BAT

[Sanjay Gupta MD]

In almost all trauma centers, patients with BAT are
scanned without PO contrast.  You might miss bowel
injuries and duodenal injuries this way, but that is
far safer than waiting for 3-4 hours.  


When we go to our regional meetings, the message that
we try to spread to the small ERs and hospitals is
that if they have a major trauma patient, a CT scan
will just delay their management.  If the patient is
hemodynamically unstable, he needs an intervention -
either laparotomy, chest tube etc in that center and
if he or she is stable, then he needs to be
transferred to a trauma center.  If the referring
facility thinks that the patient has no major
injuries, a CT scan to confirm that and avoid the
journey and aggravation for the patient and cost to
the health system is certainly justified.



An opinion from the senior members of the list will be
appreciated.



Sanjay



--- Trauma Doc <miamitraumasurgeon at gmail.com> wrote:

> Waiting 2 hours is not necessary and may be
> dangerous.  PO contrast adds
> very little.  Water soluble contrast down the NGT or
> taken PO within a few
> minutes of the scan is fine and may help identify a
> proximal duodenal
> injury, if present.  As for waiting for a reading,
> that is also not
> necessary and may be dangerous.  The high potential
> for rapid decompensation
> always exists.  All CT imaging is read by us (trauma
> surgeons) as soon as
> the images are available, which is generally before
> the patient is even off
> the scanner.  A radiologist reviews the scans at a
> later time.  Although we
> may miss tiny injuries (a thoracic transverse
> process fracture for example),
> solid organ injury, free air, free fluid,
> pneumothoraces, and vascular
> injuries (thoracic and abdominal) are easily
> identified even by the
> neophyte.  Additionally, a brief look at brain CT
> imaging will easily
> identify lesions that require emergent neugosurgical
> intervention.
> 
> 
> >
> > Today's Topics:
> >
> >   1. BAT (ccrone at charter.net)
> >   2. Re: BAT (SJASMD at aol.com)
> >   3. Re: BAT (Gad Shaked)
> >   4. Re: BAT (Ronald Gross)
> >
> >
> >
>
----------------------------------------------------------------------
> >
> > Message: 1
> > Date: Mon, 24 Dec 2007 21:37:46 -0800
> > From: <ccrone at charter.net>
> > Subject: BAT
> > To: trauma-list at trauma.org
> > Message-ID:
> <20071225003746.SVITD.115026.root at fepweb13>
> > Content-Type: text/plain; charset=utf-8
> >
> > I work at a small, rural ER (about 18, 000 annual
> ED volume).  We have no
> > FAST/Ultrasound immediately available at all
> times.  If we have a case of
> > blunt abdominal trauma & order a CT scan, our
> radiologist demands that we
> > have the patient drink oral contrast & wait 2
> hours for the CT to be
> > performed.  It then takes another 30 minutes for
> the report to be
> > obtained.    What do other institutions currently
> do regarding the use of
> > oral contrast when obtaining abdominal/pelvic CT's
> for blunt abdominal
> > trauma in a hemodynamically stable patient-- with
> suspected internal
> > injuries?
> >
> > Thanks
> >
> >
> > ------------------------------
> >
> --
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> 


Sanjay Gupta
Tel: 412 335 6304


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