Login
Site Search
Trauma-List Subscription

Subscribe

Would you like to receive list emails batched into one daily digest?
No Yes
Modify Your Subscription

Modify

Home > List Archives

splenic case

Mikloshbala mikloshbala at gmail.com
Mon Dec 29 09:21:48 GMT 2014


The patient had grade 4 splenic tear through the hilum and transverse colon serosal laceration . 2 l of blood in abdomen. Doing well on POD 3. 



Sent from my iPhone

> On 29 בדצמ 2014, at 10:08, trauma-list-request at trauma.org wrote:
> 
> Send trauma-list mailing list submissions to
>    trauma-list at trauma.org
> 
> To subscribe or unsubscribe via the World Wide Web, visit
>    http://list.mistral.net/mailman/listinfo/trauma-list
> or, via email, send a message with subject or body 'help' to
>    trauma-list-request at trauma.org
> 
> You can reach the person managing the list at
>    trauma-list-owner at trauma.org
> 
> When replying, please edit your Subject line so it is more specific
> than "Re: Contents of trauma-list digest..."
> 
> 
> Today's Topics:
> 
>   1. SPLEEN (jrhmdtraum at aol.com)
>   2. Re: Medivac (Charles Krin)
>   3. Re: Medivac (Stephen Richey)
>   4. Re: Medivac (Charles Krin)
>   5. Re: Medivac (Stephen Richey)
>   6. Re: Medivac (Charles Krin)
> 
> 
> ----------------------------------------------------------------------
> 
> Message: 1
> Date: Sun, 28 Dec 2014 18:18:08 -0500
> From: "jrhmdtraum at aol.com" <jrhmdtraum at aol.com>
> Subject: SPLEEN
> To: trauma-list at trauma.org
> Message-ID: <8D1F10BAD04BC64-F24-7BDD1 at webmail-m262.sysops.aol.com>
> Content-Type: text/plain; charset="us-ascii"
> 
> 
> 
> 
> 
> 
>>> On Dec 27, 2014, at 02:31, Miklosh Bala <mikloshbala at gmail.com<mailto:mikloshbala at gmail.com>>
>> wrote:
>> 
>> 22 yo female following car crush, on arrival HR 120, BP 90/60,
>> seatbelt sign and posterior hip dislocation. Following resuscitation
>> (crystalloids) and hip reduction, CT showed splenic rupture (Grade 4)
>> -no active contrast extravasation.
>> BP 100' HP 100. No other injury.
>> The patient 2 years following Sleeve Gastrectomy.
>> Do you thing angio is safe for this specific case? Short gastric
>> arteries are divided - is that come to consideration?
>> 
>> --
> 
> I probably have one of the largest series of non-operative spleen cases in the US.  However, the "seatbelt sign" bothers me.  I would explore to make sure that there is no bowel injury and repair/wrap the spleen.
> 
> 
> 
> 
> John R Hall, MD, FACS, FCCM
> Professor of Surgery 
> 
> 
> 
> 
> 
> -----Original Message-----
> From: trauma-list-request <trauma-list-request at trauma.org>
> To: trauma-list <trauma-list at trauma.org>
> Sent: Sun, Dec 28, 2014 5:54 pm
> Subject: trauma-list Digest, Vol 138, Issue 8
> 
> 
> Send trauma-list mailing list submissions to
>    trauma-list at trauma.org
> 
> To subscribe or unsubscribe via the World Wide Web, visit
>    http://list.mistral.net/mailman/listinfo/trauma-list
> or, via email, send a message with subject or body 'help' to
>    trauma-list-request at trauma.org
> 
> You can reach the person managing the list at
>    trauma-list-owner at trauma.org
> 
> When replying, please edit your Subject line so it is more specific
> than "Re: Contents of trauma-list digest..."
> 
> 
> Today's Topics:
> 
>   1. Re: Splenic injury case (Tom Robb)
>   2. Re: Splenic injury case (Kmattox)
>   3. RE: Splenic injury case (Gad Shaked)
>   4. Re: Splenic injury case (Karim Brohi)
>   5. Re: Splenic injury case (Duchesne, Juan C)
>   6. Re: Splenic injury case (William Bromberg)
>   7. Re: Splenic injury case (Duchesne, Juan C)
>   8. Re: Splenic injury case (William Bromberg)
>   9. RE: Splenic injury case (Timothy Hardcastle)
>  10. RE: Splenic injury case (Bellanova Giovanni)
>  11. Re: Medivac (Robert Smith)
>  12. Re: Splenic injury case (Duchesne, Juan C)
>  13. Re: Medivac (Gustavo E. Flores)
>  14. Re: Medivac (Charles Krin)
>  15. Re: Medivac (Stephen Richey)
>  16. Re: Medivac (Dave)
> 
> 
> ----------------------------------------------------------------------
> 
> Message: 1
> Date: Sat, 27 Dec 2014 08:34:41 -0500
> From: Tom Robb <thomas.robb at verizon.net>
> Subject: Re: Splenic injury case
> To: "Trauma-List [TRAUMA.ORG]" <trauma-list at trauma.org>
> Message-ID: <549EB571.4000807 at verizon.net>
> Content-Type: text/plain; charset=windows-1252; format=flowed
> 
> Agree
> 
> Running the SB is a bonus in this patient
> 
> 
> 
> T. Robb
> Newburgh NY
> 
> 
> 
>> On 12/27/2014 3:57 AM, Duchesne, Juan C wrote:
>> This patient shock index is 1.4 on arrival.
>> I recommend effective low volume resuscitation , hemostatic resuscitation and
> a #10 blade.
>> 
>> 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 27, 2014, at 02:31, Miklosh Bala <mikloshbala at gmail.com<mailto:mikloshbala at gmail.com>>
>> wrote:
>> 
>> 22 yo female following car crush, on arrival HR 120, BP 90/60,
>> seatbelt sign and posterior hip dislocation. Following resuscitation
>> (crystalloids) and hip reduction, CT showed splenic rupture (Grade 4)
>> -no active contrast extravasation.
>> BP 100' HP 100. No other injury.
>> The patient 2 years following Sleeve Gastrectomy.
>> Do you thing angio is safe for this specific case? Short gastric
>> arteries are divided - is that come to consideration?
>> 
>> --
>> Miklosh Bala, MD
>> Head of Trauma and Acute Care Surgery Unit
>> Hadassah - Hebrew University Medical Center
>> Tel: (972) 26778800; Fax: (972) 26449412
>> Email: mikloshbala at gmail.com<mailto:mikloshbala at gmail.com>
>> --
>> trauma-list : TRAUMA.ORG<http://TRAUMA.ORG>
>> To change your settings or unsubscribe visit:
>> http://www.trauma.org/index.php?/community/
>> --
>> trauma-list : TRAUMA.ORG
>> To change your settings or unsubscribe visit:
>> http://www.trauma.org/index.php?/community/
> 
> 
> ---
> This email is free from viruses and malware because avast! Antivirus protection 
> is active.
> http://www.avast.com
> 
> 
> 
> ------------------------------
> 
> Message: 2
> Date: Sat, 27 Dec 2014 09:56:20 -0600
> From: Kmattox <kmattox at aol.com>
> Subject: Re: Splenic injury case
> To: "Trauma-List [TRAUMA.ORG]" <trauma-list at trauma.org>
> Message-ID: <7DA03DDB-25A1-4459-BD14-1D893B0DD565 at aol.com>
> Content-Type: text/plain;    charset=us-ascii
> 
> As described, limited crystaloid resuscitation in the OR, 10 minutes after 
> arrival at the hospital, and as the skin is being prepped for formal exploratory 
> laparotomy.    
> 
> Do what is safe, not a gamble with egos & inadequate experience.   
> 
> K Mattox 
> 
> Sent from my iPad
> 
>> On Dec 27, 2014, at 7:34 AM, Tom Robb <thomas.robb at verizon.net> wrote:
>> 
>> Agree
>> 
>> Running the SB is a bonus in this patient
>> 
>> 
>> 
>> T. Robb
>> Newburgh NY
>> 
>> 
>> 
>>> On 12/27/2014 3:57 AM, Duchesne, Juan C wrote:
>>> This patient shock index is 1.4 on arrival.
>>> I recommend effective low volume resuscitation , hemostatic resuscitation and
> a #10 blade.
>>> 
>>> 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 27, 2014, at 02:31, Miklosh Bala <mikloshbala at gmail.com<mailto:mikloshbala at gmail.com>>
> wrote:
>>> 
>>> 22 yo female following car crush, on arrival HR 120, BP 90/60,
>>> seatbelt sign and posterior hip dislocation. Following resuscitation
>>> (crystalloids) and hip reduction, CT showed splenic rupture (Grade 4)
>>> -no active contrast extravasation.
>>> BP 100' HP 100. No other injury.
>>> The patient 2 years following Sleeve Gastrectomy.
>>> Do you thing angio is safe for this specific case? Short gastric
>>> arteries are divided - is that come to consideration?
>>> 
>>> --
>>> Miklosh Bala, MD
>>> Head of Trauma and Acute Care Surgery Unit
>>> Hadassah - Hebrew University Medical Center
>>> Tel: (972) 26778800; Fax: (972) 26449412
>>> Email: mikloshbala at gmail.com<mailto:mikloshbala at gmail.com>
>>> --
>>> trauma-list : TRAUMA.ORG<http://TRAUMA.ORG>
>>> To change your settings or unsubscribe visit:
>>> http://www.trauma.org/index.php?/community/
>>> --
>>> trauma-list : TRAUMA.ORG
>>> To change your settings or unsubscribe visit:
>>> http://www.trauma.org/index.php?/community/
>> 
>> 
>> ---
>> This email is free from viruses and malware because avast! Antivirus
> protection is active.
>> http://www.avast.com
>> 
>> --
>> trauma-list : TRAUMA.ORG
>> To change your settings or unsubscribe visit:
>> http://www.trauma.org/index.php?/community/
> 
> 
> ------------------------------
> 
> Message: 3
> Date: Sat, 27 Dec 2014 19:34:48 +0000
> From: Gad Shaked <shakedg at bgu.ac.il>
> Subject: RE: Splenic injury case
> To: "Trauma-List [TRAUMA.ORG]" <trauma-list at trauma.org>
> Message-ID:
>    <28C1BB4D0142E249A7BD2D5D18417D6A1C71E3CD at hawk3.auth.ad.bgu.ac.il>
> Content-Type: text/plain; charset="iso-8859-8-i"
> 
> The patient responded well to resus. Was stable enoug to undergo CT scan, no 
> contrast material extravasation, no other injury detected. She is a good 
> candidate to non operative management regardless her grade of injury, which may 
> be upgraded by the CT reading. Surgery if she becomes unstable or shows signs of 
> peritonitis during surveillance.
> Gad Shaked
> Prof. of Surgery
> Soroka University Medical Center
> Ben-Gurion University
> Beer Sheva
> Israel
> Tel. 972 54 2365600
> 
> ________________________________________
> From: trauma-list-bounces at trauma.org [trauma-list-bounces at trauma.org] on behalf 
> of Miklosh Bala [mikloshbala at gmail.com]
> Sent: Saturday, December 27, 2014 10:31
> To: trauma-list at trauma.org
> Subject: Splenic injury case
> 
> 22 yo female following car crush, on arrival HR 120, BP 90/60,
> seatbelt sign and posterior hip dislocation. Following resuscitation
> (crystalloids) and hip reduction, CT showed splenic rupture (Grade 4)
> -no active contrast extravasation.
> BP 100' HP 100. No other injury.
> The patient 2 years following Sleeve Gastrectomy.
> Do you thing angio is safe for this specific case? Short gastric
> arteries are divided - is that come to consideration?
> 
> --
> Miklosh Bala, MD
> Head of Trauma and Acute Care Surgery Unit
> Hadassah - Hebrew University Medical Center
> Tel: (972) 26778800; Fax: (972) 26449412
> Email: mikloshbala at gmail.com
> --
> trauma-list : TRAUMA.ORG
> To change your settings or unsubscribe visit:
> http://www.trauma.org/index.php?/community/
> 
> 
> ------------------------------
> 
> Message: 4
> Date: Sat, 27 Dec 2014 20:44:11 +0000
> From: Karim Brohi <karimbrohi at gmail.com>
> Subject: Re: Splenic injury case
> To: "Trauma-List [TRAUMA.ORG]" <trauma-list at trauma.org>
> Message-ID:
>    <CAE-U-g_E+w2cJeYSUfjEMV3kYb6_7hYnAwPPW+hZ5sT54g4LYw at mail.gmail.com>
> Content-Type: text/plain; charset=UTF-8
> 
> Miklosh hi
> 
> Assuming this patient has no on-going fluid requirements then she would be
> suitable for observation.  There's no active bleed on CT so embolisation
> would be proximal splenic artery to reduce overall flow.   I think the jury
> is still out on whether proximal coil embolisation reduces the subsequent
> splenectomy rate for these injuries although I think the evidence is
> tending to support it.
> 
> Given this patient has previous surgery and has lost her short gastrics I
> would avoid embolisation and just manage her conservatively( - and do a
> splenectomy if she fails observation).
> 
> Karim
> 
>> On Sat, Dec 27, 2014 at 8:31 AM, Miklosh Bala <mikloshbala at gmail.com> wrote:
>> 
>> 22 yo female following car crush, on arrival HR 120, BP 90/60,
>> seatbelt sign and posterior hip dislocation. Following resuscitation
>> (crystalloids) and hip reduction, CT showed splenic rupture (Grade 4)
>> -no active contrast extravasation.
>> BP 100' HP 100. No other injury.
>> The patient 2 years following Sleeve Gastrectomy.
>> Do you thing angio is safe for this specific case? Short gastric
>> arteries are divided - is that come to consideration?
>> 
>> --
>> Miklosh Bala, MD
>> Head of Trauma and Acute Care Surgery Unit
>> Hadassah - Hebrew University Medical Center
>> Tel: (972) 26778800; Fax: (972) 26449412
>> Email: mikloshbala at gmail.com
>> --
>> trauma-list : TRAUMA.ORG
>> To change your settings or unsubscribe visit:
>> http://www.trauma.org/index.php?/community/
> 
> 
> ------------------------------
> 
> Message: 5
> Date: Sat, 27 Dec 2014 21:34:48 +0000
> From: "Duchesne, Juan C" <jduchesn at tulane.edu>
> Subject: Re: Splenic injury case
> To: "Trauma-List [TRAUMA.ORG]" <trauma-list at trauma.org>
> Message-ID: <D0C47D84.142D8%jduchesn at tulane.edu>
> Content-Type: text/plain; charset="us-ascii"
> 
> Seat belt syndrome is a real issue here, this combine with a splenic
> injury and shock in blunt trauma needs further attention. If you are a
> minimalist the least I will recommend is a DPL. If you are an aggressive
> minimalist then I will recommend a diagnostic laparoscopic exam.......and
> if you just want to do what is the right answer on the ABS boards you
> extend that DPL incision a little bit more upward until you reach the
> xiphoid and a little bit more downward to reach the pubis ;)
> 
> Key points: Define observation?
> 1.FAST as documented by Nicole in Archives 2002 doest have any role in
> seatbelt syndrome. Title: Abdominal Seatbelt Marks in the ERA of FAST.
> 2. F/U CT scans are inconclusive at best
> 3. Serial PE- this needs to be done by the same examiner and although it
> sounds great.....good luck in finding that person. When to finish this
> serial PE? Once SIRS is identified? Small Bowel devascularization with
> gangrene and perforation might not occur until late (day 5 to day 8)
> 4. Serial labs: WBC might increase due to 1. bowel injury 2.spleen infarct
> 3.sepsis 4. Other missed injuries
> 
> 
> I personally don't like to observe polytrauma patients with too many
> variables in the air
> 
> My 2 cents
> 
> J
> 
> 
> 
>> On 12/27/14 2:44 PM, "Karim Brohi" <karimbrohi at gmail.com> wrote:
>> 
>> Miklosh hi
>> 
>> Assuming this patient has no on-going fluid requirements then she would be
>> suitable for observation.  There's no active bleed on CT so embolisation
>> would be proximal splenic artery to reduce overall flow.   I think the
>> jury
>> is still out on whether proximal coil embolisation reduces the subsequent
>> splenectomy rate for these injuries although I think the evidence is
>> tending to support it.
>> 
>> Given this patient has previous surgery and has lost her short gastrics I
>> would avoid embolisation and just manage her conservatively( - and do a
>> splenectomy if she fails observation).
>> 
>> Karim
>> 
>> On Sat, Dec 27, 2014 at 8:31 AM, Miklosh Bala <mikloshbala at gmail.com>
>> wrote:
>> 
>>> 22 yo female following car crush, on arrival HR 120, BP 90/60,
>>> seatbelt sign and posterior hip dislocation. Following resuscitation
>>> (crystalloids) and hip reduction, CT showed splenic rupture (Grade 4)
>>> -no active contrast extravasation.
>>> BP 100' HP 100. No other injury.
>>> The patient 2 years following Sleeve Gastrectomy.
>>> Do you thing angio is safe for this specific case? Short gastric
>>> arteries are divided - is that come to consideration?
>>> 
>>> --
>>> Miklosh Bala, MD
>>> Head of Trauma and Acute Care Surgery Unit
>>> Hadassah - Hebrew University Medical Center
>>> Tel: (972) 26778800; Fax: (972) 26449412
>>> Email: mikloshbala at gmail.com
>>> --
>>> trauma-list : TRAUMA.ORG
>>> To change your settings or unsubscribe visit:
>>> http://www.trauma.org/index.php?/community/
>> --
>> trauma-list : TRAUMA.ORG
>> To change your settings or unsubscribe visit:
>> http://www.trauma.org/index.php?/community/
> 
> 
> 
> ------------------------------
> 
> Message: 6
> Date: Sat, 27 Dec 2014 16:45:07 -0500
> From: "William Bromberg" <brombwi1 at memorialhealth.com>
> Subject: Re: Splenic injury case
> To: <trauma-list at trauma.org>
> Message-ID: <549EE2210200003A0003C1FC at mhgw2.mh.com>
> Content-Type: text/plain; charset=US-ASCII
> 
> So you recommend DPL, laparoscopic exploration or laparotomy in every patient 
> with a seat belt sign?
> 
> William J. Bromberg, MD, FACS
> Sent from my iPhone
> 
>> On Dec 27, 2014, at 16:34, Duchesne, Juan C <jduchesn at tulane.edu> wrote:
>> 
>> Seat belt syndrome is a real issue here, this combine with a splenic
>> injury and shock in blunt trauma needs further attention. If you are a
>> minimalist the least I will recommend is a DPL. If you are an aggressive
>> minimalist then I will recommend a diagnostic laparoscopic exam.......and
>> if you just want to do what is the right answer on the ABS boards you
>> extend that DPL incision a little bit more upward until you reach the
>> xiphoid and a little bit more downward to reach the pubis ;)
>> 
>> Key points: Define observation?
>> 1.FAST as documented by Nicole in Archives 2002 doest have any role in
>> seatbelt syndrome. Title: Abdominal Seatbelt Marks in the ERA of FAST.
>> 2. F/U CT scans are inconclusive at best
>> 3. Serial PE- this needs to be done by the same examiner and although it
>> sounds great.....good luck in finding that person. When to finish this
>> serial PE? Once SIRS is identified? Small Bowel devascularization with
>> gangrene and perforation might not occur until late (day 5 to day 8)
>> 4. Serial labs: WBC might increase due to 1. bowel injury 2.spleen infarct
>> 3.sepsis 4. Other missed injuries
>> 
>> 
>> I personally don't like to observe polytrauma patients with too many
>> variables in the air
>> 
>> My 2 cents
>> 
>> J
>> 
>> 
>> 
>>> On 12/27/14 2:44 PM, "Karim Brohi" <karimbrohi at gmail.com> wrote:
>>> 
>>> Miklosh hi
>>> 
>>> Assuming this patient has no on-going fluid requirements then she would be
>>> suitable for observation.  There's no active bleed on CT so embolisation
>>> would be proximal splenic artery to reduce overall flow.   I think the
>>> jury
>>> is still out on whether proximal coil embolisation reduces the subsequent
>>> splenectomy rate for these injuries although I think the evidence is
>>> tending to support it.
>>> 
>>> Given this patient has previous surgery and has lost her short gastrics I
>>> would avoid embolisation and just manage her conservatively( - and do a
>>> splenectomy if she fails observation).
>>> 
>>> Karim
>>> 
>>> On Sat, Dec 27, 2014 at 8:31 AM, Miklosh Bala <mikloshbala at gmail.com>
>>> wrote:
>>> 
>>>> 22 yo female following car crush, on arrival HR 120, BP 90/60,
>>>> seatbelt sign and posterior hip dislocation. Following resuscitation
>>>> (crystalloids) and hip reduction, CT showed splenic rupture (Grade 4)
>>>> -no active contrast extravasation.
>>>> BP 100' HP 100. No other injury.
>>>> The patient 2 years following Sleeve Gastrectomy.
>>>> Do you thing angio is safe for this specific case? Short gastric
>>>> arteries are divided - is that come to consideration?
>>>> 
>>>> --
>>>> Miklosh Bala, MD
>>>> Head of Trauma and Acute Care Surgery Unit
>>>> Hadassah - Hebrew University Medical Center
>>>> Tel: (972) 26778800; Fax: (972) 26449412
>>>> Email: mikloshbala at gmail.com
>>>> --
>>>> trauma-list : TRAUMA.ORG
>>>> To change your settings or unsubscribe visit:
>>>> http://www.trauma.org/index.php?/community/
>>> --
>>> trauma-list : TRAUMA.ORG
>>> To change your settings or unsubscribe visit:
>>> http://www.trauma.org/index.php?/community/
>> 
>> --
>> trauma-list : TRAUMA.ORG
>> To change your settings or unsubscribe visit:
>> http://www.trauma.org/index.php?/community/
> 
> "This electronic mail message contains information which may be confidential, 
> privileged and protected from further disclosure. Such information relates to 
> and is used for all purposes outlined in the statutes below, including Peer 
> Review, Performance Improvement, Quality Assurance and Claims Management and 
> Handling functions and/or Attorney-Client Communications. It is being produced 
> within the scope of all Georgia and Federal laws governing record 
> confidentiality, including (but not limited to) Official Code of Georgia 
> Annotated Sections 31-7-15; 31-7-130; 31-7-131; 31-7-132; 31-7-133; 31-7-140; 
> 31-7-143. 
> If you are not the intended recipient, please be aware that any disclosure, 
> photocopying, distribution or use of the contents of the received information is 
> prohibited. If you have received this e-mail in error, please reply to the 
> sender immediately and permanently delete this message and all copies of it. 
> Thank you.
> 
> Communication of electronic protected health information (ePHI) is protected 
> under the Health Insurance Portability and Accountability Act (HIPAA) Act of 
> 1996. Electronic mail (e-mail) communication is not encrypted or secure. The 
> HIPAA Security Rule allows for patients to initiate communication of personal 
> health information over this medium and for providers to respond accordingly 
> with the understanding that privacy of communication is not guaranteed."
> 
> 
> 
> ------------------------------
> 
> Message: 7
> Date: Sat, 27 Dec 2014 22:44:11 +0000
> From: "Duchesne, Juan C" <jduchesn at tulane.edu>
> Subject: Re: Splenic injury case
> To: "Trauma-List [TRAUMA.ORG]" <trauma-list at trauma.org>
> Message-ID: <793978E8-4DEA-47CA-A999-7CA732F87074 at tulane.edu>
> Content-Type: text/plain; charset="us-ascii"
> 
> William- read carefully what I stated. Multiple variables : spleen, fluid in 
> abdomen, questionable bowel or mesenteric injury due to presence of seat belt. 
> That's my point. To answer your question : NOT in isolated seat belts signs
> J
> 
> 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 27, 2014, at 15:45, William Bromberg <brombwi1 at memorialhealth.com<mailto:brombwi1 at memorialhealth.com>> 
> wrote:
> 
> So you recommend DPL, laparoscopic exploration or laparotomy in every patient 
> with a seat belt sign?
> 
> William J. Bromberg, MD, FACS
> Sent from my iPhone
> 
> On Dec 27, 2014, at 16:34, Duchesne, Juan C <jduchesn at tulane.edu<mailto:jduchesn at tulane.edu>> 
> wrote:
> 
> Seat belt syndrome is a real issue here, this combine with a splenic
> injury and shock in blunt trauma needs further attention. If you are a
> minimalist the least I will recommend is a DPL. If you are an aggressive
> minimalist then I will recommend a diagnostic laparoscopic exam.......and
> if you just want to do what is the right answer on the ABS boards you
> extend that DPL incision a little bit more upward until you reach the
> xiphoid and a little bit more downward to reach the pubis ;)
> 
> Key points: Define observation?
> 1.FAST as documented by Nicole in Archives 2002 doest have any role in
> seatbelt syndrome. Title: Abdominal Seatbelt Marks in the ERA of FAST.
> 2. F/U CT scans are inconclusive at best
> 3. Serial PE- this needs to be done by the same examiner and although it
> sounds great.....good luck in finding that person. When to finish this
> serial PE? Once SIRS is identified? Small Bowel devascularization with
> gangrene and perforation might not occur until late (day 5 to day 8)
> 4. Serial labs: WBC might increase due to 1. bowel injury 2.spleen infarct
> 3.sepsis 4. Other missed injuries
> 
> 
> I personally don't like to observe polytrauma patients with too many
> variables in the air
> 
> My 2 cents
> 
> J
> 
> 
> 
> On 12/27/14 2:44 PM, "Karim Brohi" <karimbrohi at gmail.com<mailto:karimbrohi at gmail.com>> 
> wrote:
> 
> Miklosh hi
> 
> Assuming this patient has no on-going fluid requirements then she would be
> suitable for observation.  There's no active bleed on CT so embolisation
> would be proximal splenic artery to reduce overall flow.   I think the
> jury
> is still out on whether proximal coil embolisation reduces the subsequent
> splenectomy rate for these injuries although I think the evidence is
> tending to support it.
> 
> Given this patient has previous surgery and has lost her short gastrics I
> would avoid embolisation and just manage her conservatively( - and do a
> splenectomy if she fails observation).
> 
> Karim
> 
> On Sat, Dec 27, 2014 at 8:31 AM, Miklosh Bala <mikloshbala at gmail.com<mailto:mikloshbala at gmail.com>>
> wrote:
> 
> 22 yo female following car crush, on arrival HR 120, BP 90/60,
> seatbelt sign and posterior hip dislocation. Following resuscitation
> (crystalloids) and hip reduction, CT showed splenic rupture (Grade 4)
> -no active contrast extravasation.
> BP 100' HP 100. No other injury.
> The patient 2 years following Sleeve Gastrectomy.
> Do you thing angio is safe for this specific case? Short gastric
> arteries are divided - is that come to consideration?
> 
> --
> Miklosh Bala, MD
> Head of Trauma and Acute Care Surgery Unit
> Hadassah - Hebrew University Medical Center
> Tel: (972) 26778800; Fax: (972) 26449412
> Email: mikloshbala at gmail.com<mailto:mikloshbala at gmail.com>
> --
> trauma-list : TRAUMA.ORG<http://TRAUMA.ORG>
> To change your settings or unsubscribe visit:
> http://www.trauma.org/index.php?/community/
> 
> --
> trauma-list : TRAUMA.ORG<http://TRAUMA.ORG>
> To change your settings or unsubscribe visit:
> http://www.trauma.org/index.php?/community/
> 
> --
> trauma-list : TRAUMA.ORG<http://TRAUMA.ORG>
> To change your settings or unsubscribe visit:
> http://www.trauma.org/index.php?/community/
> 
> "This electronic mail message contains information which may be confidential, 
> privileged and protected from further disclosure. Such information relates to 
> and is used for all purposes outlined in the statutes below, including Peer 
> Review, Performance Improvement, Quality Assurance and Claims Management and 
> Handling functions and/or Attorney-Client Communications. It is being produced 
> within the scope of all Georgia and Federal laws governing record 
> confidentiality, including (but not limited to) Official Code of Georgia 
> Annotated Sections 31-7-15; 31-7-130; 31-7-131; 31-7-132; 31-7-133; 31-7-140; 
> 31-7-143.
> If you are not the intended recipient, please be aware that any disclosure, 
> photocopying, distribution or use of the contents of the received information is 
> prohibited. If you have received this e-mail in error, please reply to the 
> sender immediately and permanently delete this message and all copies of it. 
> Thank you.
> 
> Communication of electronic protected health information (ePHI) is protected 
> under the Health Insurance Portability and Accountability Act (HIPAA) Act of 
> 1996. Electronic mail (e-mail) communication is not encrypted or secure. The 
> HIPAA Security Rule allows for patients to initiate communication of personal 
> health information over this medium and for providers to respond accordingly 
> with the understanding that privacy of communication is not guaranteed."
> 
> --
> trauma-list : TRAUMA.ORG<http://TRAUMA.ORG>
> To change your settings or unsubscribe visit:
> http://www.trauma.org/index.php?/community/
> 
> 
> ------------------------------
> 
> Message: 8
> Date: Sat, 27 Dec 2014 21:51:09 -0500
> From: "William Bromberg" <brombwi1 at memorialhealth.com>
> Subject: Re: Splenic injury case
> To: <trauma-list at trauma.org>
> Message-ID: <549F29D50200003A0003C20F at mhgw2.mh.com>
> Content-Type: text/plain; charset=US-ASCII
> 
> OK. But this is actually different than the old dictum which was fluid + NO 
> solid organ injury should go to OR. Which was why I was confused. 
> 
> William J. Bromberg, MD, FACS
> Sent from my iPhone
> 
>> On Dec 27, 2014, at 17:44, Duchesne, Juan C <jduchesn at tulane.edu> wrote:
>> 
>> William- read carefully what I stated. Multiple variables : spleen, fluid in
> abdomen, questionable bowel or mesenteric injury due to presence of seat belt. 
> That's my point. To answer your question : NOT in isolated seat belts signs
>> J
>> 
>> 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 27, 2014, at 15:45, William Bromberg <brombwi1 at memorialhealth.com<mailto:brombwi1 at memorialhealth.com>>
>> wrote:
>> 
>> So you recommend DPL, laparoscopic exploration or laparotomy in every patient
> with a seat belt sign?
>> 
>> William J. Bromberg, MD, FACS
>> Sent from my iPhone
>> 
>>> On Dec 27, 2014, at 16:34, Duchesne, Juan C <jduchesn at tulane.edu<mailto:jduchesn at tulane.edu>>
>> wrote:
>> 
>> Seat belt syndrome is a real issue here, this combine with a splenic
>> injury and shock in blunt trauma needs further attention. If you are a
>> minimalist the least I will recommend is a DPL. If you are an aggressive
>> minimalist then I will recommend a diagnostic laparoscopic exam.......and
>> if you just want to do what is the right answer on the ABS boards you
>> extend that DPL incision a little bit more upward until you reach the
>> xiphoid and a little bit more downward to reach the pubis ;)
>> 
>> Key points: Define observation?
>> 1.FAST as documented by Nicole in Archives 2002 doest have any role in
>> seatbelt syndrome. Title: Abdominal Seatbelt Marks in the ERA of FAST.
>> 2. F/U CT scans are inconclusive at best
>> 3. Serial PE- this needs to be done by the same examiner and although it
>> sounds great.....good luck in finding that person. When to finish this
>> serial PE? Once SIRS is identified? Small Bowel devascularization with
>> gangrene and perforation might not occur until late (day 5 to day 8)
>> 4. Serial labs: WBC might increase due to 1. bowel injury 2.spleen infarct
>> 3.sepsis 4. Other missed injuries
>> 
>> 
>> I personally don't like to observe polytrauma patients with too many
>> variables in the air
>> 
>> My 2 cents
>> 
>> J
>> 
>> 
>> 
>>> On 12/27/14 2:44 PM, "Karim Brohi" <karimbrohi at gmail.com<mailto:karimbrohi at gmail.com>>
>> wrote:
>> 
>> Miklosh hi
>> 
>> Assuming this patient has no on-going fluid requirements then she would be
>> suitable for observation.  There's no active bleed on CT so embolisation
>> would be proximal splenic artery to reduce overall flow.   I think the
>> jury
>> is still out on whether proximal coil embolisation reduces the subsequent
>> splenectomy rate for these injuries although I think the evidence is
>> tending to support it.
>> 
>> Given this patient has previous surgery and has lost her short gastrics I
>> would avoid embolisation and just manage her conservatively( - and do a
>> splenectomy if she fails observation).
>> 
>> Karim
>> 
>> On Sat, Dec 27, 2014 at 8:31 AM, Miklosh Bala <mikloshbala at gmail.com<mailto:mikloshbala at gmail.com>>
>> wrote:
>> 
>> 22 yo female following car crush, on arrival HR 120, BP 90/60,
>> seatbelt sign and posterior hip dislocation. Following resuscitation
>> (crystalloids) and hip reduction, CT showed splenic rupture (Grade 4)
>> -no active contrast extravasation.
>> BP 100' HP 100. No other injury.
>> The patient 2 years following Sleeve Gastrectomy.
>> Do you thing angio is safe for this specific case? Short gastric
>> arteries are divided - is that come to consideration?
>> 
>> --
>> Miklosh Bala, MD
>> Head of Trauma and Acute Care Surgery Unit
>> Hadassah - Hebrew University Medical Center
>> Tel: (972) 26778800; Fax: (972) 26449412
>> Email: mikloshbala at gmail.com<mailto:mikloshbala at gmail.com>
>> --
>> trauma-list : TRAUMA.ORG<http://TRAUMA.ORG>
>> To change your settings or unsubscribe visit:
>> http://www.trauma.org/index.php?/community/
>> 
>> --
>> trauma-list : TRAUMA.ORG<http://TRAUMA.ORG>
>> To change your settings or unsubscribe visit:
>> http://www.trauma.org/index.php?/community/
>> 
>> --
>> trauma-list : TRAUMA.ORG<http://TRAUMA.ORG>
>> To change your settings or unsubscribe visit:
>> http://www.trauma.org/index.php?/community/
>> 
>> "This electronic mail message contains information which may be confidential,
> privileged and protected from further disclosure. Such information relates to 
> and is used for all purposes outlined in the statutes below, including Peer 
> Review, Performance Improvement, Quality Assurance and Claims Management and 
> Handling functions and/or Attorney-Client Communications. It is being produced 
> within the scope of all Georgia and Federal laws governing record 
> confidentiality, including (but not limited to) Official Code of Georgia 
> Annotated Sections 31-7-15; 31-7-130; 31-7-131; 31-7-132; 31-7-133; 31-7-140; 
> 31-7-143.
>> If you are not the intended recipient, please be aware that any disclosure,
> photocopying, distribution or use of the contents of the received information is 
> prohibited. If you have received this e-mail in error, please reply to the 
> sender immediately and permanently delete this message and all copies of it. 
> Thank you.
>> 
>> Communication of electronic protected health information (ePHI) is protected
> under the Health Insurance Portability and Accountability Act (HIPAA) Act of 
> 1996. Electronic mail (e-mail) communication is not encrypted or secure. The 
> HIPAA Security Rule allows for patients to initiate communication of personal 
> health information over this medium and for providers to respond accordingly 
> with the understanding that privacy of communication is not guaranteed."
>> 
>> --
>> trauma-list : TRAUMA.ORG<http://TRAUMA.ORG>
>> To change your settings or unsubscribe visit:
>> http://www.trauma.org/index.php?/community/
>> --
>> trauma-list : TRAUMA.ORG
>> To change your settings or unsubscribe visit:
>> http://www.trauma.org/index.php?/community/
> 
> "This electronic mail message contains information which may be confidential, 
> privileged and protected from further disclosure. Such information relates to 
> and is used for all purposes outlined in the statutes below, including Peer 
> Review, Performance Improvement, Quality Assurance and Claims Management and 
> Handling functions and/or Attorney-Client Communications. It is being produced 
> within the scope of all Georgia and Federal laws governing record 
> confidentiality, including (but not limited to) Official Code of Georgia 
> Annotated Sections 31-7-15; 31-7-130; 31-7-131; 31-7-132; 31-7-133; 31-7-140; 
> 31-7-143. 
> If you are not the intended recipient, please be aware that any disclosure, 
> photocopying, distribution or use of the contents of the received information is 
> prohibited. If you have received this e-mail in error, please reply to the 
> sender immediately and permanently delete this message and all copies of it. 
> Thank you.
> 
> Communication of electronic protected health information (ePHI) is protected 
> under the Health Insurance Portability and Accountability Act (HIPAA) Act of 
> 1996. Electronic mail (e-mail) communication is not encrypted or secure. The 
> HIPAA Security Rule allows for patients to initiate communication of personal 
> health information over this medium and for providers to respond accordingly 
> with the understanding that privacy of communication is not guaranteed."
> 
> 
> 
> ------------------------------
> 
> Message: 9
> Date: Sun, 28 Dec 2014 05:12:51 +0000
> From: Timothy Hardcastle <Hardcastle at ukzn.ac.za>
> Subject: RE: Splenic injury case
> To: "Trauma-List [TRAUMA.ORG]" <trauma-list at trauma.org>
> Message-ID:
>    <fb997de3d77742b988ed63cde4f7ed33 at MED-MBX-2.local.ukzn.ac.za>
> Content-Type: text/plain; charset=WINDOWS-1252
> 
> Hi Gad
> 
> Provided she is evaluable (GCS good, above 12) and you can do serial Hb, Lactate 
> etc, plus review her regularly. This may be difficult in some settings. As Juan 
> has mentioned the seat-belt scar is also a confounder.
> 
> Regards,
> Tim
> Dr Timothy Hardcastle
> MB,ChB(Stell); M.Med(Chir)(Stell); PhD, FCS(SA), Trauma Surgery(HPCSA)
> Head: UKZN Trauma Surgery Training Unit
> Deputy Director: IALCH Trauma Service and Trauma ICU
> Hardcastle at ukzn.ac.za / timothyhar at ialch.co.za
> Mobile +27824681615
> Postal: PostNet 27, Private Bag X05, MALVERN, 4055
> Durban, South Africa
> 
> -----Original Message-----
> From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] On 
> Behalf Of Gad Shaked
> Sent: 27 December 2014 21:35
> To: Trauma-List [TRAUMA.ORG]
> Subject: RE: Splenic injury case
> 
> The patient responded well to resus. Was stable enoug to undergo CT scan, no 
> contrast material extravasation, no other injury detected. She is a good 
> candidate to non operative management regardless her grade of injury, which may 
> be upgraded by the CT reading. Surgery if she becomes unstable or shows signs of 
> peritonitis during surveillance.
> Gad Shaked
> Prof. of Surgery
> Soroka University Medical Center
> Ben-Gurion University
> Beer Sheva
> Israel
> Tel. 972 54 2365600
> 
> ________________________________________
> From: trauma-list-bounces at trauma.org [trauma-list-bounces at trauma.org] on behalf 
> of Miklosh Bala [mikloshbala at gmail.com]
> Sent: Saturday, December 27, 2014 10:31
> To: trauma-list at trauma.org
> Subject: Splenic injury case
> 
> 22 yo female following car crush, on arrival HR 120, BP 90/60, seatbelt sign and 
> posterior hip dislocation. Following resuscitation
> (crystalloids) and hip reduction, CT showed splenic rupture (Grade 4) -no active 
> contrast extravasation.
> BP 100' HP 100. No other injury.
> The patient 2 years following Sleeve Gastrectomy.
> Do you thing angio is safe for this specific case? Short gastric arteries are 
> divided - is that come to consideration?
> 
> --
> Miklosh Bala, MD
> Head of Trauma and Acute Care Surgery Unit Hadassah - Hebrew University Medical 
> Center
> Tel: (972) 26778800; Fax: (972) 26449412
> Email: mikloshbala at gmail.com
> --
> trauma-list : TRAUMA.ORG
> To change your settings or unsubscribe visit:
> http://www.trauma.org/index.php?/community/
> --
> trauma-list : TRAUMA.ORG
> To change your settings or unsubscribe visit:
> http://www.trauma.org/index.php?/community/
> 
> 
> 
> ------------------------------
> 
> Message: 10
> Date: Sun, 28 Dec 2014 06:18:35 +0000
> From: Bellanova Giovanni <giovanni.bellanova at apss.tn.it>
> Subject: RE: Splenic injury case
> To: "Trauma-List [TRAUMA.ORG]" <trauma-list at trauma.org>
> Message-ID: <9795D5872D83404185639C940127BA8802747AE4 at wsedmbxmail1p>
> Content-Type: text/plain; charset="us-ascii"
> 
> Hello everyone, at the entrance to the emergency room, the patient had a 
> bordeline hemodynamic status (HR 120 BP 90/60 - i) but I believe that in the 
> absence of signs of peritonism with a good response after fluid or hemostatic 
> resuscitation (TASH SCORE?), I would avoid surgery in favor of non-operative 
> management and embolization, reserving laparotomy in case of failure.
> 
> dr. Giovanni Bellanova
> Surgery 2nd Division
> S.Chiara Hospital Trento
> Italy
> tel. +390461903816 -3239
> fax +390461903735
> mob +393382420241
> 
> ________________________________________
> Da: trauma-list-bounces at trauma.org [trauma-list-bounces at trauma.org] per conto di 
> Timothy Hardcastle [Hardcastle at ukzn.ac.za]
> Inviato: domenica 28 dicembre 2014 6.12
> A: Trauma-List [TRAUMA.ORG]
> Oggetto: RE: Splenic injury case
> 
> Hi Gad
> 
> Provided she is evaluable (GCS good, above 12) and you can do serial Hb, Lactate 
> etc, plus review her regularly. This may be difficult in some settings. As Juan 
> has mentioned the seat-belt scar is also a confounder.
> 
> Regards,
> Tim
> Dr Timothy Hardcastle
> MB,ChB(Stell); M.Med(Chir)(Stell); PhD, FCS(SA), Trauma Surgery(HPCSA)
> Head: UKZN Trauma Surgery Training Unit
> Deputy Director: IALCH Trauma Service and Trauma ICU
> Hardcastle at ukzn.ac.za / timothyhar at ialch.co.za
> Mobile +27824681615
> Postal: PostNet 27, Private Bag X05, MALVERN, 4055
> Durban, South Africa
> 
> -----Original Message-----
> From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] On 
> Behalf Of Gad Shaked
> Sent: 27 December 2014 21:35
> To: Trauma-List [TRAUMA.ORG]
> Subject: RE: Splenic injury case
> 
> The patient responded well to resus. Was stable enoug to undergo CT scan, no 
> contrast material extravasation, no other injury detected. She is a good 
> candidate to non operative management regardless her grade of injury, which may 
> be upgraded by the CT reading. Surgery if she becomes unstable or shows signs of 
> peritonitis during surveillance.
> Gad Shaked
> Prof. of Surgery
> Soroka University Medical Center
> Ben-Gurion University
> Beer Sheva
> Israel
> Tel. 972 54 2365600
> 
> ________________________________________
> From: trauma-list-bounces at trauma.org [trauma-list-bounces at trauma.org] on behalf 
> of Miklosh Bala [mikloshbala at gmail.com]
> Sent: Saturday, December 27, 2014 10:31
> To: trauma-list at trauma.org
> Subject: Splenic injury case
> 
> 22 yo female following car crush, on arrival HR 120, BP 90/60, seatbelt sign and 
> posterior hip dislocation. Following resuscitation
> (crystalloids) and hip reduction, CT showed splenic rupture (Grade 4) -no active 
> contrast extravasation.
> BP 100' HP 100. No other injury.
> The patient 2 years following Sleeve Gastrectomy.
> Do you thing angio is safe for this specific case? Short gastric arteries are 
> divided - is that come to consideration?
> 
> --
> Miklosh Bala, MD
> Head of Trauma and Acute Care Surgery Unit Hadassah - Hebrew University Medical 
> Center
> Tel: (972) 26778800; Fax: (972) 26449412
> Email: mikloshbala at gmail.com
> --
> trauma-list : TRAUMA.ORG
> To change your settings or unsubscribe visit:
> http://www.trauma.org/index.php?/community/
> --
> trauma-list : TRAUMA.ORG
> To change your settings or unsubscribe visit:
> http://www.trauma.org/index.php?/community/
> 
> --
> trauma-list : TRAUMA.ORG
> To change your settings or unsubscribe visit:
> http://www.trauma.org/index.php?/community/
> 
> 
> ------------------------------
> 
> Message: 11
> Date: Sun, 28 Dec 2014 10:35:55 -0500
> From: Robert Smith <rfsmithmd at comcast.net>
> Subject: Re: Medivac
> To: "Trauma-List [TRAUMA.ORG]" <trauma-list at trauma.org>
> Message-ID: <7BE43C6F-456A-4736-AB2C-49530DBAF24B at comcast.net>
> Content-Type: text/plain; charset=us-ascii
> 
> Does anyone have a thought on the possible problems of medivac for a 78 yr old 
> guy with a closed (presumed) skull fx and small stable epidural?
> 
> ------------------------------
> 
> Message: 12
> Date: Sun, 28 Dec 2014 16:37:19 +0000
> From: "Duchesne, Juan C" <jduchesn at tulane.edu>
> Subject: Re: Splenic injury case
> To: "Trauma-List [TRAUMA.ORG]" <trauma-list at trauma.org>
> Message-ID: <D0C58D4B.1431F%jduchesn at tulane.edu>
> Content-Type: text/plain; charset="Windows-1252"
> 
> Dr Giovanni- I personally use the ABC score for MTP but its really cool to
> see the TASH SCORE still in use! I like it personally but it takes a
> calculator to do the prediction
> Cheers
> 
> Juan
> 
> 
> "Everyday I do my best not to be average??"
> 
> Juan Duchesne, MD, FACS, FCCP, FCCM
> Trauma Medical Director
> GME Medical Director
> North Oaks Health System, Hammond LA
> 
> 
> Clinical Associate Professor of Surgery
> Tulane University, 
> New Orleans LA
> LSUHSC, New Orleans LA
> Chairman, Louisiana Committee of Trauma
> 
> Trauma Program
> 15790 Paul Vega MD Dr.
> Hammond, La 70403
> Office 230-2476 | Fax 230-2478
> 
> 
> 
> 
> 
> 
> 
> On 12/28/14 12:18 AM, "Bellanova Giovanni" <giovanni.bellanova at apss.tn.it>
> wrote:
> 
>> Hello everyone, at the entrance to the emergency room, the patient had a
>> bordeline hemodynamic status (HR 120 BP 90/60 - i) but I believe that in
>> the absence of signs of peritonism with a good response after fluid or
>> hemostatic resuscitation (TASH SCORE?), I would avoid surgery in favor of
>> non-operative management and embolization, reserving laparotomy in case
>> of failure.
>> 
>> dr. Giovanni Bellanova
>> Surgery 2nd Division
>> S.Chiara Hospital Trento
>> Italy
>> tel. +390461903816 -3239
>> fax +390461903735
>> mob +393382420241
>> 
>> ________________________________________
>> Da: trauma-list-bounces at trauma.org [trauma-list-bounces at trauma.org] per
>> conto di Timothy Hardcastle [Hardcastle at ukzn.ac.za]
>> Inviato: domenica 28 dicembre 2014 6.12
>> A: Trauma-List [TRAUMA.ORG]
>> Oggetto: RE: Splenic injury case
>> 
>> Hi Gad
>> 
>> Provided she is evaluable (GCS good, above 12) and you can do serial Hb,
>> Lactate etc, plus review her regularly. This may be difficult in some
>> settings. As Juan has mentioned the seat-belt scar is also a confounder.
>> 
>> Regards,
>> Tim
>> Dr Timothy Hardcastle
>> MB,ChB(Stell); M.Med(Chir)(Stell); PhD, FCS(SA), Trauma Surgery(HPCSA)
>> Head: UKZN Trauma Surgery Training Unit
>> Deputy Director: IALCH Trauma Service and Trauma ICU
>> Hardcastle at ukzn.ac.za / timothyhar at ialch.co.za
>> Mobile +27824681615
>> Postal: PostNet 27, Private Bag X05, MALVERN, 4055
>> Durban, South Africa
>> 
>> -----Original Message-----
>> From: trauma-list-bounces at trauma.org
>> [mailto:trauma-list-bounces at trauma.org] On Behalf Of Gad Shaked
>> Sent: 27 December 2014 21:35
>> To: Trauma-List [TRAUMA.ORG]
>> Subject: RE: Splenic injury case
>> 
>> The patient responded well to resus. Was stable enoug to undergo CT scan,
>> no contrast material extravasation, no other injury detected. She is a
>> good candidate to non operative management regardless her grade of
>> injury, which may be upgraded by the CT reading. Surgery if she becomes
>> unstable or shows signs of peritonitis during surveillance.
>> Gad Shaked
>> Prof. of Surgery
>> Soroka University Medical Center
>> Ben-Gurion University
>> Beer Sheva
>> Israel
>> Tel. 972 54 2365600
>> 
>> ________________________________________
>> From: trauma-list-bounces at trauma.org [trauma-list-bounces at trauma.org] on
>> behalf of Miklosh Bala [mikloshbala at gmail.com]
>> Sent: Saturday, December 27, 2014 10:31
>> To: trauma-list at trauma.org
>> Subject: Splenic injury case
>> 
>> 22 yo female following car crush, on arrival HR 120, BP 90/60, seatbelt
>> sign and posterior hip dislocation. Following resuscitation
>> (crystalloids) and hip reduction, CT showed splenic rupture (Grade 4) -no
>> active contrast extravasation.
>> BP 100' HP 100. No other injury.
>> The patient 2 years following Sleeve Gastrectomy.
>> Do you thing angio is safe for this specific case? Short gastric arteries
>> are divided - is that come to consideration?
>> 
>> --
>> Miklosh Bala, MD
>> Head of Trauma and Acute Care Surgery Unit Hadassah - Hebrew University
>> Medical Center
>> Tel: (972) 26778800; Fax: (972) 26449412
>> Email: mikloshbala at gmail.com
>> --
>> trauma-list : TRAUMA.ORG
>> To change your settings or unsubscribe visit:
>> http://www.trauma.org/index.php?/community/
>> --
>> trauma-list : TRAUMA.ORG
>> To change your settings or unsubscribe visit:
>> http://www.trauma.org/index.php?/community/
>> 
>> --
>> trauma-list : TRAUMA.ORG
>> To change your settings or unsubscribe visit:
>> http://www.trauma.org/index.php?/community/
>> --
>> trauma-list : TRAUMA.ORG
>> To change your settings or unsubscribe visit:
>> http://www.trauma.org/index.php?/community/
> 
> 
> 
> ------------------------------
> 
> Message: 13
> Date: Sun, 28 Dec 2014 13:33:17 -0400
> From: "Gustavo E. Flores" <gflores911 at gmail.com>
> Subject: Re: Medivac
> To: "Trauma-List [TRAUMA.ORG]" <trauma-list at trauma.org>
> Message-ID: <921146E9-07B9-4308-A6D9-99DEA117DA4A at gmail.com>
> Content-Type: text/plain;    charset=us-ascii
> 
> Altered mental status causing airway problems
> 
> Sea-level cabin pressurization. 
> 
> Gustavo E. Flores, MD, EMT-P
> 787.630.6301
> @gflores911
> 
>> On Dec 28, 2014, at 11:35, Robert Smith <rfsmithmd at comcast.net> wrote:
>> 
>> Does anyone have a thought on the possible problems of medivac for a 78 yr old
> guy with a closed (presumed) skull fx and small stable epidural?
>> --
>> trauma-list : TRAUMA.ORG
>> To change your settings or unsubscribe visit:
>> http://www.trauma.org/index.php?/community/
> 
> 
> ------------------------------
> 
> Message: 14
> Date: Sun, 28 Dec 2014 15:14:24 -0600
> From: Charles Krin <cskrin2 at hughes.net>
> Subject: Re: Medivac
> To: "Trauma-List [TRAUMA.ORG]" <trauma-list at trauma.org>
> Message-ID: <54A072B0.5090300 at hughes.net>
> Content-Type: text/plain; charset=ISO-8859-1
> 
> 1: how high and how far? (fixed vs rotor, for ex)
> 
> 2: any other medical problems? (no breathing problems? Glasgow 14 or
> better?)
> 
> ck
> 
>> On 12/28/2014 09:35, Robert Smith wrote:
>> Does anyone have a thought on the possible problems of medivac for a 78 yr old
> guy with a closed (presumed) skull fx and small stable epidural?
>> --
>> trauma-list : TRAUMA.ORG
>> To change your settings or unsubscribe visit:
>> http://www.trauma.org/index.php?/community/
> 
> 
> 
> ------------------------------
> 
> Message: 15
> Date: Sun, 28 Dec 2014 17:07:59 -0500
> From: Stephen Richey <stephen.richey at gmail.com>
> Subject: Re: Medivac
> To: "Trauma &amp, Critical Care mailing list" <trauma-list at trauma.org>
> Message-ID:
>    <CAFhEgi2-QFMpe0e9qJHw35M8B5Sb2GquatQNqDRSh=iXRMe7mQ at mail.gmail.com>
> Content-Type: text/plain; charset=UTF-8
> 
> All of the above.  If he's stable and it's less than four hours away by
> ground, why fly them?  A ground ambulance crew is just as able to transfer
> such a case unless you're going really far.
>> On Dec 28, 2014 4:14 PM, "Charles Krin" <cskrin2 at hughes.net> wrote:
>> 
>> 1: how high and how far? (fixed vs rotor, for ex)
>> 
>> 2: any other medical problems? (no breathing problems? Glasgow 14 or
>> better?)
>> 
>> ck
>> 
>>> On 12/28/2014 09:35, Robert Smith wrote:
>>> Does anyone have a thought on the possible problems of medivac for a 78
>> yr old guy with a closed (presumed) skull fx and small stable epidural?
>>> --
>>> trauma-list : TRAUMA.ORG
>>> To change your settings or unsubscribe visit:
>>> http://www.trauma.org/index.php?/community/
>> 
>> --
>> trauma-list : TRAUMA.ORG
>> To change your settings or unsubscribe visit:
>> http://www.trauma.org/index.php?/community/
> 
> 
> ------------------------------
> 
> Message: 16
> Date: Sun, 28 Dec 2014 17:53:35 -0500
> From: Dave <nappio at aol.com>
> Subject: Re: Medivac
> To: "Trauma-List [TRAUMA.ORG]" <trauma-list at trauma.org>
> Message-ID: <506CA47E-74F3-4F6A-9DAD-538AE446F739 at aol.com>
> Content-Type: text/plain;    charset=us-ascii
> 
> Define stable epidural?
> 
> David Andrew Napoliello MD FACS
> _____________________________
> 
> It is proof of a base and low mind for one to wish to think with the masses or 
> majority, merely because the majority is the majority. Truth does not change 
> because it is, or is not, believed by a majority of the people.
> 
> Giordano Bruno
> 
> 
> Read more at http://www.brainyquote.com/quotes/quotes/g/giordanobr129175.html#QHcycDb87vHmBCMD.99
> 
> 
> 
> Giordano Bruno
> 
> 
> Read more at http://www.brainyquote.com/quotes/quotes/g/giordanobr129175.html#QHcycDb87vHmBCMD.99
> 
> 
> Sent from my iPhone
> 
>> On Dec 28, 2014, at 5:07 PM, Stephen Richey <stephen.richey at gmail.com> wrote:
>> 
>> All of the above.  If he's stable and it's less than four hours away by
>> ground, why fly them?  A ground ambulance crew is just as able to transfer
>> such a case unless you're going really far.
>>> On Dec 28, 2014 4:14 PM, "Charles Krin" <cskrin2 at hughes.net> wrote:
>>> 
>>> 1: how high and how far? (fixed vs rotor, for ex)
>>> 
>>> 2: any other medical problems? (no breathing problems? Glasgow 14 or
>>> better?)
>>> 
>>> ck
>>> 
>>>> On 12/28/2014 09:35, Robert Smith wrote:
>>>> Does anyone have a thought on the possible problems of medivac for a 78
>>> yr old guy with a closed (presumed) skull fx and small stable epidural?
>>>> --
>>>> trauma-list : TRAUMA.ORG
>>>> To change your settings or unsubscribe visit:
>>>> http://www.trauma.org/index.php?/community/
>>> 
>>> --
>>> trauma-list : TRAUMA.ORG
>>> To change your settings or unsubscribe visit:
>>> http://www.trauma.org/index.php?/community/
>> --
>> trauma-list : TRAUMA.ORG
>> To change your settings or unsubscribe visit:
>> http://www.trauma.org/index.php?/community/
> 
> 
> ------------------------------
> 
> --
> trauma-list : TRAUMA.ORG
> To change your settings or unsubscribe visit:
> http://www.trauma.org/index.php?/community/
> 
> End of trauma-list Digest, Vol 138, Issue 8
> *******************************************
> 
> 
> 
> 
> ------------------------------
> 
> Message: 2
> Date: Sun, 28 Dec 2014 18:41:53 -0600
> From: Charles Krin <cskrin2 at hughes.net>
> Subject: Re: Medivac
> To: "Trauma-List [TRAUMA.ORG]" <trauma-list at trauma.org>
> Message-ID: <54A0A351.4070407 at hughes.net>
> Content-Type: text/plain; charset=ISO-8859-1
> 
> Stephen:
> 
> having worked in many rural EDs over the years, I'll point out that many
> of those service districts are not equipped or staffed to 'lose' a
> critical care truck for 6 to 8 hours at a time... and in many cases, the
> only 'mutual aid' group that could help would be the regional Air
> Ambulance service. (It used to be the Military Assistance to Safety and
> Traffic program using (mostly) Army DUSTOFF assets...but after civilian
> helo medical services spread out, and especially after 2001, military
> helos are rarely available for civilian transfers.)
> 
> As an NR EMT-A/91B2F flight medic in the early 1980s, I cared for more
> than a few patients this sick or sicker as we hauled them out of North
> Central Texas and most of Southern and Western Oklahoma.
> 
> ck
> 
>> On 12/28/2014 16:07, Stephen Richey wrote:
>> All of the above.  If he's stable and it's less than four hours away by
>> ground, why fly them?  A ground ambulance crew is just as able to transfer
>> such a case unless you're going really far.
>>> On Dec 28, 2014 4:14 PM, "Charles Krin" <cskrin2 at hughes.net> wrote:
>>> 
>>> 1: how high and how far? (fixed vs rotor, for ex)
>>> 
>>> 2: any other medical problems? (no breathing problems? Glasgow 14 or
>>> better?)
>>> 
>>> ck
>>> 
>>>> On 12/28/2014 09:35, Robert Smith wrote:
>>>> Does anyone have a thought on the possible problems of medivac for a 78
>>> yr old guy with a closed (presumed) skull fx and small stable epidural?
>>>> --
> 
> 
> 
> ------------------------------
> 
> Message: 3
> Date: Sun, 28 Dec 2014 19:45:35 -0500
> From: Stephen Richey <stephen.richey at gmail.com>
> Subject: Re: Medivac
> To: "Trauma &amp, Critical Care mailing list" <trauma-list at trauma.org>
> Message-ID:
>    <CAFhEgi0gcEJG9Q7+Qm0gEZ9=psUnQhDcn7-t_go6Rqd6XzeTUw at mail.gmail.com>
> Content-Type: text/plain; charset=UTF-8
> 
> True but honestly, in that setting, call for a fixed wing turboprop rather
> than a helicopter.  If the patient is stable you can wait a little while
> longer for a less risky mode of transportation (especially at night or in
> marginal weather).
>> On Dec 28, 2014 7:42 PM, "Charles Krin" <cskrin2 at hughes.net> wrote:
>> 
>> Stephen:
>> 
>> having worked in many rural EDs over the years, I'll point out that many
>> of those service districts are not equipped or staffed to 'lose' a
>> critical care truck for 6 to 8 hours at a time... and in many cases, the
>> only 'mutual aid' group that could help would be the regional Air
>> Ambulance service. (It used to be the Military Assistance to Safety and
>> Traffic program using (mostly) Army DUSTOFF assets...but after civilian
>> helo medical services spread out, and especially after 2001, military
>> helos are rarely available for civilian transfers.)
>> 
>> As an NR EMT-A/91B2F flight medic in the early 1980s, I cared for more
>> than a few patients this sick or sicker as we hauled them out of North
>> Central Texas and most of Southern and Western Oklahoma.
>> 
>> ck
>> 
>>> On 12/28/2014 16:07, Stephen Richey wrote:
>>> All of the above.  If he's stable and it's less than four hours away by
>>> ground, why fly them?  A ground ambulance crew is just as able to
>> transfer
>>> such a case unless you're going really far.
>>>> On Dec 28, 2014 4:14 PM, "Charles Krin" <cskrin2 at hughes.net> wrote:
>>>> 
>>>> 1: how high and how far? (fixed vs rotor, for ex)
>>>> 
>>>> 2: any other medical problems? (no breathing problems? Glasgow 14 or
>>>> better?)
>>>> 
>>>> ck
>>>> 
>>>>> On 12/28/2014 09:35, Robert Smith wrote:
>>>>> Does anyone have a thought on the possible problems of medivac for a 78
>>>> yr old guy with a closed (presumed) skull fx and small stable epidural?
>>>>> --
>> 
>> --
>> trauma-list : TRAUMA.ORG
>> To change your settings or unsubscribe visit:
>> http://www.trauma.org/index.php?/community/
> 
> 
> ------------------------------
> 
> Message: 4
> Date: Sun, 28 Dec 2014 21:44:19 -0600
> From: Charles Krin <cskrin2 at hughes.net>
> Subject: Re: Medivac
> To: "Trauma-List [TRAUMA.ORG]" <trauma-list at trauma.org>
> Message-ID: <54A0CE13.5090300 at hughes.net>
> Content-Type: text/plain; charset=ISO-8859-1
> 
> Stephen:
> 
> I agree that for distances further than the unrefueled operational
> radius of the helo, fixed wing should be considered as primary... many
> of the facilities I worked at did NOT have an airstrip of over 3000 feet
> within 30 miles, and even those that did had *at best* a Visual Approach
> Slope Indicator (VASI) system. Add in the additional transfer/transport
> time from even the smaller 'downtown' air port to the receiving
> hospital...and the near 'door to door' of a helo flight can cut
> significant time off- one memorable trip from Ft Sill Indian Hospital to
> Parkland Dallas ended up with us having to land at Love Field for some
> reason, and wait for ground transport- I seem to recall that for some
> reason, the Parkland helopad was occupied and could not accommodate our
> Huey... since our patient was a 400 pound alcoholic GI bleeder...that
> was NOT a comfortable wait for *either of us*-
> 
> In the early 1980s, our Hueys could leave Ft Sill, make a pick up at any
> hospital within 80 miles or so and get to Oklahoma City or Wichita Falls
> generally before a ground ambulance could go direct from the little
> hospital into the city...at least partially because there frequently was
> no 'good way' to get from the small hospital to OKC or WF. Additionally,
> because of common weather patterns, even after civilian air ambulances
> started springing up in OKC, Tulsa and WF, we would frequently get the
> call, because we could sneak around a weather front and follow said
> weather into the City...while the city units would have to punch through
> the weather- it also helped that we were equipped and staffed to fly
> dual pilot night IFR and could handle light icing, something that the
> smaller JetRangers and AStars of the day were not.
> 
> I have some friends who work with an ambulance service in Northern
> Louisiana- this outfit has both fixed and rotor wings, and the most
> common use of the fixed wings is to take cancer patients from the
> Monroe/Ruston catchment areas into Houston for care.
> 
> (While aircraft flying with "Lifeguard," "DUSTOFF," or "MEDEVAC" call
> signs have relative priority over any other aircraft in the sky *except*
> balloons and unpowered gliders, past practical experience has indicated
> to me that it's not really smart to try to insert a KingAir or smaller
> aircraft; or any rotorwing craft into a busy traffic pattern full of
> 'heavies' short of a truly emergent patient!)
> 
> without drawing the ire of Dr. Mattox (with whom I have locked horns
> with in the past on this matter), there is a time and a place for every
> form of transport, from a blanket drag to a LearJet or Gulfstream....and
> consideration of the distance, patient, weather and available staff all
> need to be considered to provide the best and most appropriate transport
> for any given patient.
> 
> ck
> 
>> On 12/28/2014 18:45, Stephen Richey wrote:
>> True but honestly, in that setting, call for a fixed wing turboprop rather
>> than a helicopter.  If the patient is stable you can wait a little while
>> longer for a less risky mode of transportation (especially at night or in
>> marginal weather).
>>> On Dec 28, 2014 7:42 PM, "Charles Krin" <cskrin2 at hughes.net> wrote:
>>> 
>>> Stephen:
>>> 
>>> having worked in many rural EDs over the years, I'll point out that many
>>> of those service districts are not equipped or staffed to 'lose' a
>>> critical care truck for 6 to 8 hours at a time... and in many cases, the
>>> only 'mutual aid' group that could help would be the regional Air
>>> Ambulance service. (It used to be the Military Assistance to Safety and
>>> Traffic program using (mostly) Army DUSTOFF assets...but after civilian
>>> helo medical services spread out, and especially after 2001, military
>>> helos are rarely available for civilian transfers.)
>>> 
>>> As an NR EMT-A/91B2F flight medic in the early 1980s, I cared for more
>>> than a few patients this sick or sicker as we hauled them out of North
>>> Central Texas and most of Southern and Western Oklahoma.
>>> 
>>> ck
>>> 
>>>> On 12/28/2014 16:07, Stephen Richey wrote:
>>>> All of the above.  If he's stable and it's less than four hours away by
>>>> ground, why fly them?  A ground ambulance crew is just as able to
>>> transfer
>>>> such a case unless you're going really far.
>>>>> On Dec 28, 2014 4:14 PM, "Charles Krin" <cskrin2 at hughes.net> wrote:
>>>>> 
>>>>> 1: how high and how far? (fixed vs rotor, for ex)
>>>>> 
>>>>> 2: any other medical problems? (no breathing problems? Glasgow 14 or
>>>>> better?)
>>>>> 
>>>>> ck
>>>>> 
>>>>>> On 12/28/2014 09:35, Robert Smith wrote:
>>>>>> Does anyone have a thought on the possible problems of medivac for a 78
>>>>> yr old guy with a closed (presumed) skull fx and small stable epidural?
>>>>>> --
> 
> 
> ------------------------------
> 
> Message: 5
> Date: Mon, 29 Dec 2014 02:37:38 -0500
> From: Stephen Richey <stephen.richey at gmail.com>
> Subject: Re: Medivac
> To: "Trauma &amp, Critical Care mailing list" <trauma-list at trauma.org>
> Message-ID:
>    <CAFhEgi0MKAx0CWNvyGTXx4GW2gMYNr5CQV823e_ijbajM=HfvQ at mail.gmail.com>
> Content-Type: text/plain; charset=UTF-8
> 
> The fixed wing we operated in was in and out of some very heavy traffic due
> to all the cargo jets at our base.  It's not that bad of a mix.
> 
> I can't argue about terrain in your part of the world.  We have it good
> because even in the hilly southern part of Indiana, you generally have
> airport within easy transport distance of any town big enough to have a
> hospital.  Almost all of them have at least a GPS/RNAV approach as do the
> majority of public airports in the US.
> 
> I think the military helo comparison is a potentially dangerous one because
> the skills, training and proficiency standards of those pilots are so much
> higher than some for profit HEMS outfit.  It leads to a mindset, if not
> tempered by knowledge of the subject as in your case, to the idea that
> civilian operators are comparable.  A few are but most are not if for no
> reason other than relying on single pilot operations in marginal VMC or IMC
> (night operations in rural areas even on crystal clear nights should just
> as a precaution be treated as IMC due to the frequency of the black hole
> effect; this goes for fixed wing as well but it's a bigger problem in
> medical helicopters) in aircraft that often are not equipped with full
> autopilot systems.
> 
> There's a time, place and way use any tool as you said.  Unfortunately, the
> aeromedical industry seems resistant to doing what seems necessary to
> achieve high operational efficacy with sacrificing ten to fifty crew
> members and patients annually.  Fortunately, the FAA finally seems to be
> getting the message that the NTSB has been screaming at them for ten years
> or so and is mandating improvements in training and equipment.  Time will
> tell if it has significant implications for safety or whether loopholes
> will be found to allow business as usual to continue.  I am optimistic
> about it.  I'm ready to see comparable safety between the two sections of
> aeromedical transport in this country.
>> On Dec 28, 2014 10:44 PM, "Charles Krin" <cskrin2 at hughes.net> wrote:
>> 
>> Stephen:
>> 
>> I agree that for distances further than the unrefueled operational
>> radius of the helo, fixed wing should be considered as primary... many
>> of the facilities I worked at did NOT have an airstrip of over 3000 feet
>> within 30 miles, and even those that did had *at best* a Visual Approach
>> Slope Indicator (VASI) system. Add in the additional transfer/transport
>> time from even the smaller 'downtown' air port to the receiving
>> hospital...and the near 'door to door' of a helo flight can cut
>> significant time off- one memorable trip from Ft Sill Indian Hospital to
>> Parkland Dallas ended up with us having to land at Love Field for some
>> reason, and wait for ground transport- I seem to recall that for some
>> reason, the Parkland helopad was occupied and could not accommodate our
>> Huey... since our patient was a 400 pound alcoholic GI bleeder...that
>> was NOT a comfortable wait for *either of us*-
>> 
>> In the early 1980s, our Hueys could leave Ft Sill, make a pick up at any
>> hospital within 80 miles or so and get to Oklahoma City or Wichita Falls
>> generally before a ground ambulance could go direct from the little
>> hospital into the city...at least partially because there frequently was
>> no 'good way' to get from the small hospital to OKC or WF. Additionally,
>> because of common weather patterns, even after civilian air ambulances
>> started springing up in OKC, Tulsa and WF, we would frequently get the
>> call, because we could sneak around a weather front and follow said
>> weather into the City...while the city units would have to punch through
>> the weather- it also helped that we were equipped and staffed to fly
>> dual pilot night IFR and could handle light icing, something that the
>> smaller JetRangers and AStars of the day were not.
>> 
>> I have some friends who work with an ambulance service in Northern
>> Louisiana- this outfit has both fixed and rotor wings, and the most
>> common use of the fixed wings is to take cancer patients from the
>> Monroe/Ruston catchment areas into Houston for care.
>> 
>> (While aircraft flying with "Lifeguard," "DUSTOFF," or "MEDEVAC" call
>> signs have relative priority over any other aircraft in the sky *except*
>> balloons and unpowered gliders, past practical experience has indicated
>> to me that it's not really smart to try to insert a KingAir or smaller
>> aircraft; or any rotorwing craft into a busy traffic pattern full of
>> 'heavies' short of a truly emergent patient!)
>> 
>> without drawing the ire of Dr. Mattox (with whom I have locked horns
>> with in the past on this matter), there is a time and a place for every
>> form of transport, from a blanket drag to a LearJet or Gulfstream....and
>> consideration of the distance, patient, weather and available staff all
>> need to be considered to provide the best and most appropriate transport
>> for any given patient.
>> 
>> ck
>> 
>>> On 12/28/2014 18:45, Stephen Richey wrote:
>>> True but honestly, in that setting, call for a fixed wing turboprop
>> rather
>>> than a helicopter.  If the patient is stable you can wait a little while
>>> longer for a less risky mode of transportation (especially at night or in
>>> marginal weather).
>>>> On Dec 28, 2014 7:42 PM, "Charles Krin" <cskrin2 at hughes.net> wrote:
>>>> 
>>>> Stephen:
>>>> 
>>>> having worked in many rural EDs over the years, I'll point out that many
>>>> of those service districts are not equipped or staffed to 'lose' a
>>>> critical care truck for 6 to 8 hours at a time... and in many cases, the
>>>> only 'mutual aid' group that could help would be the regional Air
>>>> Ambulance service. (It used to be the Military Assistance to Safety and
>>>> Traffic program using (mostly) Army DUSTOFF assets...but after civilian
>>>> helo medical services spread out, and especially after 2001, military
>>>> helos are rarely available for civilian transfers.)
>>>> 
>>>> As an NR EMT-A/91B2F flight medic in the early 1980s, I cared for more
>>>> than a few patients this sick or sicker as we hauled them out of North
>>>> Central Texas and most of Southern and Western Oklahoma.
>>>> 
>>>> ck
>>>> 
>>>>> On 12/28/2014 16:07, Stephen Richey wrote:
>>>>> All of the above.  If he's stable and it's less than four hours away by
>>>>> ground, why fly them?  A ground ambulance crew is just as able to
>>>> transfer
>>>>> such a case unless you're going really far.
>>>>>> On Dec 28, 2014 4:14 PM, "Charles Krin" <cskrin2 at hughes.net> wrote:
>>>>>> 
>>>>>> 1: how high and how far? (fixed vs rotor, for ex)
>>>>>> 
>>>>>> 2: any other medical problems? (no breathing problems? Glasgow 14 or
>>>>>> better?)
>>>>>> 
>>>>>> ck
>>>>>> 
>>>>>> On 12/28/2014 09:35, Robert Smith wrote:
>>>>>>> Does anyone have a thought on the possible problems of medivac for a
>> 78
>>>>>> yr old guy with a closed (presumed) skull fx and small stable
>> epidural?
>>>>>>> --
>>>> 
>> --
>> trauma-list : TRAUMA.ORG
>> To change your settings or unsubscribe visit:
>> http://www.trauma.org/index.php?/community/
>> 
> 
> 
> ------------------------------
> 
> Message: 6
> Date: Mon, 29 Dec 2014 02:08:41 -0600
> From: Charles Krin <cskrin2 at hughes.net>
> Subject: Re: Medivac
> To: "Trauma-List [TRAUMA.ORG]" <trauma-list at trauma.org>
> Message-ID: <54A10C09.50002 at hughes.net>
> Content-Type: text/plain; charset=ISO-8859-1
> 
> I'm familiar with the problems of commercial outfits using JetRangers
> under Single Pilot VFR/one medic conditions. I've spoken out a couple of
> times in the past about the problem and caught a fair share of flack
> over it...especially when I mention that I felt that 'industry best
> practice' should emulate the military model (two pilots, night IFR
> qualified, with at least two crew in the back, room to work on at least
> two patients, with room for at least one more attendant if needed). Dang
> near got me run out of the conference one time!
> 
> I don't think that most commercial outfits need Sikorsky S-70s (UH-60
> Blackhawks), much less  S-61s (SH-3 SeaKings), but at least EC 135s,
> SuperHueys, Dauphins or the equivalent- rigid rotor systems, twin
> engines, ducted fan tail rotors, basic anti icing equipment on critical
> moving parts, radar altimeters, stability augmentation control systems
> and *large* doors...
> 
> And I've also promoted the idea of *every* transfer receiving a follow
> up equivalent to Mortality & Morbidity conferences in the past. Again,
> not something that has made me popular in some circles....because, among
> other things, I tended to point out that too many transfers were being
> made for borderline reasons in terms of staff doctors at small hospitals
> not wanting to come in and properly evaluate a patient, instead sticking
> the ED doc with the problem of finding a bed at a tertiary care facility.
> 
> ck
> 
> On 12/29/2014 01:37, Stephen Richey wrote:
>> The fixed wing we operated in was in and out of some very heavy traffic due
>> to all the cargo jets at our base.  It's not that bad of a mix.
>> 
>> I can't argue about terrain in your part of the world.  We have it good
>> because even in the hilly southern part of Indiana, you generally have
>> airport within easy transport distance of any town big enough to have a
>> hospital.  Almost all of them have at least a GPS/RNAV approach as do the
>> majority of public airports in the US.
>> 
>> I think the military helo comparison is a potentially dangerous one because
>> the skills, training and proficiency standards of those pilots are so much
>> higher than some for profit HEMS outfit.  It leads to a mindset, if not
>> tempered by knowledge of the subject as in your case, to the idea that
>> civilian operators are comparable.  A few are but most are not if for no
>> reason other than relying on single pilot operations in marginal VMC or IMC
>> (night operations in rural areas even on crystal clear nights should just
>> as a precaution be treated as IMC due to the frequency of the black hole
>> effect; this goes for fixed wing as well but it's a bigger problem in
>> medical helicopters) in aircraft that often are not equipped with full
>> autopilot systems.
>> 
>> There's a time, place and way use any tool as you said.  Unfortunately, the
>> aeromedical industry seems resistant to doing what seems necessary to
>> achieve high operational efficacy with sacrificing ten to fifty crew
>> members and patients annually.  Fortunately, the FAA finally seems to be
>> getting the message that the NTSB has been screaming at them for ten years
>> or so and is mandating improvements in training and equipment.  Time will
>> tell if it has significant implications for safety or whether loopholes
>> will be found to allow business as usual to continue.  I am optimistic
>> about it.  I'm ready to see comparable safety between the two sections of
>> aeromedical transport in this country.
>> On Dec 28, 2014 10:44 PM, "Charles Krin" <cskrin2 at hughes.net> wrote:
>> 
>>> Stephen:
>>> 
>>> I agree that for distances further than the unrefueled operational
>>> radius of the helo, fixed wing should be considered as primary... many
>>> of the facilities I worked at did NOT have an airstrip of over 3000 feet
>>> within 30 miles, and even those that did had *at best* a Visual Approach
>>> Slope Indicator (VASI) system. Add in the additional transfer/transport
>>> time from even the smaller 'downtown' air port to the receiving
>>> hospital...and the near 'door to door' of a helo flight can cut
>>> significant time off- one memorable trip from Ft Sill Indian Hospital to
>>> Parkland Dallas ended up with us having to land at Love Field for some
>>> reason, and wait for ground transport- I seem to recall that for some
>>> reason, the Parkland helopad was occupied and could not accommodate our
>>> Huey... since our patient was a 400 pound alcoholic GI bleeder...that
>>> was NOT a comfortable wait for *either of us*-
>>> 
>>> In the early 1980s, our Hueys could leave Ft Sill, make a pick up at any
>>> hospital within 80 miles or so and get to Oklahoma City or Wichita Falls
>>> generally before a ground ambulance could go direct from the little
>>> hospital into the city...at least partially because there frequently was
>>> no 'good way' to get from the small hospital to OKC or WF. Additionally,
>>> because of common weather patterns, even after civilian air ambulances
>>> started springing up in OKC, Tulsa and WF, we would frequently get the
>>> call, because we could sneak around a weather front and follow said
>>> weather into the City...while the city units would have to punch through
>>> the weather- it also helped that we were equipped and staffed to fly
>>> dual pilot night IFR and could handle light icing, something that the
>>> smaller JetRangers and AStars of the day were not.
>>> 
>>> I have some friends who work with an ambulance service in Northern
>>> Louisiana- this outfit has both fixed and rotor wings, and the most
>>> common use of the fixed wings is to take cancer patients from the
>>> Monroe/Ruston catchment areas into Houston for care.
>>> 
>>> (While aircraft flying with "Lifeguard," "DUSTOFF," or "MEDEVAC" call
>>> signs have relative priority over any other aircraft in the sky *except*
>>> balloons and unpowered gliders, past practical experience has indicated
>>> to me that it's not really smart to try to insert a KingAir or smaller
>>> aircraft; or any rotorwing craft into a busy traffic pattern full of
>>> 'heavies' short of a truly emergent patient!)
>>> 
>>> without drawing the ire of Dr. Mattox (with whom I have locked horns
>>> with in the past on this matter), there is a time and a place for every
>>> form of transport, from a blanket drag to a LearJet or Gulfstream....and
>>> consideration of the distance, patient, weather and available staff all
>>> need to be considered to provide the best and most appropriate transport
>>> for any given patient.
>>> 
>>> ck
>>> 
> 
> 
> 
> ------------------------------
> 
> --
> trauma-list : TRAUMA.ORG
> To change your settings or unsubscribe visit:
> http://www.trauma.org/index.php?/community/
> 
> End of trauma-list Digest, Vol 138, Issue 9
> *******************************************


More information about the trauma-list mailing list