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VOMIT - Victim of Modern Imaging Technology

Kmattox kmattox at aol.com
Wed Aug 24 20:58:31 BST 2011


Thoracic aortogram.   If there had been a screening positive chest CT for a mediastinal hematoma I would always also do a diagnostic thoracic aortogram.    The physical exam would determine further tests on the abdomen vs straight to lap.    Increasingly I am using FAST only to evaluate for hemopericardium, not for any confusing belly interpretations.    Sorry to not be dogmatic enough, nut one states a point to make a point.  

k

Sent from my iPhone

On 2011-08-24, at 4:21 PM, Sanjay Gupta <sanjaygupta99_91 at yahoo.com> wrote:

> Dogmatism is a way of looking at facts - or rather a way of refusing to look at facts.
>  
> For instance: 
>  
> How do you manage a trauma patient who is hemodynamically stable, with a GCS of 9 and who has a widened mediastinum on a chest X-ray?  Lets throw in a positive FAST exam with fluid in the abdomen.  
>  
>  
> Remember - no IV fluids, no IV lines, no CT scans.
>  
>  
> This is a "real world" example - not  an uncommon scenario.
>  
>  
> Sanjay Gupta
> 
>  
> From: Charles Brault <c_brault at yahoo.com>
> To: Trauma-List [TRAUMA.ORG] <trauma-list at trauma.org>
> Sent: Wednesday, August 24, 2011 3:21 AM
> Subject: Re: VOMIT - Victim of Modern Imaging Technology
> 
> Dogmatisimes !
>  
> Is surprisingly ALWAYS coming from other people 
>  
> Never quietly understood that
>  
> Charles
> 
> From: Sanjay Gupta <sanjaygupta99_91 at yahoo.com>
> To: Trauma-List [TRAUMA.ORG] <trauma-list at trauma.org>
> Sent: Tuesday, August 23, 2011 8:12 PM
> Subject: Re: VOMIT - Victim of Modern Imaging Technology
> 
> What I can figure out after all these discussions is - 
>  
> Trauma patient arrives, do not put in a line and certainly do not give crystalloids.  I am not sure about giving blood and if we do give blood - do we draw a specimen to cross-match or not.  Maybe a chest x-ray will help.  If something is clinically obvious fix it.  If the patient is hypotensive - do some surgery based on clinical exam and chest x-ray.  And if the patient is hypotensive - again do not put in a line - open the abdomen first, do something and then see if a line will help.  
>  
>  
> If not in shock - I am not clear what to do - Whether send the patient home or admit and observe his pulse, blood pressure and GCS?  or there is something else that needs to be done.  
>  
>  
> Never do a CT scan because 80% are useless - I thought the purpose of CT scan is to figure out the 20% in which it would be useful.  If we all knew the 80% in whom the CT will not be useful and also the 20% in which it would be useful, I guess the scan will not be done in anyone - I thought a CT scan is a diagnostic test - not to prove your clinical diagnosis. 
>  
> Oh yes - you pick up VOMIT with CT scan.  Great acronym, makes you sound very smart. 
> 
> Sanjay Gupta
> 
> From: caesar ursic <cmursic at gmail.com>
> To: Trauma-List [TRAUMA.ORG] <trauma-list at trauma.org>
> Sent: Tuesday, August 23, 2011 1:58 PM
> Subject: Re: VOMIT - Victim of Modern Imaging Technology
> 
> *The, Dr. Mattox, you must be placing great faith in the sensitivity of the
> supine AP portable chest x-ray to rule-out a thoracic aortic or great vessel
> traumatic pseudoaneurysm.*
> 
> 
> C. Ursic, MD
> Honolulu
> 
> 
> 
> On Mon, Aug 22, 2011 at 9:30 AM, <KMATTOX at aol.com> wrote:
> 
>> I know of almost NO indications for an ACUTE CT OF THE CHEST following
>> chest trauma, especially blunt chest trauma.        Mediastinal traverse
>> following GSW,  maybe, depending on the finding of the  initial plain chest
>> X-ray.
>> 
>> 
>> k
>> 
>> 
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