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Sat Sep 12 23:10:15 BST 2009

We did have cellsaver ready and available, but did not use because of the esophageal injury

-----Original Message-----
From: Krin135 at aol.com
To: trauma-list at trauma.org
Sent: Sat, Sep 12, 2009 2:01 pm
Subject: Re: TRANSMEDIASTINAL GSW

In a message dated 9/12/2009 12:43:35 Central Standard Time,  
moore677 at aol.com writes:

Two patients arrived with GSW's, first with GSW L shoulder to L chest  
(didn't require chest tube though) and second with GSW L shoulder, through L  
chest, mediastinum, lodging in R chest.? Hypotensive, placed 2 left chest  
tubes (first failed to evacuate HTX) and one left chest tube, MTP protocol  
initiated.? Prepping chest for ED thoracotomy as pressure initially in 40's,  
but responded to blood products.? Managed to resusc to get CT scan which  
showed persistent large L HTX despite 2 chest tubes, ? esophag injury, ? L SCL  
artery injury.? CT's initially out about 1000, with second tube 200, and by 
 finishing?CAT scan?about 1800-2000.? ? intra-abd injury on CT.

With this much blood out of the chest tube, would it have been reasonable  
to have set up the CellSaver kit? Or would the chances of esophageal  
damage/contamination have been too high?

ck

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TRANSMEDIASTINAL GSW