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Wed Aug 24 21:24:26 BST 2011

Would you do a DPL first? 

Daniel R. Gerard, MS, RN, NREMT-P 
Secretary - International Association of Emergency Medical Services Chief's 

http://www.linkedin.com/in/dangerard 

http://www.iaemsc.org/index.html 

----- Original Message -----
From: "Sanjay Gupta" <sanjaygupta99_91 at yahoo.com> 
To: "Trauma-List [TRAUMA.ORG]" <trauma-list at trauma.org> 
Sent: Wednesday, August 24, 2011 12:21:32 PM 
Subject: Re: VOMIT - Victim of Modern Imaging Technology 

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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VOMIT - Victim of Modern Imaging Technology