Blunt Splenic Injuries

[sjasmd at aol.com]

matthew
what are you questioning about angio. Do you think that splenectomy is preferable to splenic salvage? Do you have difficulties with angio or are your interventionalists not particularly useful, interested, adept at trauma care?


sal


-----Original Message-----
From: Matthew Reeds <mgreeds at reeds.uk.com>
To: 'Trauma &amp; Critical Care mailing list' <trauma-list at trauma.org>
Sent: Wed, 7 May 2008 2:29 pm
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

 

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