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chest and spine trauma for surgery

Duchesne, Juan C jduchesn at tulane.edu
Thu Dec 11 16:31:32 GMT 2014


nikahat- what is prophylactic ICD's? Chest tubes? And I am assuming you meant T fractures.
For patients with occult PTX the answer is not but a word of caution and communication need to occur between trauma team and anesthesia looking for increase peak pressures and decrease in end tidal CO2. This will mean worsening PTX on clinical grounds.
The problem here is hemothorax. Based on manipulation and movement to OR table I will have a low threshold on placing CT's for 2 reasons:
1. Intraop hypothermia and manipulation in OR room might render patient prone to coagulopathy with increase in size of hemothorax. If this occur then my second point is:
2. Avoidance of PTD 5 VATS for bilateral retained hemothorax with lung entrapment. This in combination with flail chest and lung contusion can be a bad mix. More than 3 fractures by itself increases his mortality and pulmonary complications. I rather be proactive than reactive.

Hope this help.

Juan

Juan Duchesne
Trauma Medical Director
GME Medical Director
North Oaks Health System
Hammond LA
Associate Professor of Surgery
Tulane New Orleans LA
LSUHSC New Orleans LA



On Dec 11, 2014, at 09:38, Nikahat Jahan <nikahat at gmail.com<mailto:nikahat at gmail.com>> wrote:

Should we place prophylactic ICD's for a patient with multiple bilateral
rib fractures (3-4 ribs) with minimal  hemothoraces, no flail chest.
Patient is on ventilatory support for lung contusion for last couple of
hours-no pneumothorax as of now after starting positive pressure
vetntilation.
The patient also has vertebral fractures D4, D5 and D8 with paraplegia. He
is to be taken up for pedicle screw and rod fixation of D8 in prone
position.

regards
nikahat

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