In article <[log in to unmask]>, Rowland Cottingham
<[log in to unmask]> writes
>Male brought in tonight 'glassed' in the neck. Laceration about 6 cm long
>at junction of middle and lower third of left sternomastoid. Obvious
>muscle damage, has bled around 200ml or so; now not bleeding much.
>
>Nothing else to find apart from associated grazes to neck and face and
>haemodynamically stable.
>
>I recommend putting him head-down to protect from air embolism. General
>surgeon and ENT both disagree; if he has clot on the jugular vessels this
>may be dislodged and cause further bleeding that may be difficult to stop
>so they want him to be sat up overnight for observation to consider
>angiography in the morning.
!??!
>
>I acquiesced gracefully (yes, really!) as I was outvoted. However, I see
>merit in both approaches. What do the team think?
the suggestion that sitting a patient with a hole in his neck upright
all night prevents a clot from dislodging has as much scientific basis
as the use of leeches.
it's probably as old, too.
--
chris taylor,frcs cd a&e queen marys sidcup, kent, UK
"I am dying with the help of too many physicians." Alexander the Great
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