<html><div style='background-color:'><P>Diagnostic laparoscopy is an extremely useful tool for the evaluation of penetrating trauma of the anterior abdominal wall. If the exam is negative, patients can be discharged after routine postop recovery. Guys it's 2007 not 1957.<BR><BR> TS</P><BR><BR><BR>
<DIV>NOTHING SPLENDID Has Ever Been Achieved Except By Those Who DARED BELIEVE THAT SOMETHING INSIDE THEM Was Superior to CIRCUMSTANCE</DIV>
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From: <I>Michael Bayme <mbayme@bgu.ac.il></I><BR>Reply-To: <I>"Trauma &amp; Critical Care mailing list" <trauma-list@trauma.org></I><BR>To: <I>"Trauma &amp; Critical Care mailing list" <trauma-list@trauma.org></I><BR>Subject: <I>Re: stab wounds to anterior abdomen</I><BR>Date: <I>Thu, 10 May 2007 09:00:25 +0300</I><BR>>Funny, but we do the exact opposite. Not many of our patients will <BR>>lie still for a thorough exploration of the wound, and so what if <BR>>there's penetration of the peritoneum. With the right population you <BR>> still have over 50% chance of then performing a non-therapeutic <BR>>laparotomy. It's the surgical equivalent of VOMIT!<BR>><BR>>We have a well-defined protocol for observation - really, is it so <BR>>tough to examine someone once every couple of hours? Vital signs <BR>>every couple of hours? Tenderness
remote from the stab wound or <BR>>vital signs outside our limits leads to exploration.<BR>><BR>>The key is a good protocol, will exclusion criteria well-defined.<BR>><BR>>Michael<BR>>On May 10, 2007, at 7:43 AM, Errington Thompson wrote:<BR>><BR>>>What is your comfort level? I like wound explorations in patients <BR>>>that will<BR>>>be still. It doesn’t take long. I can washout the wound and close <BR>>> it in 15<BR>>>- 20 minutes. The key seeing the whole wound. You need good <BR>>>lighting. If<BR>>>you don't have that then go to the OR and do the same thing. IN <BR>>>the OR use<BR>>>your retractors see everything. Don't guess. If the peritoneum is <BR>>>violated<BR>>>open the patient. If it isn't then close the wound and send the <BR>>>patient<BR>>>home.<BR>>><BR>>>Serial
abdominal exams are labor intensive. Would not use unless <BR>>>you have<BR>>>residents and an excellent nursing staff. Need to monitor these <BR>>>patients.<BR>>><BR>>>I use CT a lot in abdominal trauma but not really for evaluation of <BR>>> the<BR>>>anterior abdomen with a penetrating wound.<BR>>><BR>>>My 2 cents.<BR>>><BR>>>Errington C. Thompson, MD, FACS, FCCM<BR>>>Trauma/Surgical Critical Care<BR>>>Mission Hospital<BR>>>Asheville, NC<BR>>>Author - A Letter to America<BR>>>www.whereistheoutrage.net<BR>>><BR>>><BR>>>Everyone deserves to make an informed decision<BR>>> - Errington Thompson, MD<BR>>><BR>>><BR>>>-----Original Message-----<BR>>>From: trauma-list-bounces@trauma.org [mailto:trauma-list- <BR>>>bounces@trauma.org]<BR>>>On
Behalf Of Abdullah Harthy<BR>>>Sent: Wednesday, May 09, 2007 9:40 PM<BR>>>To: Trauma &amp; Critical Care mailing list<BR>>>Subject: stab wounds to anterior abdomen<BR>>><BR>>>I was recently presenting a case scenario to a group<BR>>>of surgical residents, and we had a bit of a debate on<BR>>>how to manage pt.. with stab wound to the anterior<BR>>>abdomen (not in the cardiac box), hemodynamically<BR>>>stable, no peritonitis. Wound exploration, CT abdomen<BR>>>vs. serial abdominal exam.<BR>>>I'd like to know the group practice is (considering a<BR>>>lot of our patients are intoxicated with one thing or<BR>>>another). I would also appreciate referrences if<BR>>>available. How low is your threshold for an<BR>>>explorative laprotomy.<BR>>><BR>>>Abdullah Al-
Harthy<BR>>><BR>>><BR>>> Get news delivered with the All new Yahoo! Mail. Enjoy RSS <BR>>>feeds<BR>>>right on your Mail page. Start today at<BR>>>http://mrd.mail.yahoo.com/try_beta?.intl=ca<BR>>>--<BR>>>trauma-list : TRAUMA.ORG<BR>>>To change your settings or unsubscribe visit:<BR>>>http://www.trauma.org/index.php?/community/<BR>>><BR>>><BR>>>--<BR>>>trauma-list : TRAUMA.ORG<BR>>>To change your settings or unsubscribe visit:<BR>>>http://www.trauma.org/index.php?/community/<BR>><BR>>Michael J. Bayme, M.D., FACS<BR>>Soroka University Medical Center<BR>>Beer-Sheva, Israel<BR>><BR>><BR>><BR>>--<BR>>trauma-list : TRAUMA.ORG<BR>>To change your settings or unsubscribe visit:<BR>>http://www.trauma.org/index.php?/community/<BR></FONT></BLOCKQUOTE></div><br
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