Blunt splenic injuries

[julie miller]

Dear Ian,
We send patients with grade IV or V to ICU for the first day (we don't have an HDU), as our ward nurses are stretched somewhat thin. We know then that a new tachycardia or drop in urine output will be picked up earlier than if they are on the ward. I also like to vaccinate the high grade spleens just in case the spleen will be taking a walk.  If there is a  contrast blush on CT, or a drop in Hb in the first day with markedly increased blood on a repeat CT (obtained only if drop in Hb), we have recently begun requesting angioembolization from our very accommodating interventional radiologists.All things being equal, it's better to have  your spleen than not (many patients retain splenic function after embolization), and it is better not to have a laparotomy than to have one (no incisional hernias, shorter LOS, etc). 
We typically keep patients 3 days if they have stable Hb and have no ileus. I recently saw some great data from the NTDB with many thousands of patients, that 95% of failures occur in the first 72 hours, then the curve flattens completely and you would have to keep patients 30 days to capture 99% of failures. (published J Trauma 2008) The main thing is to encourage patients to take it easy, and to return if they feel unwell, dizzy, etc. after discharge. I cannot recall any readmissions for spleens, but we had one renal injury return with collapse from a ruptured psuedoaneurysm that was successfully embolized. 
Julie Miller
Royal Melbourne Hospital
Australia



----- Original Message ----
From: Matt Oliver <moliverzw at gmail.com>
To: "Trauma & Critical Care mailing list" <trauma-list at trauma.org>
Sent: Wednesday, May 7, 2008 10:29:53 PM
Subject: RE: Blunt splenic injuries

Ian

ICU for 24 hours.

Matt Oliver
Bendigo
Australia

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of Ian Seppelt
Sent: Wednesday, 7 May 2008 4:50 PM
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

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