Catopsy article request
Ivan Hronek
ivanhronek at yahoo.com
Fri Feb 29 03:00:24 GMT 2008
Anyone has the full article for Sanjay ?
Postmortem computed tomography, "CATopsy", predicts cause of death in trauma patients. - Hoey BA - J Trauma - 01-NOV-2007; 63(5): 979-85; discussion 985-6 (From NIH/NLM MEDLINE)
Abstract:
BACKGROUND: The autopsy remains the gold standard for evaluating traumatic deaths. The number of autopsies performed has declined dramatically. This study examines whether postmortem computed tomography ("CATopsy") can be used to determine cause of death in trauma patients. METHODS: Patients who presented to the trauma service and subsequently died within the first 24 hours of their hospitalization were prospectively enrolled. Any patient who underwent a major invasive procedure within this time frame was excluded. After pronouncement of death, each patient had a CATopsy performed, which was a noncontrast whole body scan. The patient then underwent an autopsy. These results were compared with those generated by the CATopsy. RESULTS: There were 12 patients enrolled in the study; average Injury Severity Scores was 33.5 +/- 19.0. In 10 of the 12 cases (83%), the CATopsy successfully indicated cause of death when compared with the autopsy. Seven of the 12
(58%) CATopsies demonstrated air in various parts of the circulatory system, including the heart in four cases. Five of the 12 (42%) patients had clinically significant findings (including the presence of an esophageal intubation) noted on the CATopsy not previously identified on any radiographic studies or on the autopsy. These findings were addressed as part of our performance improvement process. CONCLUSION: This study suggests that a postmortem imaging test, a CATopsy, can be used to determine cause of death in trauma patients. Beyond offering a noninvasive alternative to autopsy, it provides similar information to that provided in postmortem examination and may be used in trauma performance improvement activities.
Ivan Hronek MD
SFMC, Los Angeles
cell: 310 487-3288
http://health.groups.yahoo.com/group/Anesthideas/
Don't fight darkness. Bring the light, and darkness will disappear.
Maharishi Mahesh Yogi
Confidentiality Notice: This transmission and any attached documents may be confidential and contain information protected by State and Federal Medical Privacy statutes and is legally privileged. They are intended for use only by the addressee. If you are not the intended recipient of this transmission, or an agent of the intended recipient, you are prohibited from reading, disclosing, printing, saving, copying, using, or otherwise disseminating any information contained in this transmission. If you received this transmission in error, please accept our apologies and notify me at ivanhronek at yahoo.com and delete the entire message and its attachments. Thank you. Disclaimer: this message contains the personal views of the author. The author will not be responsible in any way for procedures or approaches perfomed in the way suggested in this note.
----- Original Message ----
From: Sanjay Gupta MD <sanjaygupta99_91 at yahoo.com>
To: "Trauma &, Critical Care mailing list" <trauma-list at trauma.org>
Sent: Thursday, February 28, 2008 4:33:20 PM
Subject: Re: Postmortem data
Did it really happen? Was an esophageal intubation
really discovered post-mortem on a CATopsy? If you
have the picture, I would like to see it. I must
submit that I have never seen that!!
Sanjay
--- Stephen Richey <stephen.richey at gmail.com> wrote:
> The discussion of the CT autopsy article made me
> think of something. If any
> of the trauma professionals here has access to data
> on those who survived to
> hospital admission following aircraft crashes
> (including planes,
> helicopters, ultralights, hot air balloons,
> gyrocopters, etc) please let me
> know. I would be willing to partner with anyone
> necessary to gain access to
> the information. Currently I am working on a
> database of fatal aviation
> data and would like to expand this and develop a
> comparable database for
> non-fatal injury resulting from aircraft crashes.
> Please feel free to
> contact me off list to discuss further if anyone is
> interested.
>
>
> Steve
>
> On Tue, Feb 26, 2008 at 7:01 AM,
> <trauma-list-request at trauma.org> wrote:
>
> > Send trauma-list mailing list submissions to
> > trauma-list at trauma.org
> >
> > To subscribe or unsubscribe via the World Wide
> Web, visit
> >
> http://list.mistral.net/mailman/listinfo/trauma-list
> > or, via email, send a message with subject or body
> 'help' to
> > trauma-list-request at trauma.org
> >
> > You can reach the person managing the list at
> > trauma-list-owner at trauma.org
> >
> > When replying, please edit your Subject line so it
> is more specific
> > than "Re: Contents of trauma-list digest..."
> >
> >
> > Today's Topics:
> >
> > 1. RE: trauma-list Digest, Vol 56, Issue 28
> (Sise, Mike MD)
> > 2. From the sound of it, C-1 fracture, OAD or
> the like.
> > (Ronald Gross)
> > 3. "CATopsy" - postmortem CT. (Ivan Hronek)
> > 4. RE: "CATopsy" - postmortem CT. (Howard
> Berkowitz)
> > 5. RE: (no subject) (Anthony Caruso)
> > 6. Re: "CATopsy" - postmortem CT. (Ronald Gross)
> > 7. Re: cause of hypotension in shock/trauma
> (aktham yaghi)
> > 8. RE: (no subject) (Ronald Gross)
> > 9. RE: trauma-list Digest, Vol 56, Issue 28
> (William Bromberg)
> > 10. Re: "CATopsy" - postmortem CT. (Ivan Hronek)
> > 11. etiology of bradycardia in spinal (Ivan
> Hronek)
> > 12. Re: "CATopsy" - postmortem CT. (Ronald Gross)
> >
> >
> >
>
----------------------------------------------------------------------
> >
> > Message: 1
> > Date: Mon, 25 Feb 2008 04:50:18 -0800
> > From: "Sise, Mike MD"
> <Sise.Mike at scrippshealth.org>
> > Subject: RE: trauma-list Digest, Vol 56, Issue 28
> > To: trauma-list at trauma.org
> > Message-ID:
> >
>
<FEECA018557C774EB876F0D3BCB54E1B01103A9D at MSG02.corp.scripps.org>
> > Content-Type: text/plain; charset="iso-8859-1"
> >
> > This case re-emphasizes the importance of
> post-mortem examination
> > following every death from injury. Even the most
> aggressive and
> > comprehensive pre-mortem CT or MRI imaging can
> substitute for the old
> > fashion autopsy. We can speculate until our next
> birthdays, there is no
> > answer without a post-mortem. In San Diego, we
> don't present our deaths to
> > our system wide Medical Audit Committee until the
> post-mortem results are
> > ready and a member of the County Medical
> Examiner's physician staff joins us
> > for the discussion.
> >
> > Mike Sise
> > San Diego
> >
> > ________________________________
> >
> > From: trauma-list-bounces at trauma.org on behalf of
> > trauma-list-request at trauma.org
> > Sent: Mon 2/25/2008 4:00 AM
> > To: trauma-list at trauma.org
> > Subject: trauma-list Digest, Vol 56, Issue 28
> >
> >
> >
> > Send trauma-list mailing list submissions to
> > trauma-list at trauma.org
> >
> > To subscribe or unsubscribe via the World Wide
> Web, visit
> >
> http://list.mistral.net/mailman/listinfo/trauma-list
> > or, via email, send a message with subject or body
> 'help' to
> > trauma-list-request at trauma.org
> >
> > You can reach the person managing the list at
> > trauma-list-owner at trauma.org
> >
> > When replying, please edit your Subject line so it
> is more specific
> > than "Re: Contents of trauma-list digest..."
> >
> >
> >
> > "Scripps Information Security"
> >
> >
>
------------------------------------------------------------------------------
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> >
> > ------------------------------
> >
> > Message: 2
> > Date: Mon, 25 Feb 2008 08:17:00 -0500
> > From: "Ronald Gross" <rgross at harthosp.org>
> > Subject: From the sound of it, C-1 fracture, OAD
> or the like.
> > To: <trauma-list at trauma.org>
> > Message-ID:
> <47C2797C020000B90001AB45 at gwmail6.harthosp.org>
> > Content-Type: text/plain; charset=US-ASCII
> >
> > >From the sound of it, C-1 fracture, OAD or the
> like.
> >
> > And the answer is???
> >
> > Ron
> >
> >
> > ------------------------------
> >
> > Message: 3
> > Date: Mon, 25 Feb 2008 06:26:09 -0800 (PST)
> > From: Ivan Hronek <ivanhronek at yahoo.com>
> > Subject: "CATopsy" - postmortem CT.
> > To: "Trauma & Critical Care mailing list"
> <trauma-list at trauma.org>
> > Message-ID:
> <924576.98806.qm at web62305.mail.re1.yahoo.com>
> > Content-Type: text/plain; charset=us-ascii
> >
> > Any way to instititute CATopsy - that would be
> great self-education -
> > immediately learning the cause of death !
> > We rarely are allowed to do any autopsies and then
> when the results come 8
> > months later noone remembers the case anymore.
> >
> > Fulltext | PDF (558 K)
> > Postmortem Computed Tomography, "CATopsy",
> Predicts Cause of Death in
> > Trauma Patients.
> >
> > Original Articles
> > Journal of Trauma-Injury Infection & Critical
> Care. 63(5):979-986,
> > November 2007.
> > Hoey, Brian A. MD; Cipolla, James MD; Grossman,
> Michael D. MD; McQuay,
> > Nathaniel MD; Shukla, Pratik R. MD; Stawicki,
> Stanislaw P. MD; Stehly,
> > Christy BS; Hoff, William S. MD
> > Abstract:
> > Background: The autopsy remains the gold standard
> for evaluating traumatic
> > deaths. The number of autopsies performed has
> declined dramatically. This
> > study examines whether postmortem computed
> tomography ("CATopsy") can be
> > used to determine cause of death in trauma
> patients.
> > Methods: Patients who presented to the trauma
> service and subsequently
> > died within the first 24 hours of their
> hospitalization were prospectively
> > enrolled. Any patient who underwent a major
> invasive procedure within this
> > time frame was excluded. After pronouncement of
> death, each patient had a
> > CATopsy performed, which was a noncontrast whole
> body scan. The patient then
> > underwent an autopsy. These results were compared
> with those generated by
> > the CATopsy.
> > Results: There were 12 patients enrolled in the
> study; average Injury
> > Severity Scores was 33.5 +/- 19.0. In 10 of the 12
> cases (83%), the
> > CATopsy successfully indicated cause of death when
> compared with the
> > autopsy. Seven of the 12 (58%) CATopsies
> demonstrated air in various parts
> > of the circulatory system, including the heart in
> four cases. Five of the 12
> > (42%) patients had clinically significant findings
> (including the presence
> > of an esophageal intubation) noted on the CATopsy
> not previously identified
> > on any radiographic studies or on the autopsy.
> These findings were addressed
> > as part of our performance improvement process.
> > Conclusion: This study suggests that a postmortem
> imaging test, a CATopsy,
> > can be used to determine cause of death in trauma
> patients. Beyond offering
> > a noninvasive alternative to autopsy, it provides
> similar information to
> > that provided in postmortem examination and may be
> used in trauma
> > performance improvement activities.
> >
> > Ivan Hronek MD
> > SFMC, Los Angeles
> > cell: 310 487-3288
> > http://health.groups.yahoo.com/group/Anesthideas/
> > Don't fight darkness. Bring the light, and
> darkness will disappear.
> > Maharishi Mahesh Yogi
> >
> >
> >
> > Confidentiality Notice: This transmission and any
> attached documents may
> > be confidential and contain information protected
> by State and Federal
> > Medical Privacy statutes and is legally
> privileged. They are intended for
> > use only by the addressee. If you are not the
> intended recipient of this
> > transmission, or an agent of the intended
> recipient, you are prohibited from
> > reading, disclosing, printing, saving, copying,
> using, or otherwise
> > disseminating any information contained in this
> transmission. If you
> > received this transmission in error, please accept
> our apologies and notify
> > me at ivanhronek at yahoo.com and delete the entire
> message and its
> > attachments. Thank you. Disclaimer: this message
> contains the personal views
> > of the author. The author will not be responsible
> in any way for procedures
> > or approaches perfomed in the way suggested in
> this note.
> >
> >
> >
> >
> >
> >
> >
> > ----- Original Message ----
> > From: "Sise, Mike MD"
> <Sise.Mike at scrippshealth.org>
> > To: trauma-list at trauma.org
> > Sent: Monday, February 25, 2008 4:50:18 AM
> > Subject: RE: trauma-list Digest, Vol 56, Issue 28
> >
> > This case re-emphasizes the importance of
> post-mortem examination
> > following every death from injury. Even the most
> aggressive and
> > comprehensive pre-mortem CT or MRI imaging can
> substitute for the old
> > fashion autopsy. We can speculate until our next
> birthdays, there is no
> > answer without a post-mortem. In San Diego, we
> don't present our deaths to
> > our system wide Medical Audit Committee until the
> post-mortem results are
> > ready and a member of the County Medical
> Examiner's physician staff joins us
> > for the discussion.
> >
> > Mike Sise
> > San Diego
> >
> > ________________________________
> >
> > From: trauma-list-bounces at trauma.org on behalf of
> > trauma-list-request at trauma.org
> > Sent: Mon 2/25/2008 4:00 AM
> > To: trauma-list at trauma.org
> > Subject: trauma-list Digest, Vol 56, Issue 28
> >
> >
> >
> > Send trauma-list mailing list submissions to
> > trauma-list at trauma.org
> >
> > To subscribe or unsubscribe via the World Wide
> Web, visit
> >
> http://list.mistral.net/mailman/listinfo/trauma-list
> > or, via email, send a message with subject or body
> 'help' to
> > trauma-list-request at trauma.org
> >
> > You can reach the person managing the list at
> > trauma-list-owner at trauma.org
> >
> > When replying, please edit your Subject line so it
> is more specific
> > than "Re: Contents of trauma-list digest..."
> >
> >
> >
> > "Scripps Information Security"
> >
> >
>
------------------------------------------------------------------------------
> > This e-mail and any files transmitted with it may
> contain privileged and
> > confidential information and are intended solely
> for the use of the
> > individual or entity to which they are addressed.
> If you are not the
> > intended recipient or the person responsible for
> delivering the e-mail to
> > the intended recipient, you are hereby notified
> that any dissemination or
> > copying of this e-mail or any of its attachment(s)
> is strictly prohibited.
> > If you have received this e-mail in error, please
> immediately notify the
> > sending individual or entity by e-mail and
> permanently delete the original
> > e-mail and attachment(s) from your computer
> system. Thank you for your
> > cooperation.
> >
> >
> >
> >
>
==============================================================================
> >
> >
> >
> > -----Inline Attachment Follows-----
> >
> > --
> > trauma-list : TRAUMA.ORG
> > To change your settings or unsubscribe visit:
> > http://www.trauma.org/index.php?/community/
> >
> >
> >
> >
>
____________________________________________________________________________________
> > Be a better friend, newshound, and
> > know-it-all with Yahoo! Mobile. Try it now.
> >
>
http://mobile.yahoo.com/;_ylt=Ahu06i62sR8HDtDypao8Wcj9tAcJ
> >
> >
> > ------------------------------
> >
> > Message: 4
> > Date: Mon, 25 Feb 2008 09:37:57 -0500
> > From: Howard Berkowitz <hcberkowitz at hotmail.com>
> > Subject: RE: "CATopsy" - postmortem CT.
> > To: "Trauma & Critical Care mailing list"
> <trauma-list at trauma.org>
> > Message-ID:
> <BAY116-W29F86799CB89D27DC0DCFA5180 at phx.gbl>
> > Content-Type: text/plain; charset="iso-8859-1"
> >
> >
> >
> > Hmmm. In principle, it seems a good idea. Assuming
> the institution pays
> > the costs, is there a requirement for consent from
> next of kin?
> >
> > > Date: Mon, 25 Feb 2008 06:26:09 -0800
> > > From: ivanhronek at yahoo.com
> > > To: trauma-list at trauma.org
> > > Subject: "CATopsy" - postmortem CT.
> > >
> > > Any way to instititute CATopsy - that would be
> great self-education -
> > immediately learning the cause of death !
> > > We rarely are allowed to do any autopsies and
> then when the results come
> > 8 months later noone remembers the case anymore.
> > >
> > > Fulltext | PDF (558 K)
> > > Postmortem Computed Tomography, "CATopsy",
> Predicts Cause of Death in
> > Trauma Patients.
> > >
> > > Original Articles
> > > Journal of Trauma-Injury Infection & Critical
> Care. 63(5):979-986,
> > November 2007.
> > > Hoey, Brian A. MD; Cipolla, James MD; Grossman,
> Michael D. MD; McQuay,
> > Nathaniel MD; Shukla, Pratik R. MD; Stawicki,
> Stanislaw P. MD; Stehly,
> > Christy BS; Hoff, William S. MD
> > > Abstract:
> > > Background: The autopsy remains the gold
> standard for evaluating
> > traumatic deaths. The number of autopsies
> performed has declined
> > dramatically. This study examines whether
> postmortem computed tomography
> > ("CATopsy") can be used to determine cause of
> death in trauma patients.
> > > Methods: Patients who presented to the trauma
> service and subsequently
> > died within the first 24 hours of their
> hospitalization were prospectively
> > enrolled. Any patient who underwent a major
> invasive procedure within this
> > time frame was excluded. After pronouncement of
> death, each patient had a
> > CATopsy performed, which was a noncontrast whole
> body scan. The patient then
> > underwent an autopsy. These results were compared
> with those generated by
> > the CATopsy.
> > > Results: There were 12 patients enrolled in the
> study; average Injury
> > Severity Scores was 33.5 +/- 19.0. In 10 of the 12
> cases (83%), the
> > CATopsy successfully indicated cause of death when
> compared with the
> > autopsy. Seven of the 12 (58%) CATopsies
> demonstrated air in various parts
> > of the circulatory system, including the heart in
> four cases. Five of the 12
> > (42%) patients had clinically significant findings
> (including the presence
> > of an esophageal intubation) noted on the CATopsy
> not previously identified
> > on any radiographic studies or on the autopsy.
> These findings were addressed
> > as part of our performance improvement process.
> > > Conclusion: This study suggests that a
> postmortem imaging test, a
> > CATopsy, can be used to determine cause of death
> in trauma patients. Beyond
> > offering a noninvasive alternative to autopsy, it
> provides similar
> > information to that provided in postmortem
> examination and may be used in
> > trauma performance improvement activities.
> > >
> > > Ivan Hronek MD
> > > SFMC, Los Angeles
> > > cell: 310 487-3288
> > >
> http://health.groups.yahoo.com/group/Anesthideas/
> > > Don't fight darkness. Bring the light, and
> darkness will disappear.
> > > Maharishi Mahesh Yogi
> > >
> > >
> > >
> > > Confidentiality Notice: This transmission and
> any attached documents may
> > be confidential and contain information protected
> by State and Federal
> > Medical Privacy statutes and is legally
> privileged. They are intended for
> > use only by the addressee. If you are not the
> intended recipient of this
> > transmission, or an agent of the intended
> recipient, you are prohibited from
> > reading, disclosing, printing, saving, copying,
> using, or otherwise
> > disseminating any information contained in this
> transmission. If you
> > received this transmission in error, please accept
> our apologies and notify
> > me at ivanhronek at yahoo.com and delete the entire
> message and its
> > attachments. Thank you. Disclaimer: this message
> contains the personal views
> > of the author. The author will not be responsible
> in any way for procedures
> > or approaches perfomed in the way suggested in
> this note.
> > >
> > >
> > >
> > >
> > >
> > >
> > >
> > > ----- Original Message ----
> > > From: "Sise, Mike MD"
> <Sise.Mike at scrippshealth.org>
> > > To: trauma-list at trauma.org
> > > Sent: Monday, February 25, 2008 4:50:18 AM
> > > Subject: RE: trauma-list Digest, Vol 56, Issue
> 28
> > >
> > > This case re-emphasizes the importance of
> post-mortem examination
> > following every death from injury. Even the most
> aggressive and
> > comprehensive pre-mortem CT or MRI imaging can
> substitute for the old
> > fashion autopsy. We can speculate until our next
> birthdays, there is no
> > answer without a post-mortem. In San Diego, we
> don't present our deaths to
> > our system wide Medical Audit Committee until the
> post-mortem results are
> > ready and a member of the County Medical
> Examiner's physician staff joins us
> > for the discussion.
> > >
> > > Mike Sise
> > > San Diego
> > >
> > > ________________________________
> > >
> > > From: trauma-list-bounces at trauma.org on behalf
> of
> > trauma-list-request at trauma.org
> > > Sent: Mon 2/25/2008 4:00 AM
> > > To: trauma-list at trauma.org
> > > Subject: trauma-list Digest, Vol 56, Issue 28
> > >
> > >
> > >
> > > Send trauma-list mailing list submissions to
> > > trauma-list at trauma.org
> > >
> > > To subscribe or unsubscribe via the World Wide
> Web, visit
> > >
> http://list.mistral.net/mailman/listinfo/trauma-list
> > > or, via email, send a message with subject or
> body 'help' to
> > > trauma-list-request at trauma.org
> > >
> > > You can reach the person managing the list at
> > > trauma-list-owner at trauma.org
> > >
> > > When replying, please edit your Subject line so
> it is more specific
> > > than "Re: Contents of trauma-list digest..."
> > >
> > >
> > >
> > > "Scripps Information Security"
> > >
> >
>
------------------------------------------------------------------------------
> > > This e-mail and any files transmitted with it
> may contain privileged and
> > confidential information and are intended solely
> for the use of the
> > individual or entity to which they are addressed.
> If you are not the
> > intended recipient or the person responsible for
> delivering the e-mail to
> > the intended recipient, you are hereby notified
> that any dissemination or
> > copying of this e-mail or any of its attachment(s)
> is strictly prohibited.
> > If you have received this e-mail in error, please
> immediately notify the
> > sending individual or entity by e-mail and
> permanently delete the original
> > e-mail and attachment(s) from your computer
> system. Thank you for your
> > cooperation.
> > >
> > >
> > >
> >
>
==============================================================================
> > >
> > >
> > >
> > > -----Inline Attachment Follows-----
> > >
> > > --
> > > trauma-list : TRAUMA.ORG
> > > To change your settings or unsubscribe visit:
> > > http://www.trauma.org/index.php?/community/
> > >
> > >
> > >
> >
>
____________________________________________________________________________________
> > > Be a better friend, newshound, and
> > > know-it-all with Yahoo! Mobile. Try it now.
> >
>
http://mobile.yahoo.com/;_ylt=Ahu06i62sR8HDtDypao8Wcj9tAcJ
> > > --
> > > trauma-list : TRAUMA.ORG
> > > To change your settings or unsubscribe visit:
> > > http://www.trauma.org/index.php?/community/
> >
> >
>
_________________________________________________________________
> > Climb to the top of the charts! Play the word
> scramble challenge with star
> > power.
> >
>
http://club.live.com/star_shuffle.aspx?icid=starshuffle_wlmailtextlink_jan
> >
> > ------------------------------
> >
> > Message: 5
> > Date: Mon, 25 Feb 2008 09:42:52 -0500
> > From: Anthony Caruso <medic541 at hotmail.com>
> > Subject: RE: (no subject)
> > To: "Trauma & Critical Care mailing list"
> <trauma-list at trauma.org>
> > Message-ID:
> <BAY141-W32B572C07908CF7FD31DC99180 at phx.gbl>
> > Content-Type: text/plain; charset="iso-8859-1"
> >
> >
> > Just curious, but do these patients with cord
> compromise respond well to
> > certain types of catecholamine infusions????
> >
> > Anthony Caruso EMT-P
> >
> >
> >
> > > From: KMATTOX at aol.com> Date: Sun, 24 Feb 2008
> 22:09:22 -0500> To:
> > trauma-list at trauma.org; RUTLEDGELEGALRN at aol.com>
> CC: > Subject: Re: (no
> > subject)> > Which case are you referring to
> specifically. We now know that >
> > prehospital fluids more times than not are a
> DETRIMENT to survival. You do
> > not usually > "but time" by infusing fluids,
> unless the BP is below 50/- and
> > one cannot > feel a peripheral pulse. If there is
> a pericardial tear, then
> > change in > position is a better option than
> giving fluids and drugs in the
> > ambulance. > AND paramedics should most of the
> time NOT put tubes and
> > needles into a > chest. . I feel more strongly
> AGAINST interosseous needles
> > in the EMS setting. > > > k> > > In a message
> dated 2/24/2008 9:01:18 P.M.
> > Central Standard Time, > RUTLEDGELEGALRN at aol.com
> writes:> > This case
> > fascinates me. Would the initial resusitation with
> IVF's buy time > > as it
> > appears happened in this patient's case, in the
> events you describe as > >
> > possible? > > > > > > > ****
> > **********Ideas to please picky eaters. Watch
> video on AOL Living. > (
> >
>
http://living.aol.com/video/how-to-please-your-picky-eater/rachel-campos-duffy/>
> > 2050827?NCID=aolcmp00300000002598)> -->
> trauma-list : TRAUMA.ORG> To
> > change your settings or unsubscribe visit:>
> > http://www.trauma.org/index.php?/community/
> >
>
_________________________________________________________________
> > Shed those extra pounds with MSN and The Biggest
> Loser!
> > http://biggestloser.msn.com/
> >
> > ------------------------------
> >
> > Message: 6
> > Date: Mon, 25 Feb 2008 10:17:20 -0500
> > From: "Ronald Gross" <Rgross at harthosp.org>
> > Subject: Re: "CATopsy" - postmortem CT.
> > To: "Trauma & Critical Care mailing list"
> <trauma-list at trauma.org>
> > Message-ID: <47C295B0.7FF1.00B9.0 at harthosp.org>
> > Content-Type: text/plain; charset=US-ASCII
> >
> > That would be ideal, but - and I hate to sound
> like this - who is going to
> > pay the cost of said CT postmortem exam?
> >
> > Ron
> >
> > >>> Ivan Hronek <ivanhronek at yahoo.com> 2/25/2008
> 9:26 AM >>>
> > Any way to instititute CATopsy - that would be
> great self-education -
> > immediately learning the cause of death !
> > We rarely are allowed to do any autopsies and then
> when the results come 8
> > months later noone remembers the case anymore.
> >
> > Fulltext | PDF (558 K)
> > Postmortem Computed Tomography, "CATopsy",
> Predicts Cause of Death in
> > Trauma Patients.
> >
> > Original Articles
> > Journal of Trauma-Injury Infection & Critical
> Care. 63(5):979-986,
> > November 2007.
> > Hoey, Brian A. MD; Cipolla, James MD; Grossman,
> Michael D. MD; McQuay,
> > Nathaniel MD; Shukla, Pratik R. MD; Stawicki,
> Stanislaw P. MD; Stehly,
> > Christy BS; Hoff, William S. MD
> > Abstract:
> > Background: The autopsy remains the gold standard
> for evaluating traumatic
> > deaths. The number of autopsies performed has
> declined dramatically. This
> > study examines whether postmortem computed
> tomography ("CATopsy") can be
> > used to determine cause of death in trauma
> patients.
> > Methods: Patients who presented to the trauma
> service and subsequently
> > died within the first 24 hours of their
> hospitalization were prospectively
> > enrolled. Any patient who underwent a major
> invasive procedure within this
> > time frame was excluded. After pronouncement of
> death, each patient had a
> > CATopsy performed, which was a noncontrast whole
> body scan. The patient then
> > underwent an autopsy. These results were compared
> with those generated by
> > the CATopsy.
> > Results: There were 12 patients enrolled in the
> study; average Injury
> > Severity Scores was 33.5 +/- 19.0. In 10 of the 12
> cases (83%), the
> > CATopsy successfully indicated cause of death when
> compared with the
> > autopsy. Seven of the 12 (58%) CATopsies
> demonstrated air in various parts
> > of the circulatory system, including the heart in
> four cases. Five of the 12
> > (42%) patients had clinically significant findings
> (including the presence
> > of an esophageal intubation) noted on the CATopsy
> not previously identified
> > on any radiographic studies or on the autopsy.
> These findings were addressed
> > as part of our performance improvement process.
> > Conclusion: This study suggests that a postmortem
> imaging test, a CATopsy,
> > can be used to determine cause of death in trauma
> patients. Beyond offering
> > a noninvasive alternative to autopsy, it provides
> similar information to
> > that provided in postmortem examination and may be
> used in trauma
> > performance improvement activities.
> >
> > Ivan Hronek MD
> > SFMC, Los Angeles
> > cell: 310 487-3288
> > http://health.groups.yahoo.com/group/Anesthideas/
> > Don't fight darkness. Bring the light, and
> darkness will disappear.
> > Maharishi Mahesh Yogi
> >
> >
> >
> > Confidentiality Notice: This transmission and any
> attached documents may
> > be confidential and contain information protected
> by State and Federal
> > Medical Privacy statutes and is legally
> privileged. They are intended for
> > use only by the addressee. If you are not the
> intended recipient of this
> > transmission, or an agent of the intended
> recipient, you are prohibited from
> > reading, disclosing, printing, saving, copying,
> using, or otherwise
> > disseminating any information contained in this
> transmission. If you
> > received this transmission in error, please accept
> our apologies and notify
> > me at ivanhronek at yahoo.com and delete the entire
> message and its
> > attachments. Thank you. Disclaimer: this message
> contains the personal views
> > of the author. The author will not be responsible
> in any way for procedures
> > or approaches perfomed in the way suggested in
> this note.
> >
> >
> >
> >
> >
> >
> >
> > ----- Original Message ----
> > From: "Sise, Mike MD"
> <Sise.Mike at scrippshealth.org>
> > To: trauma-list at trauma.org
> > Sent: Monday, February 25, 2008 4:50:18 AM
> > Subject: RE: trauma-list Digest, Vol 56, Issue 28
> >
> > This case re-emphasizes the importance of
> post-mortem examination
> > following every death from injury. Even the most
> aggressive and
> > comprehensive pre-mortem CT or MRI imaging can
> substitute for the old
> > fashion autopsy. We can speculate until our next
> birthdays, there is no
> > answer without a post-mortem. In San Diego, we
> don't present our deaths to
> > our system wide Medical Audit Committee until the
> post-mortem results are
> > ready and a member of the County Medical
> Examiner's physician staff joins us
> > for the discussion.
> >
> > Mike Sise
> > San Diego
> >
> > ________________________________
> >
> > From: trauma-list-bounces at trauma.org on behalf of
> > trauma-list-request at trauma.org
> > Sent: Mon 2/25/2008 4:00 AM
> > To: trauma-list at trauma.org
> > Subject: trauma-list Digest, Vol 56, Issue 28
> >
> >
> >
> > Send trauma-list mailing list submissions to
> > trauma-list at trauma.org
> >
> > To subscribe or unsubscribe via the World Wide
> Web, visit
> >
> http://list.mistral.net/mailman/listinfo/trauma-list
> > or, via email, send a message with subject or body
> 'help' to
> > trauma-list-request at trauma.org
> >
> > You can reach the person managing the list at
> > trauma-list-owner at trauma.org
> >
> > When replying, please edit your Subject line so it
> is more specific
> > than "Re: Contents of trauma-list digest..."
> >
> >
> >
> > "Scripps Information Security"
> >
> >
>
------------------------------------------------------------------------------
> > This e-mail and any files transmitted with it may
> contain privileged and
> > confidential information and are intended solely
> for the use of the
> > individual or entity to which they are addressed.
> If you are not the
> > intended recipient or the person responsible for
> delivering the e-mail to
> > the intended recipient, you are hereby notified
> that any dissemination or
> > copying of this e-mail or any of its attachment(s)
> is strictly prohibited.
> > If you have received this e-mail in error, please
> immediately notify the
> > sending individual or entity by e-mail and
> permanently delete the original
> > e-mail and attachment(s) from your computer
> system. Thank you for your
> > cooperation.
> >
> >
> >
> >
>
==============================================================================
> >
> >
> >
> > -----Inline Attachment Follows-----
> >
> > --
> > trauma-list : TRAUMA.ORG
> > To change your settings or unsubscribe visit:
> > http://www.trauma.org/index.php?/community/
> >
> >
> >
> >
>
____________________________________________________________________________________
> > Be a better friend, newshound, and
> > know-it-all with Yahoo! Mobile. Try it now.
> >
>
http://mobile.yahoo.com/;_ylt=Ahu06i62sR8HDtDypao8Wcj9tAcJ
> > --
> > trauma-list : TRAUMA.ORG
> > To change your settings or unsubscribe visit:
> > http://www.trauma.org/index.php?/community/
> >
> >
> > ------------------------------
> >
> > Message: 7
> > Date: Mon, 25 Feb 2008 16:58:46 +0100
> > From: "aktham yaghi" <yaktham at gmail.com>
> > Subject: Re: cause of hypotension in shock/trauma
> > To: "Trauma &, Critical Care mailing list"
> <trauma-list at trauma.org>
> > Message-ID:
> >
>
<6de4dcb40802250758v7e430687l953aa63a15c80e4a at mail.gmail.com>
> > Content-Type: text/plain; charset=ISO-8859-1
> >
> > Ivan
> > Then
> > My question is why do you see bradycrdia with
> hypotension in spinal
> > anaesthesia (Lumber L2-3) not due to the dose of
> local anaesthetics?
> > Aktham Yaghi MD
> > FNsP, Bratislava, Ruzinov- ICU- KAIM
> > Clinic of Anaesthesia and Intensive Care Medicine
> > Comenius University,Faculty of Medicine
> > Ruzinovska 6
> > 82606 Bratislava
> > Slovak Republic
> > yaktham at gmail.com
> >
> > 2008/2/24 IVAN HRONEK <ih7 at msn.com>:
> >
> > > Neurogenic shock is hypotension with or without
> bradycardia - depending
> > on
> > > the cause - in high spinal cord lesions they
> will be bradycardic as to
> > the
> > > interruption of cardiac sympathetic
> accelerators. In neurogenic shock
> > due to
> > > brain lesion or thoracic spine injury the
> bradycardia is not necessarily
> > > present. The term is "relative bradycardia" i.e.
> heart rate not
> > > appropriate to the degree of hypotension ..which
> your patient actually
> > could
> > > be told to have - a HR of 110/min in a young man
> with a barely palpable
> > > pulse is certainly not a high enough reflex
> heart rate, you'd expect at
> > > least 140 / min or so.
> > > The problem with teaching about shock is that
> the bradycardia is the one
> > > thing one can easily remember about spinal shock
> - however, it does not
> > have
> > > to be present and then everyone is surprised.
> > > As dr. M. would say, a gentle clinician's touch
> is required here - this
> > is
> > > the time to use it - the diff.dg is clinical
> and that is whether or not
> > > the patient's skin is cold and clammy or warm
> and dry - hypovolemic vs.
> > > neurogenic shock.
> > >
> > >
> > >
> > >
> > >
> > >
> > >
> > > Patients with neurogenic shock are hypotensive
> and usually have warm,
> > dry
> > > skin.8 Bradycardia is characteristic but not
> universal.
> > >
> ...www.accessmedicine.com/content.aspx?aID=588768 -
> Similar pages
> > >
> > >
> > >
> >
> >
> > ------------------------------
> >
> > Message: 8
> > Date: Mon, 25 Feb 2008 11:05:19 -0500
> > From: "Ronald Gross" <Rgross at harthosp.org>
> > Subject: RE: (no subject)
> > To: "Trauma & Critical Care mailing list"
> <trauma-list at trauma.org>
> > Message-ID: <47C2A0EF.7FF1.00B9.0 at harthosp.org>
> > Content-Type: text/plain; charset=US-ASCII
> >
> > The short answer is yes.
> >
> > >>> Anthony Caruso <medic541 at hotmail.com>
> 2/25/2008 9:42 AM >>>
> >
> > Just curious, but do these patients with cord
> compromise respond well to
> > certain types of catecholamine infusions????
> >
> > Anthony Caruso EMT-P
> >
> >
> >
> > > From: KMATTOX at aol.com> Date: Sun, 24 Feb 2008
> 22:09:22 -0500> To:
> > trauma-list at trauma.org; RUTLEDGELEGALRN at aol.com>
> CC: > Subject: Re: (no
> > subject)> > Which case are you referring to
> specifically. We now know that >
> > prehospital fluids more times than not are a
> DETRIMENT to survival. You do
> > not usually > "but time" by infusing fluids,
> unless the BP is below 50/- and
> > one cannot > feel a peripheral pulse. If there is
> a pericardial tear, then
> > change in > position is a better option than
> giving fluids and drugs in the
> > ambulance. > AND paramedics should most of the
> time NOT put tubes and
> > needles into a > chest. . I feel more strongly
> AGAINST interosseous needles
> > in the EMS setting. > > > k> > > In a message
> dated 2/24/2008 9:01:18 P.M.
> > Central Standard Time, > RUTLEDGELEGALRN at aol.com
> writes:> > This case
> > fascinates me. Would the initial resusitation with
> IVF's buy time > > as it
> > appears happened in this patient's case, in the
> events you describe as > >
> > possible? > > > > > > > ****
> > **********Ideas to please picky eaters. Watch
> video on AOL Living. > (
> >
>
http://living.aol.com/video/how-to-please-your-picky-eater/rachel-campos-duffy/>
> > 2050827?NCID=aolcmp00300000002598)> -->
> trauma-list : TRAUMA.ORG> To
> > change your settings or unsubscribe visit:>
> > http://www.trauma.org/index.php?/community/
> >
>
_________________________________________________________________
> > Shed those extra pounds with MSN and The Biggest
> Loser!
> > http://biggestloser.msn.com/--
> > trauma-list : TRAUMA.ORG
> > To change your settings or unsubscribe visit:
> > http://www.trauma.org/index.php?/community/
> >
> >
> >
> > ------------------------------
> >
> > Message: 9
> > Date: Mon, 25 Feb 2008 13:12:45 -0500
> > From: "William Bromberg"
> <brombwi1 at memorialhealth.com>
> > Subject: RE: trauma-list Digest, Vol 56, Issue 28
> > To: <trauma-list at trauma.org>
> > Message-ID:
> <47C2BED1.85AB.003A.0 at memorialhealth.com>
> > Content-Type: text/plain; charset=US-ASCII
> >
> > Man, you're lucky. Chatham county runs out of
> money allocated for post
> > mortems by April. After that you only get PMs on
> people who die outside the
> > hospital in a manner that may be criminal. The
> hospital won't pay either.
> >
> >
> >
> > >>> "Sise, Mike MD" <Sise.Mike at scrippshealth.org>
> 02/25/2008 7:50 AM >>>
> > This case re-emphasizes the importance of
> post-mortem examination
> > following every death from injury. Even the most
> aggressive and
> > comprehensive pre-mortem CT or MRI imaging can
> substitute for the old
> > fashion autopsy. We can speculate until our next
> birthdays, there is no
> > answer without a post-mortem. In San Diego, we
> don't present our deaths to
> > our system wide Medical Audit Committee until the
> post-mortem results are
> > ready and a member of the County Medical
> Examiner's physician staff joins us
> > for the discussion.
> >
> > Mike Sise
> > San Diego
> >
> > ________________________________
> >
> > From: trauma-list-bounces at trauma.org on behalf of
> > trauma-list-request at trauma.org
> > Sent: Mon 2/25/2008 4:00 AM
> > To: trauma-list at trauma.org
> > Subject: trauma-list Digest, Vol 56, Issue 28
> >
> >
> >
> > Send trauma-list mailing list submissions to
> > trauma-list at trauma.org
> >
> > To subscribe or unsubscribe via the World Wide
> Web, visit
> >
> http://list.mistral.net/mailman/listinfo/trauma-list
> > or, via email, send a message with subject or body
> 'help' to
> > trauma-list-request at trauma.org
> >
> > You can reach the person managing the list at
> > trauma-list-owner at trauma.org
> >
> > When replying, please edit your Subject line so it
> is more specific
> > than "Re: Contents of trauma-list digest..."
> >
> >
> >
> > "Scripps Information Security"
> >
> >
>
------------------------------------------------------------------------------
> > This e-mail and any files transmitted with it may
> contain privileged and
> > confidential information and are intended solely
> for the use of the
> > individual or entity to which they are addressed.
> If you are not the
> > intended recipient or the person responsible for
> delivering the e-mail to
> > the intended recipient, you are hereby notified
> that any dissemination or
> > copying of this e-mail or any of its attachment(s)
> is strictly prohibited.
> > If you have received this e-mail in error, please
> immediately notify the
> > sending individual or entity by e-mail and
> permanently delete the original
> > e-mail and attachment(s) from your computer
> system. Thank you for your
> > cooperation.
> >
> >
> >
> >
>
==============================================================================
> >
> >
> >
> > ------------------------------
> >
> > Message: 10
> > Date: Mon, 25 Feb 2008 14:06:11 -0800 (PST)
> > From: Ivan Hronek <ivanhronek at yahoo.com>
> > Subject: Re: "CATopsy" - postmortem CT.
> > To: "Trauma & Critical Care mailing list"
> <trauma-list at trauma.org>
> > Message-ID:
> <362560.66922.qm at web62302.mail.re1.yahoo.com>
> > Content-Type: text/plain; charset=us-ascii
> >
> > the hospital will have to swallow the costs -
> there's not that many sudden
> > deaths that need to be explained and not all of
> them would get the CT scan.
> > It would be a great source of quality imrpovement
> and education - in the
> > paper they found esophageal intubation - imagine
> that !
> >
> > Ivan Hronek MD
> > SFMC, Los Angeles
> > cell: 310 487-3288
> > http://health.groups.yahoo.com/group/Anesthideas/
> > Don't fight darkness. Bring the light, and
> darkness will disappear.
> > Maharishi Mahesh Yogi
> >
> >
> >
> > Confidentiality Notice: This transmission and any
> attached documents may
> > be confidential and contain information protected
> by State and Federal
> > Medical Privacy statutes and is legally
> privileged. They are intended for
> > use only by the addressee. If you are not the
> intended recipient of this
> > transmission, or an agent of the intended
> recipient, you are prohibited from
> > reading, disclosing, printing, saving, copying,
> using, or otherwise
> > disseminating any information contained in this
> transmission. If you
> > received this transmission in error, please accept
> our apologies and notify
> > me at ivanhronek at yahoo.com and delete the entire
> message and its
> > attachments. Thank you. Disclaimer: this message
> contains the personal views
> > of the author. The author will not be responsible
> in any way for procedures
> > or approaches perfomed in the way suggested in
> this note.
> >
> >
> >
> >
> >
> >
> >
> > ----- Original Message ----
> > From: Ronald Gross <Rgross at harthosp.org>
> > To: "Trauma & Critical Care mailing list"
> <trauma-list at trauma.org>
> > Sent: Monday, February 25, 2008 7:17:20 AM
> > Subject: Re: "CATopsy" - postmortem CT.
> >
> > That would be ideal, but - and I hate to sound
> like this - who is going to
> > pay the cost of said CT postmortem exam?
> >
> > Ron
> >
> > >>> Ivan Hronek <ivanhronek at yahoo.com> 2/25/2008
> 9:26 AM >>>
> > Any way to instititute CATopsy - that would be
> great self-education -
> > immediately learning the cause of death !
> > We rarely are allowed to do any autopsies and then
> when the results come 8
> > months later noone remembers the case anymore.
> >
> > Fulltext | PDF (558 K)
> > Postmortem Computed Tomography, "CATopsy",
> Predicts Cause of Death in
> > Trauma Patients.
> >
> > Original Articles
> > Journal of Trauma-Injury Infection & Critical
> Care. 63(5):979-986,
> > November 2007.
> > Hoey, Brian A. MD; Cipolla, James MD; Grossman,
> Michael D. MD; McQuay,
> > Nathaniel MD; Shukla, Pratik R. MD; Stawicki,
> Stanislaw P. MD; Stehly,
> > Christy BS; Hoff, William S. MD
> > Abstract:
> > Background: The autopsy remains the gold standard
> for evaluating traumatic
> > deaths. The number of autopsies performed has
> declined dramatically. This
> > study examines whether postmortem computed
> tomography ("CATopsy") can be
> > used to determine cause of death in trauma
> patients.
> > Methods: Patients who presented to the trauma
> service and subsequently
> > died within the first 24 hours of their
> hospitalization were prospectively
> > enrolled. Any patient who underwent a major
> invasive procedure within this
> > time frame was excluded. After pronouncement of
> death, each patient had a
> > CATopsy performed, which was a noncontrast whole
> body scan. The patient then
> > underwent an autopsy. These results were compared
> with those generated by
> > the CATopsy.
> > Results: There were 12 patients enrolled in the
> study; average Injury
> > Severity Scores was 33.5 +/- 19.0. In 10 of the 12
> cases (83%), the
> > CATopsy successfully indicated cause of death when
> compared with the
> > autopsy. Seven of the 12 (58%) CATopsies
> demonstrated air in various parts
> > of the circulatory system, including the heart in
> four cases. Five of the 12
> > (42%) patients had clinically significant findings
> (including the presence
> > of an esophageal intubation) noted on the CATopsy
> not previously identified
> > on any radiographic studies or on the autopsy.
> These findings were addressed
> > as part of our performance improvement process.
> > Conclusion: This study suggests that a postmortem
> imaging test, a CATopsy,
> > can be used to determine cause of death in trauma
> patients. Beyond offering
> > a noninvasive alternative to autopsy, it provides
> similar information to
> > that provided in postmortem examination and may be
> used in trauma
> > performance improvement activities.
> >
> > Ivan Hronek MD
> > SFMC, Los Angeles
> > cell: 310 487-3288
> > http://health.groups.yahoo.com/group/Anesthideas/
> > Don't fight darkness. Bring the light, and
> darkness will disappear.
> > Maharishi Mahesh Yogi
> >
> >
> >
> > Confidentiality Notice: This transmission and any
> attached documents may
> > be confidential and contain information protected
> by State and Federal
> > Medical Privacy statutes and is legally
> privileged. They are intended for
> > use only by the addressee. If you are not the
> intended recipient of this
> > transmission, or an agent of the intended
> recipient, you are prohibited from
> > reading, disclosing, printing, saving, copying,
> using, or otherwise
> > disseminating any information contained in this
> transmission. If you
> > received this transmission in error, please accept
> our apologies and notify
> > me at ivanhronek at yahoo.com and delete the entire
> message and its
> > attachments. Thank you. Disclaimer: this message
> contains the personal views
> > of the author. The author will not be responsible
> in any way for procedures
> > or approaches perfomed in the way suggested in
> this note.
> >
> >
> >
> >
> >
> >
> >
> > ----- Original Message ----
> > From: "Sise, Mike MD"
> <Sise.Mike at scrippshealth.org>
> > To: trauma-list at trauma.org
> > Sent: Monday, February 25, 2008 4:50:18 AM
> > Subject: RE: trauma-list Digest, Vol 56, Issue 28
> >
> > This case re-emphasizes the importance of
> post-mortem examination
> > following every death from injury. Even the most
> aggressive and
> > comprehensive pre-mortem CT or MRI imaging can
> substitute for the old
> > fashion autopsy. We can speculate until our next
> birthdays, there is no
> > answer without a post-mortem. In San Diego, we
> don't present our deaths to
> > our system wide Medical Audit Committee until the
> post-mortem results are
> > ready and a member of the County Medical
> Examiner's physician staff joins us
> > for the discussion.
> >
> > Mike Sise
> > San Diego
> >
> > ________________________________
> >
> > From: trauma-list-bounces at trauma.org on behalf of
> > trauma-list-request at trauma.org
> > Sent: Mon 2/25/2008 4:00 AM
> > To: trauma-list at trauma.org
> > Subject: trauma-list Digest, Vol 56, Issue 28
> >
> >
> >
> > Send trauma-list mailing list submissions to
> > trauma-list at trauma.org
> >
> > To subscribe or unsubscribe via the World Wide
> Web, visit
> >
> http://list.mistral.net/mailman/listinfo/trauma-list
> > or, via email, send a message with subject or body
> 'help' to
> > trauma-list-request at trauma.org
> >
> > You can reach the person managing the list at
> > trauma-list-owner at trauma.org
> >
> > When replying, please edit your Subject line so it
> is more specific
> > than "Re: Contents of trauma-list digest..."
> >
> >
> >
> > "Scripps Information Security"
> >
> >
>
------------------------------------------------------------------------------
> > This e-mail and any files transmitted with it may
> contain privileged and
> > confidential information and are intended solely
> for the use of the
> > individual or entity to which they are addressed.
> If you are not the
> > intended recipient or the person responsible for
> delivering the e-mail to
> > the intended recipient, you are hereby notified
> that any dissemination or
> > copying of this e-mail or any of its attachment(s)
> is strictly prohibited.
> > If you have received this e-mail in error, please
> immediately notify the
> > sending individual or entity by e-mail and
> permanently delete the original
> > e-mail and attachment(s) from your computer
> system. Thank you for your
> > cooperation.
> >
> >
> >
> >
>
==============================================================================
> >
> >
> >
> > -----Inline Attachment Follows-----
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> > ------------------------------
> >
> > Message: 11
> > Date: Mon, 25 Feb 2008 14:35:24 -0800 (PST)
> > From: Ivan Hronek <ivanhronek at yahoo.com>
> > Subject: etiology of bradycardia in spinal
> > To: "Trauma & Critical Care mailing list"
> <trauma-list at trauma.org>
> > Cc: Anesthideas at yahoogroups.com
> > Message-ID:
> <98250.9189.qm at web62309.mail.re1.yahoo.com>
> > Content-Type: text/plain; charset=iso-8859-7
> >
> > That's all I got Yaghi..
> >
> > Summary
> > While many factors can contribute to cardiac
> arrest during spinal
> > anesthesia, vagal responses to hypovolemia often
> play a key role. It is well
> > established that vagal responses can be triggered
> by decreases in preload.
> > JB Pollard, Stanford.
> >
>
http://www.apsf.org/resource_center/newsletter/2001/fall/04cardiac.htm
> >
> >
> >
> > It is postulated that the etiology
> > of the bradycardia and asystole might be
> > a reflex mechanism such as the Bezold-Jarisch
> > reflex (4). H.Hyderally, Mt. Sinai J Med. 1/2
> 2002.
> >
> http://www.mssm.edu/msjournal/69/v69_1&2_055_056.pdf
> >
> >
> > High levels of spinal or epidural blockade can
> produce severe hypotension.
> > In a review of closed claims of patients who
> suffered perioperative cardiac
> > arrest, a series of cases were identified that
> involved generally healthy
> > patients undergoing spinal anesthesia.[178] Common
> features of these cases
> > and subsequent case series[179] included high
> dermatomal levels of spinal
> > anesthesia, liberal use of sedatives, and
> hypotension accompanied by
> > bradycardia. The authors noted that adverse
> outcomes seemed to be associated
> > with delays in recognition of the problem, delays
> in instituting airway
> > support (particularly in sedated patients), and
> delays in administration of
> > direct-acting combined á- and â-adrenergic
> agonists such as epinephrine.
> > Although mild degrees of hypotension generally
> respond well to
> > indirect-acting sympathomimetics such as ephedrine
> or incremental dosing of
> > phenylephrine, the combination of severe
> hypotension and significant
> > bradycardia under
> > spinal anesthesia should in most clinical
> settings be treated promptly
> > with incremental dosing of epinephrine.
> > (Miller textbook)
> >
> > When properly conducted, spinal anesthesia has
> proved to be extremely
> > safe. Caplan and associates[109] identified 14
> cases of sudden cardiac
> > arrest in healthy patients receiving spinal
> anesthesia. Because these cases
> > seemed to appear suddenly after stable hemodynamic
> status, they concluded
> > that a poorly understood potential exists for
> sudden cardiac arrest in
> > healthy patients. It can be debated whether this
> represented a lack of
> > vigilant monitoring and treatment as opposed to
> some mysterious physiologic
> > explanation.[128] It is clear that hypoxemia and
> oversedation are not
> > required for severe bradycardia and asystole to
> develop during
> > well-conducted spinal anesthesia.[49][129]
> Likewise, it is clear that the
> > development of severe brady-cardia after spinal
> anesthesia is not a new
> > phenomenon but has been recognized for many
> years.[130][131] In any case, it
> > should be emphasized that cardiovascular changes
> can occur rather suddenly
> > after spinal anesthesia, and
> > as Auroy and colleagues[114] highlight, these
> events continue to occur.
> > (Miller textbook)
> >
> >
> > 128. Zornow MH, Scheller MS: Cardiac arrest during
> spinal anesthesia
> > [letter]. Anesthesiology 1988; 68:970.
> > 129. Mackey DC, Carpenter RL, Thompson GE, et al:
> Bradycardia and asystole
> > during spinal anesthesia: A report of three cases
> without morbidity.
> > Anesthesiology 1989; 70:866.
> > 130. Thompson KW: Fatalities from spinal
> anesthesia. Anesth Analg 1934;
> > 13:75.
> > 131. Wetstone DL, Wong KC: Sinus bradycardia and
> asystole during spinal
> > anesthesia. Anesthesiology 1974; 41:87.
> >
> > Ivan Hronek MD
> > SFMC, Los Angeles
> > cell: 310 487-3288
> > http://health.groups.yahoo.com/group/Anesthideas/
> > Don't fight darkness. Bring the light, and
> darkness will disappear.
> > Maharishi Mahesh Yogi
> >
> >
> >
> > Confidentiality Notice: This transmission and any
> attached documents may
> > be confidential and contain information protected
> by State and Federal
> > Medical Privacy statutes and is legally
> privileged. They are intended for
> > use only by the addressee. If you are not the
> intended recipient of this
> > transmission, or an agent of the intended
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> > received this transmission in error, please accept
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> > me at ivanhronek at yahoo.com and delete the entire
> message and its
> > attachments. Thank you. Disclaimer: this message
> contains the personal views
> > of the author. The author will not be responsible
> in any way for procedures
> > or approaches perfomed in the way suggested in
> this note.
> >
> >
> >
> >
> >
> >
> >
> > ----- Original Message ----
> > From: aktham yaghi <yaktham at gmail.com>
> > To: "Trauma &, Critical Care mailing list"
> <trauma-list at trauma.org>
> > Sent: Monday, February 25, 2008 7:58:46 AM
> > Subject: Re: cause of hypotension in shock/trauma
> >
> > Ivan
> > Then
> > My question is why do you see bradycrdia with
> hypotension in spinal
> > anaesthesia (Lumber L2-3) not due to the dose of
> local anaesthetics?
> > Aktham Yaghi MD
> > FNsP, Bratislava, Ruzinov- ICU- KAIM
> > Clinic of Anaesthesia and Intensive Care Medicine
> > Comenius University,Faculty of Medicine
> > Ruzinovska 6
> > 82606 Bratislava
> > Slovak Republic
> > yaktham at gmail.com
> >
> > 2008/2/24 IVAN HRONEK <ih7 at msn.com>:
> >
> > > Neurogenic shock is hypotension with or without
> bradycardia - depending
> > on
> > > the cause - in high spinal cord lesions they
> will be bradycardic as to
> > the
> > > interruption of cardiac sympathetic
> accelerators. In neurogenic shock
> > due to
> > > brain lesion or thoracic spine injury the
> bradycardia is not necessarily
> > > present. The term is "relative bradycardia" i.e.
> heart rate not
> > > appropriate to the degree of hypotension ..which
> your patient actually
> > could
> > > be told to have - a HR of 110/min in a young man
> with a barely palpable
> > > pulse is certainly not a high enough reflex
> heart rate, you'd expect at
> > > least 140 / min or so.
> > > The problem with teaching about shock is that
> the bradycardia is the one
> > > thing one can easily remember about spinal shock
> - however, it does not
> > have
> > > to be present and then everyone is surprised.
> > > As dr. M. would say, a gentle clinician's touch
> is required here - this
> > is
> > > the time to use it - the diff.dg is clinical
> and that is whether or not
> > > the patient's skin is cold and clammy or warm
> and dry - hypovolemic vs.
> > > neurogenic shock.
> > >
> > >
> > >
> > >
> > >
> > >
> > >
> > > Patients with neurogenic shock are hypotensive
> and usually have warm,
> > dry
> > > skin.8 Bradycardia is characteristic but not
> universal.
> > >
> ...www.accessmedicine.com/content.aspx?aID=588768 -
> Similar pages
> > >
> > >
> > >
> > --
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> >
> > ------------------------------
> >
> > Message: 12
> > Date: Tue, 26 Feb 2008 06:46:22 -0500
> > From: "Ronald Gross" <Rgross at harthosp.org>
> > Subject: Re: "CATopsy" - postmortem CT.
> > To: "Trauma & Critical Care mailing list"
> <trauma-list at trauma.org>
> > Message-ID: <47C3B5BE.7FF1.00B9.0 at harthosp.org>
> > Content-Type: text/plain; charset=US-ASCII
> >
> > >>"the hospital will have to swallow the costs"<<
> > I want to work where you work. Some hospitals
> balk at paying physician
> > salaries because there are some folks that don't
> understand why, in a Level
> > I trauma center, the docs have to get paid even if
> they aren't seeing
> > patients the entire time they are in house. So,
> do you think they would pay
> > the cost of a procedure that won't help the bottom
> line????
> >
> > Good luck with that one,
> > Ron
> >
> >
> > >>> Ivan Hronek <ivanhronek at yahoo.com> 2/25/2008
> 5:06 PM >>>
> > the hospital will have to swallow the costs -
> there's not that many sudden
> > deaths that need to be explained and not all of
> them would get the CT scan.
> > It would be a great source of quality imrpovement
> and education - in the
> > paper they found esophageal intubation - imagine
> that !
> >
> > Ivan Hronek MD
> > SFMC, Los Angeles
> > cell: 310 487-3288
> > http://health.groups.yahoo.com/group/Anesthideas/
> > Don't fight darkness. Bring the light, and
> darkness will disappear.
> > Maharishi Mahesh Yogi
> >
> >
> >
> > Confidentiality Notice: This transmission and any
> attached documents may
> > be confidential and contain information protected
> by State and Federal
> > Medical Privacy statutes and is legally
> privileged. They are intended for
> > use only by the addressee. If you are not the
> intended recipient of this
> > transmission, or an agent of the intended
> recipient, you are prohibited from
> > reading, disclosing, printing, saving, copying,
> using, or otherwise
> > disseminating any information contained in this
> transmission. If you
> > received this transmission in error, please accept
> our apologies and notify
> > me at ivanhronek at yahoo.com and delete the entire
> message and its
> > attachments. Thank you. Disclaimer: this message
> contains the personal views
> > of the author. The author will not be responsible
> in any way for procedures
> > or approaches perfomed in the way suggested in
> this note.
> >
> >
> >
> >
> >
> >
> >
> > ----- Original Message ----
> > From: Ronald Gross <Rgross at harthosp.org>
> > To: "Trauma & Critical Care mailing list"
> <trauma-list at trauma.org>
> > Sent: Monday, February 25, 2008 7:17:20 AM
> > Subject: Re: "CATopsy" - postmortem CT.
> >
> > That would be ideal, but - and I hate to sound
> like this - who is going to
> > pay the cost of said CT postmortem exam?
> >
> > Ron
> >
> > >>> Ivan Hronek <ivanhronek at yahoo.com> 2/25/2008
> 9:26 AM >>>
> > Any way to instititute CATopsy - that would be
> great self-education -
> > immediately learning the cause of death !
> > We rarely are allowed to do any autopsies and then
> when the results come 8
> > months later noone remembers the case anymore.
> >
> > Fulltext | PDF (558 K)
> > Postmortem Computed Tomography, "CATopsy",
> Predicts Cause of Death in
> > Trauma Patients.
> >
> > Original Articles
> > Journal of Trauma-Injury Infection & Critical
> Care. 63(5):979-986,
> > November 2007.
> > Hoey, Brian A. MD; Cipolla, James MD; Grossman,
> Michael D. MD; McQuay,
> > Nathaniel MD; Shukla, Pratik R. MD; Stawicki,
> Stanislaw P. MD; Stehly,
> > Christy BS; Hoff, William S. MD
> > Abstract:
> > Background: The autopsy remains the gold standard
> for evaluating traumatic
> > deaths. The number of autopsies performed has
> declined dramatically. This
> > study examines whether postmortem computed
> tomography ("CATopsy") can be
> > used to determine cause of death in trauma
> patients.
> > Methods: Patients who presented to the trauma
> service and subsequently
> > died within the first 24 hours of their
> hospitalization were prospectively
> > enrolled. Any patient who underwent a major
> invasive procedure within this
> > time frame was excluded. After pronouncement of
> death, each patient had a
> > CATopsy performed, which was a noncontrast whole
> body scan. The patient then
> > underwent an autopsy. These results were compared
> with those generated by
> > the CATopsy.
> > Results: There were 12 patients enrolled in the
> study; average Injury
> > Severity Scores was 33.5 +/- 19.0. In 10 of the 12
> cases (83%), the
> > CATopsy successfully indicated cause of death when
> compared with the
> > autopsy. Seven of the 12 (58%) CATopsies
> demonstrated air in various parts
> > of the circulatory system, including the heart in
> four cases. Five of the 12
> > (42%) patients had clinically significant findings
> (including the presence
> > of an esophageal intubation) noted on the CATopsy
> not previously identified
> > on any radiographic studies or on the autopsy.
> These findings were addressed
> > as part of our performance improvement process.
> > Conclusion: This study suggests that a postmortem
> imaging test, a CATopsy,
> > can be used to determine cause of death in trauma
> patients. Beyond offering
> > a noninvasive alternative to autopsy, it provides
> similar information to
> > that provided in postmortem examination and may be
> used in trauma
> > performance improvement activities.
> >
> > Ivan Hronek MD
> > SFMC, Los Angeles
> > cell: 310 487-3288
> > http://health.groups.yahoo.com/group/Anesthideas/
> > Don't fight darkness. Bring the light, and
> darkness will disappear.
> > Maharishi Mahesh Yogi
> >
> >
> >
> > Confidentiality Notice: This transmission and any
> attached documents may
> > be confidential and contain information protected
> by State and Federal
> > Medical Privacy statutes and is legally
> privileged. They are intended for
> > use only by the addressee. If you are not the
> intended recipient of this
> > transmission, or an agent of the intended
> recipient, you are prohibited from
> > reading, disclosing, printing, saving, copying,
> using, or otherwise
> > disseminating any information contained in this
> transmission. If you
> > received this transmission in error, please accept
> our apologies and notify
> > me at ivanhronek at yahoo.com and delete the entire
> message and its
> > attachments. Thank you. Disclaimer: this message
> contains the personal views
> > of the author. The author will not be responsible
> in any way for procedures
> > or approaches perfomed in the way suggested in
> this note.
> >
> >
> >
> >
> >
> >
> >
> > ----- Original Message ----
> > From: "Sise, Mike MD"
> <Sise.Mike at scrippshealth.org>
> > To: trauma-list at trauma.org
> > Sent: Monday, February 25, 2008 4:50:18 AM
> > Subject: RE: trauma-list Digest, Vol 56, Issue 28
> >
> > This case re-emphasizes the importance of
> post-mortem examination
> > following every death from injury. Even the most
> aggressive and
> > comprehensive pre-mortem CT or MRI imaging can
> substitute for the old
> > fashion autopsy. We can speculate until our next
> birthdays, there is no
> > answer without a post-mortem. In San Diego, we
> don't present our deaths to
> > our system wide Medical Audit Committee until the
> post-mortem results are
> > ready and a member of the County Medical
> Examiner's physician staff joins us
> > for the discussion.
> >
> > Mike Sise
> > San Diego
> >
> > ________________________________
> >
> > From: trauma-list-bounces at trauma.org on behalf of
> > trauma-list-request at trauma.org
> > Sent: Mon 2/25/2008 4:00 AM
> > To: trauma-list at trauma.org
> > Subject: trauma-list Digest, Vol 56, Issue 28
> >
> >
> >
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>
> --
> Stephen L. Richey, CRT
>
> "It is better to know some of the questions than all
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> Thurber
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