unusual case

[Dr Ross Hofmeyr]

Your description makes the motorcyclist in me cringe...

The other thing that makes me cringe is the mediastinum in the CXR.
Granted, although you don't mention it, I'm pretty sure it's a supine film,
it still looks far too wide for me to justify.  My eye is relatively
untrained with CT's and CTA's, so I can't pin a cause, but IF the patient
really is so stable and if the head men don't already want him under their
drills, my feeling is that a formal angio is the next logical step.

This one has my hackles up.

Dr Ross Hofmeyr
Expedition Leader  & Doctor
South African National Antarctic Expedition
ross.hofmeyr at sanae.sanap.ac.za
wildmedic at gmail.com
Tel: +2721 405 9428
Skype:  wildmedic
"Semper Paratus"

> -----Original Message-----
> From: trauma-list-bounces at trauma.org [mailto:trauma-list-
> bounces at trauma.org] On Behalf Of daniel simon
> Sent: 01 May 2008 03:29 PM
> To: trauma-list at trauma.org
> Subject: unusual case
> 
> 43 year old motorcycle crash victim , on scene intubation for GCS of 5. On
> admission intubated and ventilated, B.P 130/80 P 82 sat 100% , GCS 7 (T) .
> PE: skin lacerations and  central hematoma anterior neck - zone 1.
> Head CT - SAH, Frontal contusions,small Frontal SDH, many skull fractures.
> C-spine:  fracture of C1
> Chest XR and relevant cuts from the chest  CTA included.
> Abdominal CT normal
> What would you do now?