrasound, endoscopy or echo, that overestimates or
> > underestimates the significance of the findings. It is not
> > the procedure that is a vomit, but the actions that result.
> >
> > If there is subclavian injury of some form that results in
> > subsequent occlusion, stricture or embolism, especially in a
> > man or tennis player or woman who holds here baby in that
> > arm, the patient may very well become symptomatic in the
> > future. What we may have here is a VOID Victim of image
> > denial.
> >
> > I do not think that CTA is anything better than an
> > investigational? noninvasive screening test. Any equivocal
> > or abnormal finding warrants the gold standard to get to the
> > truth.
> >
> >
> >
> >
> >
> > sal
> >
> >
> >
> >
> >
> >
> > -----Original Message-----
> > From: Sanjay Gupta <sanjaygupta99_91 at yahoo.com>
> > To: Trauma and Critical Care mailing list <trauma-list at trauma.org>
> > Sent: Sat, 23 May 2009 6:41 am
> > Subject: RE: Subclavian artery intimal injury
> >
> >
> >
> >
> >
> >
> >
> >
> >
> >
> >
> > 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