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Subcapsular liver hematoma management

McSwain, Norman E nmcswai at tulane.edu
Fri May 13 15:00:46 BST 2011


This would be considered 'skunk poking'

Norman
Norman McSwain MD, FACS
Professor, Tulane School of Medicine
President, Orleans Parish Medical Society
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 saad shebrain
Sent: Thursday, May 12, 2011 7:49 PM
To: Trauma-List [TRAUMA.ORG]
Subject: Re: Subcapsular liver hematoma management

 
Asymptomatic hematoma --> leave it, observe.

This patient has PERSISTENT PAIN. 
 
The good thing is the normal LFTs, Stable Hg, 
 
No blush ---> Laparoscopic (preferrable)  vs Open Evacuation of hematoma, filling the pseudocavity with omentum.
 
Saad
 
 




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--- On Thu, 5/12/11, Wolfer, Rebecca <wolferr at marshall.edu> wrote:


From: Wolfer, Rebecca <wolferr at marshall.edu>
Subject: Re: Subcapsular liver hematoma management
To: "Trauma-List [TRAUMA.ORG]" <trauma-list at trauma.org>
Date: Thursday, May 12, 2011, 3:13 PM


If lfts nl and hgb stable would leave alone and follow
Rw

Sent from my iPhone so I can reply quickly so please forgive any errors

On May 12, 2011, at 2:23 PM, "Scott Bricker" <scottbricker at verizon.net> wrote:

> List members, 
> 
> Would love to hear everyone's input on a current patient;
> 
> 48 y/o female had a ground-level fall onto her right side 6 weeks ago.  
> Reported some right lower rib  lateral point tenderness, with no fractures  
> seen on xray. Presented to her MD two weeks later complaining of persitent  
> pain, with repeat xray unchanged, and hemoglobin of 10. Given NSAID  
> perscription, but little relief. Presented to MD again, 4 weeks later (6  
> weeks after the fall), with persistent pain. Hemoglobin still 10, and  
> patient referred for CT scan. CT with iv contrast shows 13x13x7 cm  
> subcapsular liver hematoma, occupying 40% of the right lobe. There is no  
> blush.  Liver funtion appears normal based on bilirubin, transaminases, and  
> coags. Normal white blood cell count, elevated platelets, and electrolytes,  
> with subjective fevers and chills.
> 
> My question is simple: what next? Seems I have at least three options  
> here...
> 
> First, and simplest, to observe and treat her symptoms. Just not sure what  
> my endpoint is here, or what my trigger to reimage should be. 
> 
> Second, would be to ultrasound the liver to get more information regarding  
> possible "liver compartment syndrome", which I'll admit I've heard discussed  
> more than I can read in the literature. Any information regarding this  
> entity would be greatly appreciated, even if just a reference to a good  
> review (can't find one). My limited understanding is there may be a risk to  
> hepatic vein thrombosis, but again, I need more information.
> 
> Third, would be drainage for symptom relief. 
> 
> Thanks to everyone in advance!
> 
> 
> Scott D. Bricker, MD
> Los Angeles, CA
> 
> -----Original message-----
> From: "johnbeckham51 at yahoo.com" <johnbeckham51 at yahoo.com>
> To: "Trauma-List [TRAUMA.ORG]" <trauma-list at trauma.org>
> Sent: Wed, May 11, 2011 19:06:05 GMT+00:00
> Subject: Re: categorization of emergency operations
> 
> As a paramedic in New Orleans for some time I have the pleasure of knowing  
> some of the doctors on this list and have the highest respect for them. I  
> have a question about RTS, on the trauma.org website there is a RTS  
> calculator. I input values for a stable patient and it gives RTS of 7.  I  
> have been taught and have always been told that 12 is as high as it can be.  
> The same page as the calculator puts the highest RTS as 7.6 or so. 
> Am I missing something or just not reading it correctly.
>   Thank you 
> John Beckham 
> 
> Sent from my HTC on the Now Network from Sprint!
> 
> ----- Reply message -----
> From: "caesar ursic" <cmursic at gmail.com>
> Date: Tue, May 10, 2011 2:59 pm
> Subject: categorization of emergency operations
> To: "Trauma-List [TRAUMA.ORG]" <trauma-list at trauma.org>
> 
> I would be grateful for comments by the list members on what, if anything,
> you do to categorize your emergency trauma cases with respect to the urgency
> of the case at the time of booking/posting the case with the operating room.
> 
> I would assume that you need and expect to get faster OR access for a stab
> wound to the heart than, let's say, for a hemodynamically normal patient
> with small bowel evisceration through an abdominal stab wound, than for a
> grade two open fracture of the tibia with normal neurovascular function.
> 
> Does anyone categorize trauma cases for this purpose?  For example, a
> Category I would be "need to go right now,"  Category II "need to go within
> 30 minutes"  Category III "within one hour", and so forth and so on.
> 
> The utility of adopting such a system would seem to be in allowing one's
> quality assurance / performance improvement & patient safety (PIPS) process
> to truly determine if and when there are delays in OR access.
> 
> Thanks in advance
> 
> C. Ursic, MD
> Honolulu
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