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Home > List Archives

trauma-list Digest, Vol 154, Issue 3

jrhmdtraum at aol.com jrhmdtraum at aol.com
Fri Apr 15 13:11:23 BST 2016


 Old school and if you can find them
At MIEMSS we had a firefighter run over by a hook and ladder with terrible pelvis.
Put stomach part MAST on her pelvis at took for angio - did not do iliacs.  Dropped pressure down to 50 and left on for several days.  Survived with some skin necrosis.

I have since done about 5 times.


Message: 2
Date: Wed, 6 Apr 2016 15:36:39 -0400
From: "Errington Thompson " <errington at erringtonthompson.com>
Subject: severe pelvic trauma 
To: "'Trauma-List [TRAUMA.ORG]'" <trauma-list at trauma.org>
Message-ID: <017801d1903b$a409a220$ec1ce660$@erringtonthompson.com>
Content-Type: text/plain;	charset="us-ascii"

Had a very bad pelvic fracture that died on the table the other day. At M&M,
I was told that I should have had IR embolize both internal iliac arteries.
I have only seen that done once before and the patient slowly necrosed his
whole butt and died. 

Thoughts?

Errington C. Thompson, MD, FACS, FCCM
Chief of Trauma Services
Marshall University
Website

 

 


John R Hall, MD, FACS, FCCM
Professor of Surgery 

 

 

-----Original Message-----
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To: trauma-list <trauma-list at trauma.org>
Sent: Fri, Apr 15, 2016 6:32 am
Subject: trauma-list Digest, Vol 154, Issue 3

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Today's Topics:

   1. RE: Pancreatic injury. CT (Timothy Hardcastle)
   2. severe pelvic trauma  (Errington Thompson )
   3. Re: severe pelvic trauma (Else Ribbe)
   4. RE: severe pelvic trauma (Errington Thompson )
   5. RE: severe pelvic trauma (Timothy Hardcastle)
   6. Paper needed (Paul Bailey)
   7. When the going gets ...  (listasmsd)
   8. Re: When the going gets ...  (G.C.Georgiou)
   9. R: When the going gets ...  (Peter)
  10. Re: When the going gets ...  (listasmsd)
  11. Re: When the going gets ...  (listasmsd)
  12. Re: When the going gets ...  (listasmsd)


----------------------------------------------------------------------

Message: 1
Date: Tue, 5 Apr 2016 07:37:33 +0000
From: Timothy Hardcastle <Hardcastle at ukzn.ac.za>
Subject: RE: Pancreatic injury. CT
To: "Trauma-List [TRAUMA.ORG]" <trauma-list at trauma.org>
Message-ID:
	<9c2aa705093846158c363a8a20dfdcb4 at MED-MBX-2.local.ukzn.ac.za>
Content-Type: text/plain; charset=WINDOWS-1252

Hi Martha

I do not see a Grade 3 pancreas injury - there is a probable grade 4, the treatment is DRAIN. The peri-hepatic abscess I would therefore pigtail-drain and simply watch the output from the fistulas that seem to be well-controlled for now. I retract my earlier suggestion to do open surgery. I may do a "gastrograffin meal and follow-through" to check distal patency and extent of any bowel leaks.

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 Martha Quiodettis
Sent: 05 April 2016 08:52
To: trauma-list at trauma.org
Subject: Pancreatic injury. CT

Some pictures of the CT. Not the best quality since were taken from my phone. 



------------------------------

Message: 2
Date: Wed, 6 Apr 2016 15:36:39 -0400
From: "Errington Thompson " <errington at erringtonthompson.com>
Subject: severe pelvic trauma 
To: "'Trauma-List [TRAUMA.ORG]'" <trauma-list at trauma.org>
Message-ID: <017801d1903b$a409a220$ec1ce660$@erringtonthompson.com>
Content-Type: text/plain;	charset="us-ascii"

Had a very bad pelvic fracture that died on the table the other day. At M&M,
I was told that I should have had IR embolize both internal iliac arteries.
I have only seen that done once before and the patient slowly necrosed his
whole butt and died. 

Thoughts?

Errington C. Thompson, MD, FACS, FCCM
Chief of Trauma Services
Marshall University
Website




------------------------------

Message: 3
Date: Wed, 6 Apr 2016 22:05:45 +0200
From: Else Ribbe <else.ribbe at gmail.com>
Subject: Re: severe pelvic trauma
To: "Trauma-List [TRAUMA.ORG]" <trauma-list at trauma.org>
Message-ID:
	<CALPbcqyj6DyAJ37NcNqBaJFWroyANu1rpmf9LBav7WzszF7dLg at mail.gmail.com>
Content-Type: text/plain; charset=UTF-8

I had a 17 year old boy with severe pelvic injury after a traffic accident
in the middle of nowhere. He was probably run over by the car after havng
fallen out of it. There was a fairly long time before reaching hospital. At
arrival he was in shock. IR thromboembolized both iliac arteries from which
severe bleeding was found. Due to colonic injury bowel resection an stoma
was performed. On day 4 he was in a severe condition with severe buttock
necroses requiring many sequential muscular resections as well as nerve
resections. The total sacral bone turned out to be fully necrotic and was
eventually extirpated. After a loooong recovery period with many events
(sepsis, intestinal obstruction etc.) he came back to life and eventually
went to school to try to become a crane operator (!). The
thrombembolisation probably saved his life. The necroses were probably
caused by a combination of 1. long period of shock, 2. severe mechanical
crush injury, 3. multiple bleeding in the area and 4. the iatrogenic
vascular reduction by the embolisation (life-saving!).
Thromboembolisation is a good tool in a desperate situation!?

?Kindly

Else
? Ribbe
Trauma/Vascular surgeon
Sweden?

** V?nligen ?verv?g effekter p? milj?n, innan du skriver ut detta
meddelande!*
** Please consider effects on the rain forests before printing this
message!*

2016-04-06 21:36 GMT+02:00 Errington Thompson <
errington at erringtonthompson.com>:

> Had a very bad pelvic fracture that died on the table the other day. At
> M&M,
> I was told that I should have had IR embolize both internal iliac arteries.
> I have only seen that done once before and the patient slowly necrosed his
> whole butt and died.
>
> Thoughts?
>
> Errington C. Thompson, MD, FACS, FCCM
> Chief of Trauma Services
> Marshall University
> Website
>
>
> --
> trauma-list : TRAUMA.ORG
> To change your settings or unsubscribe visit:
> http://www.trauma.org/index.php?/community/
>


------------------------------

Message: 4
Date: Wed, 6 Apr 2016 16:18:22 -0400
From: "Errington Thompson " <errington at erringtonthompson.com>
Subject: RE: severe pelvic trauma
To: "'Trauma-List [TRAUMA.ORG]'" <trauma-list at trauma.org>
Message-ID: <01fb01d19041$77fe6610$67fb3230$@erringtonthompson.com>
Content-Type: text/plain;	charset="utf-8"

Interesting. Thanks for the case report. I appreciate it. 

E

Errington C. Thompson, MD, FACS, FCCM
Chief of Trauma Services
Marshall University
Website


-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] On Behalf Of Else Ribbe
Sent: Wednesday, April 6, 2016 4:06 PM
To: Trauma-List [TRAUMA.ORG] <trauma-list at trauma.org>
Subject: Re: severe pelvic trauma

I had a 17 year old boy with severe pelvic injury after a traffic accident in the middle of nowhere. He was probably run over by the car after havng fallen out of it. There was a fairly long time before reaching hospital. At arrival he was in shock. IR thromboembolized both iliac arteries from which severe bleeding was found. Due to colonic injury bowel resection an stoma was performed. On day 4 he was in a severe condition with severe buttock necroses requiring many sequential muscular resections as well as nerve resections. The total sacral bone turned out to be fully necrotic and was eventually extirpated. After a loooong recovery period with many events (sepsis, intestinal obstruction etc.) he came back to life and eventually went to school to try to become a crane operator (!). The thrombembolisation probably saved his life. The necroses were probably caused by a combination of 1. long period of shock, 2. severe mechanical crush injury, 3. multiple bleeding in the area a
 nd 4. the iatrogenic vascular reduction by the embolisation (life-saving!).
Thromboembolisation is a good tool in a desperate situation!?

?Kindly

Else
? Ribbe
Trauma/Vascular surgeon
Sweden?

** V?nligen ?verv?g effekter p? milj?n, innan du skriver ut detta
meddelande!*
** Please consider effects on the rain forests before printing this
message!*

2016-04-06 21:36 GMT+02:00 Errington Thompson <
errington at erringtonthompson.com>:

> Had a very bad pelvic fracture that died on the table the other day. 
> At M&M, I was told that I should have had IR embolize both internal 
> iliac arteries.
> I have only seen that done once before and the patient slowly necrosed 
> his whole butt and died.
>
> Thoughts?
>
> Errington C. Thompson, MD, FACS, FCCM
> Chief of Trauma Services
> Marshall University
> Website
>
>
> --
> 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: 5
Date: Thu, 7 Apr 2016 03:31:02 +0000
From: Timothy Hardcastle <Hardcastle at ukzn.ac.za>
Subject: RE: severe pelvic trauma
To: "Trauma-List [TRAUMA.ORG]" <trauma-list at trauma.org>
Message-ID:
	<c83be349a0184636b86bc35c454ca3b8 at MED-MBX-2.local.ukzn.ac.za>
Content-Type: text/plain; charset=WINDOWS-1252

Hi Errington

What you have not told us is what you did do! Firstly it depends if you have rapid IR access - this usually takes 30-60 minutes to get set-up. If you have reduced the pelvis (binder around upper thighs), checked to ensure you are not missing an abdominal bleeder or chest bleeder and then done extraperitoneal pelvic packing I would say you have done what you can in most circumstances.

You could also have open ligated both IIA's but embolization is a good option if you get that far. I am not going to even go in to REBOA, but that is an emerging option too.

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 Errington Thompson 
Sent: 06 April 2016 21:37
To: 'Trauma-List [TRAUMA.ORG]'
Subject: severe pelvic trauma

Had a very bad pelvic fracture that died on the table the other day. At M&M, I was told that I should have had IR embolize both internal iliac arteries.
I have only seen that done once before and the patient slowly necrosed his whole butt and died. 

Thoughts?

Errington C. Thompson, MD, FACS, FCCM
Chief of Trauma Services
Marshall University
Website


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trauma-list : TRAUMA.ORG
To change your settings or unsubscribe visit:
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------------------------------

Message: 6
Date: Sun, 10 Apr 2016 21:31:55 +0800
From: Paul Bailey <paul.bailey at gmail.com>
Subject: Paper needed
To: "Trauma &amp, Critical Care mailing list" <trauma-list at trauma.org>
Message-ID:
	<CADYyH1Pwpm3HM=0_Dnx+=x1kKBk=et5GPjWDJCTXqkh3udTGWw at mail.gmail.com>
Content-Type: text/plain; charset=UTF-8

Hi all,
wondering if anyone has access to the following and the ability to send to
me?

J Trauma Acute Care Surg. <http://www.ncbi.nlm.nih.gov/pubmed/23354262#> 2013
Feb;74(2):634-8. doi: 10.1097/TA.0b013e31827d5d3c.
Traumatic cardiac arrest: should advanced life support be initiated?
Leis CC
<http://www.ncbi.nlm.nih.gov/pubmed/?term=Leis%20CC%5BAuthor%5D&cauthor=true&cauthor_uid=23354262>
1, Hern?ndez CC
<http://www.ncbi.nlm.nih.gov/pubmed/?term=Hern%C3%A1ndez%20CC%5BAuthor%5D&cauthor=true&cauthor_uid=23354262>
, Blanco MJ
<http://www.ncbi.nlm.nih.gov/pubmed/?term=Blanco%20MJ%5BAuthor%5D&cauthor=true&cauthor_uid=23354262>
, Paterna PC
<http://www.ncbi.nlm.nih.gov/pubmed/?term=Paterna%20PC%5BAuthor%5D&cauthor=true&cauthor_uid=23354262>
, Hern?ndez Rde E
<http://www.ncbi.nlm.nih.gov/pubmed/?term=Hern%C3%A1ndez%20Rde%20E%5BAuthor%5D&cauthor=true&cauthor_uid=23354262>
, Torres EC
<http://www.ncbi.nlm.nih.gov/pubmed/?term=Torres%20EC%5BAuthor%5D&cauthor=true&cauthor_uid=23354262>
.

Cheers

Paul


------------------------------

Message: 7
Date: Tue, 12 Apr 2016 02:52:06 -0430
From: "listasmsd" <listasmsd at gmail.com>
Subject: When the going gets ... 
To: "Trauma-List [TRAUMA.ORG]" <trauma-list at trauma.org>
Message-ID: <11B359BB41B94699BB2422EB02824BF1 at Sceptre>
Content-Type: text/plain; charset="utf-8"

This happened 04-09.3016 at 8:30 pm. at the University Hospital of Maracaibo  The emergency powerplant took 37 minutes to start..but the venezuelan surgeons continued operating with the light of their cellphones ...
source FB
Regards
Dr. Manuel Sotelo
Caracas 2016
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Message: 8
Date: Wed, 13 Apr 2016 20:25:05 +0300
From: "G.C.Georgiou" <geokgeo at otenet.gr>
Subject: Re: When the going gets ... 
To: "Trauma-List [TRAUMA.ORG]" <trauma-list at trauma.org>
Message-ID: <0BCA57A4473A49C98D1C39F86CB0F61C at LocalHost>
Content-Type: text/plain; format=flowed; charset="utf-8";
	reply-type=original

Excelent photo.
Thanks Dr Sotelo for sharing it with us.

G.C.Georgiou
Xanthi-Greece

-----?????? ??????----- 
From: listasmsd
Sent: Tuesday, April 12, 2016 10:22 AM
To: Trauma-List [TRAUMA.ORG]
Subject: When the going gets ...

This happened 04-09.3016 at 8:30 pm. at the University Hospital of Maracaibo 
The emergency powerplant took 37 minutes to start..but the venezuelan 
surgeons continued operating with the light of their cellphones ...
source FB
Regards
Dr. Manuel Sotelo
Caracas 2016





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------------------------------

Message: 9
Date: Wed, 13 Apr 2016 20:13:16 +0200
From: "Peter" <taliente at tiscalinet.it>
Subject: R: When the going gets ... 
To: "'Trauma-List [TRAUMA.ORG]'" <trauma-list at trauma.org>
Message-ID: <BAA2A41A64BB444391369124F3A88EF5 at videoe05f99dd9>
Content-Type: text/plain;	charset="UTF-8"

No light at all is a common event in many hospitals in remote areas in Africa!!!!
Peter
-----Messaggio originale-----
Da: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] Per conto di G.C.Georgiou
Inviato: mercoled? 13 aprile 2016 19.25
A: Trauma-List [TRAUMA.ORG]
Oggetto: Re: When the going gets ... 

Excelent photo.
Thanks Dr Sotelo for sharing it with us.

G.C.Georgiou
Xanthi-Greece

-----?????? ??????----- 
From: listasmsd
Sent: Tuesday, April 12, 2016 10:22 AM
To: Trauma-List [TRAUMA.ORG]
Subject: When the going gets ...

This happened 04-09.3016 at 8:30 pm. at the University Hospital of Maracaibo 
The emergency powerplant took 37 minutes to start..but the venezuelan 
surgeons continued operating with the light of their cellphones ...
source FB
Regards
Dr. Manuel Sotelo
Caracas 2016





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------------------------------

Message: 10
Date: Wed, 13 Apr 2016 20:45:15 -0430
From: "listasmsd" <listasmsd at gmail.com>
Subject: Re: When the going gets ... 
To: "Trauma-List [TRAUMA.ORG]" <trauma-list at trauma.org>
Message-ID: <A7D4F1A28B7544D1AAE4D2B96F84F158 at Sceptre>
Content-Type: text/plain;	charset="UTF-8"

Dear Peter
A black-out is something to be prepared for, especially in a  Hospital 
setting. Due to corruption ...  mental and money wise we have no operating 
electric plant in ours  big public hospitals. In private setting you feel 
the click of light and continuo operating with no problem.
It has happened to me once also and thanks to cellphones you can continue to 
operate until the lights come back. The anesthesiologists also have a 
horrible time doing everything manually in the dark.


No light at all is a common event in many hospitals in remote areas in 
Africa!!!!
Peter
-----Messaggio originale-----
Da: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] 
Per conto di G.C.Georgiou
Inviato: mercoled? 13 aprile 2016 19.25
A: Trauma-List [TRAUMA.ORG]
Oggetto: Re: When the going gets ...

Excelent photo.
Thanks Dr Sotelo for sharing it with us.

G.C.Georgiou
Xanthi-Greece

-----?????? ??????----- 
From: listasmsd
Sent: Tuesday, April 12, 2016 10:22 AM
To: Trauma-List [TRAUMA.ORG]
Subject: When the going gets ...

This happened 04-09.3016 at 8:30 pm. at the University Hospital of Maracaibo
The emergency powerplant took 37 minutes to start..but the venezuelan
surgeons continued operating with the light of their cellphones ...
source FB
Regards
Dr. Manuel Sotelo
Caracas 2016





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------------------------------

Message: 11
Date: Wed, 13 Apr 2016 20:45:48 -0430
From: "listasmsd" <listasmsd at gmail.com>
Subject: Re: When the going gets ... 
To: "Trauma-List [TRAUMA.ORG]" <trauma-list at trauma.org>
Message-ID: <BB186374ED954D728B22B0B8780F69E1 at Sceptre>
Content-Type: text/plain;	charset="UTF-8"

You are welcome!
Regards
Manuel Sotelo
Caracas 2106

Excelent photo.
Thanks Dr Sotelo for sharing it with us.

G.C.Georgiou
Xanthi-Greece

-----?????? ??????----- 
From: listasmsd
Sent: Tuesday, April 12, 2016 10:22 AM
To: Trauma-List [TRAUMA.ORG]
Subject: When the going gets ...

This happened 04-09.3016 at 8:30 pm. at the University Hospital of Maracaibo
The emergency powerplant took 37 minutes to start..but the venezuelan
surgeons continued operating with the light of their cellphones ...
source FB
Regards
Dr. Manuel Sotelo
Caracas 2016





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------------------------------

Message: 12
Date: Fri, 15 Apr 2016 06:01:54 -0430
From: "listasmsd" <listasmsd at gmail.com>
Subject: Re: When the going gets ... 
To: "Trauma-List [TRAUMA.ORG]" <trauma-list at trauma.org>
Message-ID: <726DF745C04847EC921C26A02B3B7201 at Sceptre>
Content-Type: text/plain; charset="utf-8"

I found a bigger image. It seems the surgeon was a ending a abdominal 
procedure.
Saludos
Manuel Sotelo
Caracas 2106
It also means how deep in the mud our Hospital are, well also the country...


Excelent photo.
Thanks Dr Sotelo for sharing it with us.

G.C.Georgiou
Xanthi-Greece

-----?????? ??????----- 
From: listasmsd
Sent: Tuesday, April 12, 2016 10:22 AM
To: Trauma-List [TRAUMA.ORG]
Subject: When the going gets ...

This happened 04-09.3016 at 8:30 pm. at the University Hospital of Maracaibo
The emergency powerplant took 37 minutes to start..but the venezuelan
surgeons continued operating with the light of their cellphones ...
source FB
Regards
Dr. Manuel Sotelo
Caracas 2016





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