Brain dead and bleeding

[William Bromberg]

Exactly.

It depends on what the CT showed i.e. how "unsurvivable" is unsurvivable. =
For example if the CT showed b/l carotid  occlusions with massive but not =
complete ischemia =97 the patient is dead and just doesn't know it (not =
quite brain dead by criteria but will become so when the swelling starts). =
It would be ludicrous to operate on the patients spleen in this situation =
for anything but organ salvage. Another example would be transcranial =
high-caliber GSW and one to the belly.=20

If the head injury is truly unsurvivalve then the only reason to operate =
is for organs. Of course there are few CHI's that can be categorically =
determined to be non-survivable and I can't say that this case had one =
without more info.




William J. Bromberg
Savannah Surgical Group
912 350-7412

>>> "Hardcastle, Tim, Dr <tch at sun.ac.za>" <tch at sun.ac.za> 12/22/06 12:02 =
AM >>>
Dean

As a fellow SA dr. I would not operate if the CT head showed non-survivable=
 injury in the context of a patient stable enough to have gone to scanner =
first. The critique may have been that the surgeon should first do the =
laparotomy - i.e. address a,b & C, then sort out the head (CT later); this =
would certainly hold water if the patient was UNstable. Then the justificat=
ion is simply that the potential for hypoperfusion as the contributor to =
the low GCS is excluded.=20

Your term "brain dead" here needs qualification - have you done all the =
tests yet? Or is he just a GCS 3 from scene - I've seen these WAKE-UP!

Regards
Tim
Dr T C Hardcastle
M.B.,Ch.B.(Stell); M.Med(Chir); FCS(SA)
Senior Surgeon / Senior Lecturer: Surgery (Trauma and ICU)
ATLS  instructor and DSTC Cape Town Course Director
Intern program Coordinator: Surgery
M.Med (Emergency Medicine) Executive Committee member
Clinical Head (Director): Diana Princess of Wales Trauma Unit
Division of Surgery (General) Room 4064
Department of Surgical Sciences
Tygerberg Hospital / University of Stellenbosch
PO Box 19063
Tygerberg 7505
Western Cape
South Africa
e-mail: tch at sun.ac.za=20
Cell: +27824681615
Office: +27219389281 or 4911 pager 0302



-----Original Message-----
From: trauma-list-bounces at trauma.org=20
[mailto:trauma-list-bounces at trauma.org]On Behalf Of Dean Lutrin
Sent: Thursday, December 21, 2006 7:12 PM
To: 'Trauma & Critical Care mailing list'
Subject: Brain dead and bleeding


Dear list

A quick question. What are your feelings on operating on a patient who =
comes
into your ER brain dead with intraabdominal bleeding? Do you treat the
abdomen on its own merits assuming that some of the low GCS may be
attributable to hypovolaemia etc...

I am of course assuming that the patient has been intubated without drugs,
there is no drug history etc etc...

We debated this a bit today where one of the surgeons did not operate on a
case because the CT brain showed unsurvivable injuries and was roundly
criticised.

Is this a matter of opinion or are there good answers?

Thanks=20

Dean Lutrin
JHB, SA

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