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Sat Sep 12 23:30:56 BST 2009

Useful if positive. I do not believe the results if they are negative. too paranoid perhaps, but paranoia makes a good surgeon. "Assume nothing; Trust no one; Do it yourself" as the old saying goes. Oh yes, and "the patient lies"

Norman

Norman McSwain MD
Trauma Director, Charity Hospital
Professor of Surgery, Tulane University
New Orleans LA
504 988 5111
norman.mcswain at tulane.edu <mailto:norman.mcswain at tulane.edu> 

________________________________

From: trauma-list-bounces at trauma.org on behalf of moore677 at aol.com
Sent: Sat 9/12/2009 5:08 PM
To: trauma-list at trauma.org
Subject: Re: TRANSMED GSW

Don't completely trust either as well, but are very useful tools

-----Original Message-----
From: McSwain, Norman E Jr. <nmcswai at tulane.edu>
To: Trauma-List [TRAUMA.ORG] <trauma-list at trauma.org>
Sent: Sat, Sep 12, 2009 1:49 pm
Subject: RE: TRANSMED GSW

I am very reticent to trust either CT or FAST on penetrating trauma. I have seen
too many negative exams with positive intra-operative findings or even deaths. I
know some believe that (in their hands) FAST is unquestionably correct but our
rate is no where near zero with negative exams. I can only trust my personal
experience not what others find in other hospitals.

On penetrating trauma (GSW) the eye scan is my most often used test. Stab wounds
are different. I believe that Carter Nance was correct with stab wounds

Norman

Norman McSwain MD
Trauma Director, Charity Hospital
Professor of Surgery, Tulane University
New Orleans LA
504 988 5111
norman.mcswain at tulane.edu <mailto:norman.mcswain at tulane.edu>

________________________________

From: trauma-list-bounces at trauma.org on behalf of moore677 at aol.com
Sent: Sat 9/12/2009 3:39 PM
To: trauma-list at trauma.org
Subject: TRANSMED GSW

Likely a hollow point.?

He would have never went to CT if he did not respond to the "brief" but very
aggressive resuscitation.? I debated long and hard about opening the belly, and
I guess when that happens, probably should.............the radiologist (intra-op
reading) did not feel he had any intra-abd injury and I felt with an exploration
from the L chest and an EGD (in addition to obvious esoph injury, was done
because I thought I saw a fragment in the stomach on CT) that didn't show any
obvious injury that I was pretty safe in ruling out intra-abd injury.

Dell..........
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