<html><div style='background-color:'><DIV class=RTE>Dear list,</DIV>
<DIV class=RTE>would like your coments on a recent case as i am planning to review the case for lessons learned:</DIV>
<DIV class=RTE> </DIV>
<DIV class=RTE>39 year old female, penetrating injury from a knife right posterior torax level 6/7 rib. Found on the streat, brought in to our small hospital by the ambulance (personal not qualified for bringing in infusions- unfortunatly the medicalized ambulance was occupied with an MI), pacient entered our ED following signs: A- clear B/ sat 80%, dimished breath sounds right hand side C/ pulse 130 RR 80/30 (class 3 shock). D glasgow 9 (hipoperfusion). </DIV>
<DIV class=RTE>RxTorax: hematotorax right hand side, pneumotorax right hand side with shift of of the mediastinum tio the left.</DIV>
<DIV class=RTE>Pacient was intubated while the surgeon placed a chest tube right hand side which produced 1,500-2000 ml blood and air.</DIV>
<DIV class=RTE>Libral fluid infusion first o negative then type specific without respons (4 concentrats and 2 L saline)- tensions remain same.</DIV>
<DIV class=RTE> </DIV>
<DIV class=RTE>At this moment ther is a medicalized ambulance waiting to bring the pacient to the nearest trauma center (35-40 minutes). Ours is a small hospital, 1 surgeon who happened to be new but with some experiance in toractomy, last toracotomy performed about 8 years ago</DIV>
<DIV class=RTE> </DIV>
<DIV class=RTE>question: toractomy or transport to traumacenter (easy answer for people who deal with these cases everyday)</DIV></div><br clear=all><hr>Play online games with your friends with <a href="http://g.msn.com/8HMAENNL/2746??PS=47575" target="_top">Messenger</a> </html>