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Tue Oct 6 23:14:25 BST 2009

I have read many chapters in many textbooks relating to thoracic  trauma.   
I have written many of them.  I have researched this  subject forward and 
backwards.    I have read all of the imaging  papers in an attempt to 
determine the value of the various  tests.     So.   I will summarize for this list 
 what is my firm belief.    

1.   In cases of a bullet mediastinal traverse, a CT scan might  be used to 
determine trajectory.   

2.   CT scanning of the chest does not aid in the diagnosis of  treatable 
pneumo or hemothorax. 

3.   CT might occasionally be used as a screening test to  determine a 
possible aortic injury, which is then diagnosed by  aortography.    However, 
when one compares the chest x-ray to the  CT as a SCREENING test, they are 
identical.   IDENTICAL.     When one compares CT to aortogram as a  diagnostic 
test, the CT is often a VOMIT and misleading so that the clinician  over 
treats the patient.  

4.   For the vast majority of patients, CT in the acutely injured  patient 
has no real place.  For a chest injured patient in the ICU, when  there is 
fluid over load, pulmonary contusion, possible PE, then CT might be  
beneficial.  

5.    For ANYONE at ANYTIME who orders a CT of the chest for  acute trauma, 
they must be required to write a progress note as to just why they  are 
ordering the test, what they expect to find and how the findings on the CT  
might alter treatment or decision making depending on the results of the CT 
over  the chest X-ray.   It just cannot be done.   

k

In a message dated 10/6/2009 5:05:34 P.M. Central Daylight Time,  
nmcswai at tulane.edu writes:

After  the insertion of a chest tube for a GSW of the chest today, It was
very  difficult to convince the ED resident that the chest radiograph
showed the  chest tube in the correct position and the bullet pathway was
through the  lung was medial to lateral (obvious on the film) therefore
the CT of the  chest would provide us with no additional usefully
information. Whatever  happened to thinking? Is this my senility to
believe that a physical  examination, a simple chest radiograph and an
eye-scan coupled with  thinking would properly assess care of the
patient? Oh and yes the vital  signs were within normal limits as well. I
even touched the patient, felt  warm, moist skin, that was pink and with
good capillary refilling  time

They still wanted a CT. I said "no" to their unhappiness. They  asked me
3 additional times. The answer to each was  "NO"

Norman

Norman McSwain MD
Professor - Tulane Univ.  SOM
Trauma Director - Charity Hospital
504 988  5111

-----Original Message-----
From:  trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On  Behalf Of Jose Luis Danguilan
Sent: Tuesday, October 06, 2009 3:39  PM
To: Trauma-List [TRAUMA.ORG]
Subject: Re: ABC - a different  take

The new ABC ----

A -- Airway
B -- Breathing
C -- CT  scan :)

Jose Luis J. Danguilan, MD

On Wed, Oct 7, 2009 at 4:23  AM, Gordon S. Doig
<gdoig at med.usyd.edu.au>wrote:

>
>  A = allocation concealment
> B = blinding
> C = complete  follow-up
>
> Covers 90% of the major errors you will find in  published RCTs.
>
> Gord
>
>
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A(lways) B(uy) C(T scan) - a different take