I'll have a stab then Cliff:
Patient 1 - after rapid primary survey/resus assuming he remains CVS stable
needs RSI [assume C-Spine unstable], intubation, and cranial CT [Radiologist
hopefully will have arrived in time to report it if ER team unhappy to do
so]. If stable in CT consider chest CT [spiral CT hopefully] to exclude
ruptured aorta. Assuming no NV compromise in LL secondary to open knee
fracture, plain XR's as part of secondary survey should suffice
Patient 2 - Simultaneously with above do Abdo U/S as part of primary
survey - if free fluid go to theatre for laporotomy with on table
angiography of ischaemic limb after haem. control achieved
Patient 3 - doesn't need any fancy imaging [initially] - fluid resus, chest
drain, possibly pelvic ex-fix depending on type of pelvic injury, once
stabilised [or ASAP if no response to fluid] theatre for pelvic/femoral
fixation [I assume CXR only displays flail not significant haemothorax] - as
injuries above and below diaphragm consider laporoscopy in theatre once
pelvis fixed to exclude intraabdominal bleed..
Patients 4 &5 can wait as far as imaging is concerned
Cheers, Bill
----- Original Message -----
From: Adrian Fogarty <[log in to unmask]>
To: <[log in to unmask]>
Sent: Tuesday, September 17, 2002 4:43 AM
Subject: Re: radiologists compromise timely emergency care
> No your wording was perfect Cliff! Haven't time right now myself, but
> hopefully someone will have a stab at this conundrum before the day's out.
> (Maybe Rowley's order is correct but he hasn't explained the imaging
> priorities.)
>
> Adrian
>
> ----- Original Message -----
> From: "Cliff Reid" <[log in to unmask]>
> To: <[log in to unmask]>
> Sent: Tuesday, September 17, 2002 3:16 AM
> Subject: Re: radiologists compromise timely emergency care
>
>
> They were treated together. The question (probably poorly worded) referred
> to your imaging priorities, with one CT scanner, the radiologist not in
yet,
> and an US machine available.
>
> >From: Rowley Cottingham <[log in to unmask]>
>
> >Ah, my arcane message was my answer to the trauma quiz set by Cliff -
> >the order in which I would have treated his five patients.
> >
> >Q:
> >
> >1. 30 yr M, open head injury, combative, GCS E3V4M5, compound right knee
> >injury. Large heart on CXR ++
> >2. 65 yr F, Abdo pain, hypotensive on scene then sys ~ 90 in ED, wobbly
> >humeral fracture with cold hand and absent radial pulse
> >3. 62 yr F, flail chest, resps 40, shocked sys BP 75, pelvic butterfly
> >#, bilateral distal femoral shaft #s, one compound, conscious but
> >non-english speaking, sternotomy scar
> >4. 55 yr F, ABC okay, compound left knee injury, closed right ankle #
> >5. 12 yr F, vitals okay, pain on inspiration, extensive seatbelt
> >bruising to chest, severe seatbelt abrasions over her (tender) pelvis,
> >tingling in fingers (no neck pain). some ? pulm contusion on CXR.
> >
> >A:
> >
> >31245.
>
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