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Fri Oct 23 18:33:04 BST 2009

LOL - real loud!!!
Ron

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] On Behalf Of McSwain, Norman E Jr.
Sent: Friday, October 23, 2009 10:35 AM
To: Trauma-List [TRAUMA.ORG]
Subject: RE: Ref:selectice conservative management of stab injury abdomen-roleof ct in pt wthout peritonitis , hemodynamically stable pt

But as Carter Nance taught us in the 1960's (previous quoted article), a hole in the peritoneum is NOT a reason to do a laparotomy. It is simply an indication to do serial observational physical examinations on the patient. The indication for surgery is an acute abdomen on examination or hemodynamic instability. If a  hole in the peritoneum from a stab wound was an indication for surgical exploration, every patient who has peritoneal dialysis would undergo a laparotomy.

Norman

Norman McSwain MD
Professor, Tulane School of Medicine
Trauma Director, Charity Hospital Trauma Center
norman.mcswain at tulane.edu
504 988 5111

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] On Behalf Of caesar ursic
Sent: Thursday, October 22, 2009 4:36 PM
To: Trauma-List [TRAUMA.ORG]
Subject: Re: Ref:selectice conservative management of stab injury abdomen-roleof ct in pt wthout peritonitis , hemodynamically stable pt

Eh.. what you say?  I read the papers in the Journal of Trauma, Injury,
Infection and Critical Care.  They showed that laparoscopy in asymptomatic
patients stabbed in abdomen can easily show any peritoneal penetration.  If
you see that, you can open with a scapel and explore the abdomen right then
and there and look with the naked eyes (TV screen not so good for looking
around inside) -they are already asleep and prepped, so really only one
procedure - saves money!.  That way you can find out for yourself if the
knife cut open something valuable.  If not - no harm done, right?  Nobody
ever died of a negative laparotomy, did they?  Seems logical to me.

Laparoscopy gives you answers.

C. Ursic, MD
general surgeon

On Thu, Oct 22, 2009 at 11:03 AM, <nappio at aol.com> wrote:

> What are u looking for???? A hole in the abd wall? If your not bleeding and
> your not getting septic you can watch them.  This has been studied.dn
> Sent from my Verizon Wireless BlackBerry
>
> -----Original Message-----
> From: caesar ursic <cmursic at gmail.com>
> Date: Thu, 22 Oct 2009 10:52:22
> To: Trauma-List [TRAUMA.ORG <http://trauma.org/>]<trauma-list at trauma.org>
> Subject: Re: Ref:selectice conservative management of stab injury
> abdomen-role
>        of ct in pt wthout peritonitis , hemodynamically stable pt
>
> I am shocked (and dismayed) that no one, anyone, is recommending diagnostic
> laparoscopy in this case.  Laparoscopy gives you answers.
>
> C. Ursic, MD
> general surgeon
>
> On Sun, Oct 18, 2009 at 9:23 AM, josemaya01 <josemaya01 at prodigy.net.mx
> >wrote:
>
> > There is a good deal of information that in select cases like this one, a
> > conservative approach (non surgical) is warranted if the ttrauma team can
> > committ to serial exams.
> >
> > José Mayagoitia MD
> > Hospital General de Mexicali, México
> > De : "fiaz fazili" fiazmfazili at yahoo.com
> > Para : trauma-list at trauma.org
> > Copia :
> > Fecha : Fri, 16 Oct 2009 10:59:30 -0700 (PDT)
> > Asunto : selectice conservative management of stab injury abdomen-role of
> > ct in pt wthout peritonitis , hemodynamically stable pt
> >
> >
> > > a 28 ys male was admitted because of having stab injury anterior
> abdomen,
> > even after 8hrs he was hemodynamically stable, no tachycardi, no fever
> ,not
> > complaining of pain abdomen,no signs of peritonitis,no evisceration of
> bowel
> >  omentum- ;no pneumoperitoneum, LWE and ct scan not definitive for
> > penetraion of post sheath,some  inflammatory changes  upto muscle---;with
> > minimal collection in pelvis- no hb fall- shold we operate on this
> isplated
> > finding or proceed with selective conservative management with serial
> > physical exam available ,having been initially examind by surgical
> > specialist and same spoecilist is is on duty for next 24 hrsplease
> > advise--dr fiaz fazili
> > >
> > >
> > >
> > --
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>
>
>
> --
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> Did gyre and gimble in the wabe:
> All mimsy were the borogoves,
> And the mome raths outgrabe.
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-- 
'Twas brillig, and the slithy toves
Did gyre and gimble in the wabe:
All mimsy were the borogoves,
And the mome raths outgrabe.
--
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Ref:selectice conservative management of stab injury abdomen-roleof ct in pt wthout peritonitis , hemodynamically stable pt