Blunt Splenic Injuries

[Ronald Gross]

If non-operative management is successful, I allow the Grade I patients back to regular activity at 2-3 months, including contact sports if they so choose, remembering, however, that there was no post injury RE-scanning.  Any higher grade I will not allow back to anything other than sedentary activity for 6 months.  I admit that this is purely arbitrary, with not a shred of good evidence to support this practice -  other than what these patients' spleens used to look like on followup scans when I did scan them to follow the "healing process" (and that was a very long time ago!).

As to vaccines, I do vaccinate all patients that have been angio-embolized, regardless of whether the gelfoam and/or coils were placed "selectively" or proximally.  Given the variance of "opinion/evidence" about the correct timing of post-splenectomy vaccination, I give the vaccines to the  patient in the recovery room, lest I (or someone else) forget to give it to them on discharge!

Just my 2 cents,
Ron

>>> <nappio at aol.com> 5/7/2008 2:39 PM >>>
What activities can they pursue and when?  Including rough sports.  Do you give vaccines?  DN
Sent from my Verizon Wireless BlackBerry

-----Original Message-----
From: "Matthew Reeds" <mgreeds at reeds.uk.com>

Date: Wed, 7 May 2008 19:29:20 
To:"'Trauma &amp; Critical Care mailing list'" <trauma-list at trauma.org>
Subject: Blunt Splenic Injuries


If the patient is "stable" (translated to mean that the patient is not
having their "spleen preserved in a bucket") then, at least in our hospital,
they would be observed on the HDU for the first 24-48 hours. Like what used
to happen with Tim previously, grade is not a factor as to where they go as
there is not a "normal" dedicated trauma ward. If the patient shows no
clinical change after this time (they will have check Hb with HCT 12 hourly
- not 4 hourly like Tim's previous unit) and other vital signs remain
unchanged, then they get transferred to a general ward. I would not get
obsessed with specific observational readings such as BP & HR etc. - as it
is the patient's clinical condition that counts (treat the patient not the
numbers etc.) It is a change in the patient's vital signs that would warrant
reassessment of conservative management and not absolute values. After 2-4
days, if the patient remains well, they would be discharged home. Like Tim,
there is no further imaging or follow-up.

 

I agree with Ron that if transferring the patient to ITU is being
considered, then the patient is not "stable" and cannot be managed
conservatively (as the old saying goes - stable = a place for horses with
mess on the floor!!) In that case, I question the role for preserving the
spleen with angio rather than in a bucket. I also agree with Ron in that the
patient should not be transferred straight from the ED to ITU.

 

 

Matthew

 

 

-----Original Message-----
From: Ian Seppelt [mailto:seppeli at wahs.nsw.gov.au] 
Sent: 07 May 2008 07:50
To: trauma-list at trauma.org 
Subject: Blunt splenic injuries

 

Quick and dirty survey:

 

Where do you nurse haemodynamically stable patients with an isolated

spleen injury being managed conservatively, and no other injuries? ICU?

General ward? Higher acuity ward?

What acuity of nursing? What monitors? 

Does the exact CT grade of injury matter, or merely the fact that the

patient is stable and the trauma surgeon is comfortable to watch?

 

Many thanks,

 

Ian

 

correspondence to: seppelt at med.usyd.edu.au 

 

Ian Seppelt FANZCA FJFICM

Senior Staff Specialist

Dept of Intensive Care Medicine

The Nepean Hospital, PO Box 63 Penrith NSW 2751

Director of Clinical Research, Sydney West AHS

Clinical Lecturer, University of Sydney

 

____________________________________________________________________________
__

 

This electronic message and any attachments may be confidential.  If you

are not the intended recipient of this message would you please delete the

message and any attachments and advise the sender. Sydney West

Area Health Service (SWAHS) uses virus scanning software but excludes 

any liability for viruses contained in any email or attachment.

 

This email may contain privileged and confidential information intended

only for the use of the addressees named above. If you are not the

intended recipient of this email, you are hereby notified that any use,

dissemination, distribution, or reproduction of this email is prohibited. If

you have received this email in error, please notify SWAHS

immediately. 

 

Any views expressed in this email are those of the individual sender 

except where the sender expressly and with authority states them 

to be the views of SWAHS.

 

--
trauma-list : TRAUMA.ORG
To change your settings or unsubscribe visit:
http://www.trauma.org/index.php?/community/