VOMIT - Victim of Modern Imaging Technology

• Previous message: VOMIT - Victim of Modern Imaging Technology
• Next message: VOMIT - Victim of Modern Imaging Technology
• Messages sorted by: [ date ] [ thread ] [ subject ] [ author ]

I STRONGLY disagree w Dr. Ursic in that the historic approach is NOT currently considered the "best practice".    I do agree we should teach residents and students and FACULTY the right SAFE approach.  That is exactly what many of us are attempting  to do.  Many of Dr. Ursic's suggestion are known to be Unsafe or not needed.   

k.  

Sent from my iPhone

On 2011-08-25, at 12:19 AM, caesar ursic <cmursic at gmail.com> wrote:

> CAUTION:
> We have many, many students and junior clinicians reading this list-serve; I
> think that we would all hate for them to come away from this thread learning
> the *wrong* way of doing things, assuming that they were able to treat this
> patient ("...hemodynamically stable, GCS9, widened mediastinum, + fluid in
> abdomen on FAST...") in a hospital with a CT scanner, angiography, ICU, an
> OR, and the necessary sub-specialists (i.e. what one would expect from a
> modern trauma center) to operate on aortic and brain injuries.
> 
> Such a patient should have two large bore IVs established, blood drawn for
> crossmatch, airway closely monitored (or even secured with an endotracheal
> tube), and should be taken immediately for a CT scan of the brain, chest,
> abdomen and pelvis.  No oral contrast necessary.  Some might even include a
> CT scan of the cervical spine, but that can always wait until later and may
> be obviated if the patient wakes up and a reliable clinical neck exam can be
> performed.  Such a patient (stable, GCS9, positive abdominal FAST)
> *cannot*provide the clinician, no matter how experienced he or she may
> be, with a
> *reliable* abdominal exam upon which to base a decision to perform an
> immediate laparotomy - due to the low negative predictive value of such an
> exam in a noncooperative patient.  Unless, of course, said clinician is
> willing to accept a >50% non-therapeutic laparotomy rate and the attendant
> morbidity that such a laparotomy necessarily entails for the patient.
> 
> I believe that this would be the correct and expected answer to such an
> initial scenario if asked on the American Board of Surgery Qualifying
> Examination (i.e. oral exam), because it is the safest approach and the one
> most likely to rapidly diagnose life-threatening injuries with the least
> real risk to the patient.
> 
> C. Ursic,
> Honolulu
> -- 
> 'Twas brillig, and the slithy toves
> Did gyre and gimble in the wabe:
> All mimsy were the borogoves,
> And the mome raths outgrabe.
> --
> trauma-list : TRAUMA.ORG
> To change your settings or unsubscribe visit:
> http://www.trauma.org/index.php?/community/

• Previous message: VOMIT - Victim of Modern Imaging Technology
• Next message: VOMIT - Victim of Modern Imaging Technology
• Messages sorted by: [ date ] [ thread ] [ subject ] [ author ]