 |
 |
Perfectly reasonable strategy - but better left for departments where there is a stable group of SpR's who give each other a proper handover at shift's end !! My first intro to conservative management was as an orthopaedic SHO when I witnessed my consultant arguing nose-to-nose with a cardiothoracic SR about whether a 2 year old girl with a # humerus and a small PTX with surgical emphysema needed a drain. The consultant won, and she resolved within 36 hours under the caring eyes of the paed ward staff . I always find it amazing how quickly children bounce back to normal activities, even with appalling injuries ! BTW, what does the list think about the practice of aspirating small spontaneous pneumothoraces ? This practice/fad seems endemic amongst physicians in Hong Kong but I think it's unnecessary in most cases. I've treated dozens of these conservatively with careful advice to the patient on activity and when to seek further help, and they have all resolved by 1-2 weeks. Anyone had their fingers burned by doing similar ? Rob Cocks Prof. & Director A&E Medicine Prince of Wales Hospital Hong Kong ---------- From: acad-ae-med-request To: acadae messages Subject: conservative tx of traumatic chest trauma Date: Tuesday, September 10, 1996 11:03AM Just a quick request of the lists views. Case: 55 year old fit and well male falls 4 feet of a ladder onto the right side of the chest. Presents to A+E with right sided chest pain, decreased chest expansion and decreased air entry on that side. However, he is generally well seen by SHO in A+E and gets an erect AP X-ray. The film is of good quality and shows a fracture of the 4th rib. There is a small (5cm) area of surgical emphysema seen on the chest film laterally which is just palpable clinically. There is also blunting of the costophrenic angle - presumably blood. There is no radiographic evidence of pneumothorax (though there must be one). He is going to be admitted for observation anyway. The question is should you put a formal chest drain in this man?? We did not. The decision we made has been criticised by some of our collegues. Simon Carley Anaesthetics / Intensive Care Stepping Hill Hospital Stockport England [log in to unmask] %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%