Question about fragmentation injury

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Once again I am put in the disturbing position of having to agree with
Dr Mattox. :)
But he is very correct. Carter Nance and Isadore Cohn showed the
importance of physical examination in 1964. No one has produced a better
outcome with any advance in technology since. We MUST teach our young
residents the importance of trusting your own physical examination. You
get a CT only when the physical exam produces questions. The decision is
whether to operate or not. The decision is NOT what organ is injured.

Norman

Norman McSwain MD, FACS
Professor of Surgery, Tulane University
Trauma director, Spirit of Charity Trauma Center, ILH
504 988 5111

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of KMATTOX at aol.com
Sent: Friday, December 16, 2011 8:30 PM
To: trauma-list at trauma.org
Subject: Re: Question about fragmentation injury


First:   There is very little if any reason to ever get a CT scan  in 
penetrating trauma.    
 
Second:   Gas in the tissues of both SW and GSW is not   infrequent. 
 
Third:    Clinical evaluation and looking at physiologic  symptoms is 
always wise
 
Fourth:   If you are STILL for whatever reason getting CT scans  in 
penetrating trauma,  there MUST be an accompanying progress note
stating:  
 
    a.   Just what do you expect to discover  that you did not  already

know
 
    b.   What are the positive  and  negative and the VOMIT
implications 
as to what you find on CT?
 
    c.    How is each of those findings,  including  the Vomits GOING
TO 
CHANGE YOUR TREATMENT PLAN
 
If you cannot write a progress  note regarding these issues,   DO  NOt 
ORDER THE  CT  and if someone ordered the CT prior to  you, the surgeon
seeing 
the patient, then they must answer  these questions  to you.      
 
k
 
 
 
 
 
In a message dated 12/16/2011 8:09:10 P.M. Central Standard Time,
mylkas at prodigy.net.mx writes:

Not  infrequent at all...Practically all penetrant and perforant wounds
are detected to have a variable amount of gas visible on CT scanning. It
might be related to the wound ballistic effect of projectiles itself,
but  in all cases, hollow viscus implication must be ruled out.

Col Raul  Medina M.
Radiologist.
Chihuahua. Mexico.

2011/12/16 Matthieu  Gensburger <mat.genz at gmail.com>

> Is it usual to find  intra-peritoneal or retro-peritoneal gaz bubbles 
> on
CT
> in patients  victim of fragmentation injury (grenade) in which no 
> hollow viscus  injury was found during surgery?
>
> Matthieu
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