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trauma-list Digest, Vol 89, Issue 14

McSwain, Norman E nmcswai at tulane.edu
Fri Nov 26 01:10:34 GMT 2010


Why did they have their splenectomy?

Norman

Professor, Tulane University, Surgery
Trauma Director, Spirit of Charity Trauma Center, ILH/MCLNO
New Orleans, Louisiana
504 988 5111


-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of John Hall
Sent: Thursday, November 25, 2010 4:33 PM
To: trauma-list at trauma.org
Subject: Re: trauma-list Digest, Vol 89, Issue 14

Ken
I have taken care of two teenagers (one 13, one 18) who have died from
classic OPSS.  Neither one with any other disease.

Prophylactic antibiotics: No indication. 

Brett,
You misread mine. MAST not better than sheet etc for "splinting" pelvic
fxs.  Ant "tinker toy" INEFFECTIVE without additional posterior
stabilization

Angio only good for arterial injury, not for venous.

The only treatment (other than semipelvectomy) that can treat the
massive venous injury are the MAST inflated to > 40 mm Hg!

Sent from my iPad

John R. Hall, M.D., F.A.C.S., F.C.C.M
Professor of Surgery


On Nov 24, 2010, at 11:49 AM, trauma-list-request at trauma.org wrote:

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> When replying, please edit your Subject line so it is more specific
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> 
> 
> Today's Topics:
> 
>   1. Re: splenectomy and vaccination (Nikahat Jahan)
>   2. Re: splenectomy and vaccination (KMATTOX at aol.com)
>   3. Re:  Vaccination (Jrhmdtraum at aol.com)
>   4. RE:  Vaccination (Gross, Ronald)
> 
> 
> ----------------------------------------------------------------------
> 
> Message: 1
> Date: Wed, 24 Nov 2010 22:01:51 +0530
> From: Nikahat Jahan <nikahat at gmail.com>
> Subject: Re: splenectomy and vaccination
> To: "Trauma-List [TRAUMA.ORG]" <trauma-list at trauma.org>
> Message-ID:
>    <AANLkTimrZVaVn2bK4oPXF1ZR7Rkw5t2nDzY7b-vDLM9Z at mail.gmail.com>
> Content-Type: text/plain; charset=ISO-8859-1
> 
> Thanks to everyone for the replies. what about the antibiotic
prophylaxis?
> what drug and for how long and what dose? Is it necessary to give
daily
> antibiotic for atleast 2 yrs?
> regards
> nikahat
> 
> 
> ------------------------------
> 
> Message: 2
> Date: Wed, 24 Nov 2010 11:37:52 EST
> From: KMATTOX at aol.com
> Subject: Re: splenectomy and vaccination
> To: trauma-list at trauma.org
> Message-ID: <e4e8.5d824b30.3a1e9960 at aol.com>
> Content-Type: text/plain; charset="US-ASCII"
> 
> No, no, no.     First OPSS is virtually non-existant in  the adult who
is 
> NOT immunocompromised.  
> 
> Second:    The vaccinations are probably not needed as  suggested by a

> previous post, in normal adults.    In a child,  probably less than 2
years of 
> age, the vaccinations might make some  sense.     Antibiotics and
reliance on 
> antibiotics, except  for a very few instances, never make a B surgeon
into 
> an A surgeon, but can made  a B surgeon look foolish and into a C
doctor.   
> 
> 
> k
> 
> 
> 
> 
> 
> In a message dated 11/24/2010 10:32:35 A.M. Central Standard Time,  
> nikahat at gmail.com writes:
> 
> Thanks  to everyone for the replies. what about the antibiotic
prophylaxis?
> what  drug and for how long and what dose? Is it necessary to give
daily
> antibiotic for atleast 2  yrs?
> regards
> nikahat
> 
> 
> 
> ------------------------------
> 
> Message: 3
> Date: Wed, 24 Nov 2010 11:43:41 EST
> From: Jrhmdtraum at aol.com
> Subject: Re:  Vaccination
> To: trauma-list at trauma.org
> Message-ID: <ea6a.34ab2009.3a1e9abd at aol.com>
> Content-Type: text/plain; charset="US-ASCII"
> 
> We did a published study at MIEMS in the early 80s.  As I remember  
> (getting harder with age), if you vaccinate immediately postop,
there are little 
> titers when tested.  Probably secondary to innate high  steroids then
from 
> adrenal stimulation, etc.  You need to wait a couple of  weeks.  The
problem 
> with giving immediate postop due to patient population,  everyone
thinks 
> they have received it and essentially they have not.
> Happy Turkey Day
> 
> John R. Hall, M.D., FCCM, FACS
> Professor of Surgery  
> 
> 
> In a message dated 11/24/2010 11:27:54 A.M. Eastern Standard Time,  
> trauma-list-request at trauma.org writes:
> 
> Send  trauma-list mailing list submissions to
> trauma-list at trauma.org
> 
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> or, via email, send a  message with subject or body 'help' to
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> When replying,  please edit your Subject line so it is more specific
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> 
> 
> Today's Topics:
> 
> 1. Re:  splenectomy and vaccination (Krin135 at aol.com)
> 2. Re:  splenectomy and vaccination (Dr Timothy Hardcastle)
> 3. RE:  MAST, Pret (Bjorn, Pret)
> 4. Re: splenectomy and vaccination  (Nikahat  Jahan)
> 
> 
> ----------------------------------------------------------------------
> 
> Message:  1
> Date: Tue, 23 Nov 2010 13:49:47 EST
> From: Krin135 at aol.com
> Subject:  Re: splenectomy and vaccination
> To: trauma-list at trauma.org
> Message-ID:  <104c41.13d84e8.3a1d66cb at aol.com>
> Content-Type: text/plain;  charset="US-ASCII"
> 
> when I was practicing in Louisiana, we tried to give  ours their first
dose 
> 
> of pneumovax by the time they were 13...and  that was in the days
*before*  
> it was mandated....but then, we had a  high percentage of folks with
at 
> least 
> Sickle Cell  Trait...
> 
> ck
> 
> 
> In a message dated 11/23/10 12:46:56 Central  Standard Time,  
> nmcswai at tulane.edu writes:
> 
> Should  all  our drug dealer get prophylactic vaccine. Should this be
> included in   their first jail sentence?
> 
> Norman
> Norman McSwain MD,   FACS
> Professor, Tulane School of Medicine
> Trauma Director, Spirit  of  Charity Trauma Center, ILH/MCLNO 
> 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 Gross, Ronald
> Sent: Tuesday, November 23, 2010 8:21  AM
> To:  'Trauma-List [TRAUMA.ORG]'
> Subject: RE: splenectomy  and  vaccination
> 
> Nikahat,
> 
> Your questions are good, but  unfortunately  have no really good
answers.
> Having said that, most  folks would agree that  the vaccines work best
> prior to splenectomy,  and so to answer your 2rd  question first one
could
> assume that if you  think that a patient has a high  likelihood of
failing
> non-operative  management (NOM) you could/should  vaccinate the
patient;
> whether  there is enough time for the vaccine to be  effective prior
to
> the  (emergency) splenectomy in the face of failed NOM is   still
> questionable.
> 
> As to the timing of giving the vaccines   post-operatively, there is
> literature out there that says they should  be  given at 2 weeks
post-op,
> but it is not Class I evidence.  I  tend to  give the vaccines in the
> recovery room (sorry PACU) because  (1) our trauma  population can be
less
> than "reliable" for follow-up,  and I know that they  have gotten the
> vaccines prior to discharge, (2)  we don't forget to give  the vaccine
> prior to discharge, and lastly  (3) the patient doesn't have a  fever
from
> the vaccine that delays  discharge and increases their hospital  LOS.
> 
> Not really good  science, but I think it is good medicine,   IMHO.
> 
> Ron
> 
> -----Original Message-----
> From:   trauma-list-bounces at trauma.org
> [mailto:trauma-list-bounces at trauma.org]  On  Behalf Of Nikahat Jahan
> Sent: Tuesday, November 23, 2010 9:06  AM
> To:  Trauma-List [TRAUMA.ORG]
> Subject: splenectomy and  vaccination
> 
> Dear  All
> 1. What is the current guideline on  immunizations after  emergency
> splenectomy. (Pneumococcal,  menigococcal, H Infuenza B) and the
timing
> and
> type of vaccine-  heptavalent conjugated Pneumococcal vaccine  Vs 23
> valent?
> 2.  Should a trauma patient with splenic injury who is  being  managed
> conservatively- but might end up with a splenectomy later-   also
recieve
> Pneumococcal vaccine?
> 3. How long should the  antibiotic  prophylaxis be continued and what
> drugs
> should be   used?
> thanks
> nikahat
> -- 
> Lt Col Nikahat Jahan
> Classified  Spl  (Anaesthesiology)
> Indian Army
> --
> trauma-list :  TRAUMA.ORG
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> 
> ------------------------------
> 
> Message:  2
> Date: Wed, 24 Nov 2010 12:20:09 +0200 (SAST)
> From: "Dr Timothy  Hardcastle" <dr.tchardcastle at absamail.co.za>
> Subject: Re: splenectomy  and vaccination
> To: "Trauma-List \[TRAUMA.ORG\]"  <trauma-list at trauma.org>
> Message-ID:
> <50579.196.35.102.165.1290594009.squirrel at aiamail.lantic.net>
> Content-Type:  text/plain;charset=iso-8859-1
> 
> Nikahat
> 
> This is the South African  current teaching:
> Only Pneumovax 23 at day 14 post-injury or on day of  discharge
whichever
> comes first. Only add H-inf B if under 13 and not  immunized. Only use
> Meningococcal in endemic areas (South Africa is not  such an area) as
the
> Pneumovax cross-covers well.
> 
> Heptavalent is not  effective - use 23-valent. No role in the  patient
with
> a spleen still  inside - no proven benefit.
> 
> Tim
> Dr T C Hardcastle
> M.B., Ch.B.  (Stell); M. Med. (Chir) (Stell); FCS (SA)
> Principal Specialist Trauma  Surgeon /
> Honorary Senior Lecturer UKZN Dept Surgery
> Deputy Director -  IALCH Trauma Service
> Durban, South Africa
> 
>> Dear All
>> 1.  What is the current guideline on immunizations after emergency
>> splenectomy. (Pneumococcal, menigococcal, H Infuenza B) and the
timing  
> and
>> type of vaccine- heptavalent conjugated Pneumococcal vaccine Vs 23  
> valent?
>> 2. Should a trauma patient with splenic injury who is being  managed
>> conservatively- but might end up with a splenectomy later-  also
recieve
>> Pneumococcal vaccine?
>> 3. How long should the  antibiotic prophylaxis be continued and what
drugs
>> should be  used?
>> thanks
>> nikahat
>> --
>> Lt Col Nikahat  Jahan
>> Classified Spl (Anaesthesiology)
>> Indian  Army
> 
> 
> 
> ------------------------------
> 
> Message: 3
> Date:  Wed, 24 Nov 2010 08:49:08 -0500
> From: "Bjorn, Pret"  <pbjorn at emh.org>
> Subject: RE: MAST, Pret
> To: "Trauma-List  [TRAUMA.ORG]" <trauma-list at trauma.org>
> Message-ID:
> <9CCE32ECAAFDEB4DA01EC771B6AD951B0D4FCA59 at VALIER.me.emh.org>
> Content-Type:  text/plain;   charset="us-ascii"
> 
> Mine is one of those major  trauma centers that see blunt trauma
(about
> 95%).  We don't use  PASG's, and discretely make fun of providers who
do.
> 
> Actively  compressing the abdomen and pelvis from without is an
> insufficiently  understood maneuver, and probably carries its own
> consequences in terms of  perfusion and ventilation and access.
> Approaching venous pressures deep in  the abdomen without doing
> collateral systemic or direct tissue damage may  not even be possible
> with MAST.  It's another sexy hypothesis that  probably doesn't live
up
> to expectations in vivo.  Worse still, the  bulk and physics of PASG's
> are ill suited to ER, IR or OR  environs.
> 
> Splint (or ex-fix) the injury and make your way to  embolization.  As
for
> splinting, our providers regard pneumatic  compression as clinically
and
> functionally inferior to commercial binders  or simple bedsheets.
> 
> Pret Bjorn, RN
> Bangor, ME  USA
> 
> 
> 
> -----Original Message-----
> From:  trauma-list-bounces at trauma.org
> [mailto:trauma-list-bounces at trauma.org] On  Behalf Of John Hall
> Sent: Tuesday, November 23, 2010 8:15 AM
> To:  trauma-list at trauma.org
> Subject: MAST, Pret
> 
> The incidence of massive  pelvic fractures is exceedingly small, as
> Lewis's study demonstrated.   Prett, sheets work well on most pelvic
fxs
> to "stabilize" them.  The  problem is that you cannot get them up to >
40
> mm Pressure (or >  venous pressure) as you can the MAST.  Many major
> trauma centers (eg  MIEMS) that see primary blunt trauma have "case
> reports" of such use (eg  MIEMS: firefighter run over by ladder truck
> with shattered  pelvis).
> 
> Sent from my iPad
> 
> John R. Hall, M.D., F.A.C.S.,  F.C.C.M
> Professor of Surgery
> 
> 
> On Nov 22, 2010, at 10:56 PM,  trauma-list-request at trauma.org wrote:
> 
>> Send trauma-list mailing  list submissions to
>>   trauma-list at trauma.org
>> 
>> To subscribe or unsubscribe via the World Wide Web,  visit
>>    http://list.mistral.net/mailman/listinfo/trauma-list
>> or, via email,  send a message with subject or body 'help' to
>>    trauma-list-request at trauma.org
>> 
>> You can reach the person  managing the list at
>>   trauma-list-owner at trauma.org
>> 
>> When replying, please edit your Subject line so it is more  specific
>> than "Re: Contents of trauma-list digest..."
>> 
>> 
>> Today's Topics:
>> 
>>  1. RE: trauma-list  Digest, Vol 89, Issue 9 (McSwain, Norman E)
>>  2. Invitation  to connect on LinkedIn (shafiq chughtai via LinkedIn)
>>  3.  Re: Invitation to connect on LinkedIn (Dave Napoliello)
>>  4.  Bobby Smith wants to stay in touch on LinkedIn
>>      (Bobby Smith via LinkedIn)
>>  5. Re: Invitation to connect on  LinkedIn (Farid Pouralikhan)
>>  6. Re: Invitation to connect  on LinkedIn (Raul Medina Mireles MD)
>>  7. RE: Invitation to  connect on LinkedIn (Doc Holiday)
>>  8. RE: Invitation to  connect on LinkedIn (Hector Gullen)
>>  9. Re: Invitation to  connect on LinkedIn (listasmsd)
>> 10. Instrument sets (Stephen  Richey)
>> 11. Re: Instrument sets (Scott Bricker)
>>  12. Re: Instrument sets (Stephen Richey)
>> 13. Re: Instrument sets  (KMATTOX at aol.com)
>> 14. Re: Instrument sets  (KMATTOX at aol.com)
>> 15. Re: Instrument sets  (Krin135 at aol.com)
>> 
>> 
>>
----------------------------------------------------------------------
>> 
>> Message: 1
>> Date: Mon, 15 Nov 2010 09:00:32 -0600
>> From: "McSwain, Norman E" <nmcswai at tulane.edu>
>> Subject: RE:  trauma-list Digest, Vol 89, Issue 9
>> To: "Trauma-List [TRAUMA.ORG]"  <trauma-list at trauma.org>
>> Message-ID:
>>    <B79C02DCC4FA074DB02381DF1C5D60BA040F8381 at EX07.ad.tulane.edu>
>> Content-Type: text/plain;   charset="us-ascii"
>> 
>> The  outcome was blood loss and by implication, hemorrhage control
>> 
>> Norman
>> Norman McSwain MD, FACS
>> Professor, Tulane School of  Medicine
>> Trauma Director, Spirit of Charity Trauma Center, ILH/MCLNO  
>> 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 McSwain, Norman
E
>> Sent: Monday, November 15, 2010 8:58  AM
>> To: Trauma-List [TRAUMA.ORG]
>> Subject: RE: trauma-list  Digest, Vol 89, Issue 9
>> 
>> The only study done on this was the  study done several years ago by
>> Lewis Flint. Although a small study,  he showed benefit. To my
> knowledge
>> this is the only outcome study  done on any type of pelvic splinting.
> All
>> the rest only show  closure of the fracture
>> 
>> Norman
>> Norman McSwain MD,  FACS
>> Professor, Tulane School of Medicine
>> Trauma Director,  Spirit of Charity Trauma Center, ILH/MCLNO 
>> 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 Bjorn, Pret
>> Sent:  Monday, November 15, 2010 5:52 AM
>> To: Trauma-List [TRAUMA.ORG]
>> Subject: RE: trauma-list Digest, Vol 89, Issue 9
>> 
>> I've never  been much of a believer in the whole intrapelvic volume /
>> abdominal  tamponade thing.  It's an interesting theory, but a theory
>> nonetheless.  In my experience, there's enough space and
>> compressible/displaceable viscera in the abdomen and retroperitoneum
>> that regardless of how you swaddle these patients, blood will
probably
>> find a way.  
>> 
>> As I see it, he main indication for pelvic  fixation is
immobilization
> of
>> the fractures and minimization of  secondary bleeding.  And at least
in
>> this regard, PASG's are a  comical oversolution.  
>> 
>> Use a sheet.
>> 
>> Pret
>> 
>> 
>> -----Original Message-----
>> From:  trauma-list-bounces at trauma.org
>> [mailto:trauma-list-bounces at trauma.org]  On Behalf Of John Hall
>> Sent: Saturday, November 13, 2010 2:13  PM
>> To: tr
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