Disagree.<BR> <BR>We haven't used oral contrast in over 5 years. At first, the radiologists protested, but we were able to demonstrate that the risks of aspiration far outweigh any putative benefits. <BR> <BR>There is no strong evidence that using oral contrast enhances diagnosis of bowel injury (which is notoriously poorly sensitive by CT), and there are no data that show that a 3-4 hour "delay" in diagnosis is harmful. Indeed, we often make the diagnosis of bowel injury based solely on free fluid in the pelvis and CT changes in the mesentery. On the other hand, waiting 60-120 minutes for the CT (if you are using oral contrast that is what you would need to do, otherwise why use it?) and more importantly, dealing with emesis and possible aspiration is not an infrequent event. <BR> <BR>Use of oral contrast for CT fails a critical "once again, tell me why are we doing this?" test. It's going the way of the cross table lateral C-spine x-ray into the dust bin of "we used to do this until we thought about it" history.<BR> <BR>Jeff Hammond<BR> <BR>Jeffrey Hammond MD, MPH<BR>Chief, Trauma/Surgical Critical Care<BR>Robert Wood Johnson Medical School<BR>New Brunswick, NJ<BR><BR>----- Original Message -----<BR>From: Sanjay Gupta MD <sanjaygupta99_91@yahoo.com><BR>Date: Wednesday, December 26, 2007 9:43 am<BR>Subject: Re: BAT<BR>To: "Trauma &amp, Critical Care mailing list" <trauma-list@trauma.org><BR><BR>> In almost all trauma centers, patients with BAT are<BR>> scanned without PO contrast. You might miss bowel<BR>> injuries and duodenal injuries this way, but that is<BR>> far safer than waiting for 3-4 hours. <BR>> <BR>> <BR>> When we go to our regional meetings, the message that<BR>> we try to spread to the small ERs and hospitals is<BR>> that if they have a major trauma patient, a CT scan<BR>> will just delay their management. If the patient is<BR>> hemodynamically unstable, he needs an intervention -<BR>> either laparotomy, chest tube etc in that center and<BR>> if he or she is stable, then he needs to be<BR>> transferred to a trauma center. If the referring<BR>> facility thinks that the patient has no major<BR>> injuries, a CT scan to confirm that and avoid the<BR>> journey and aggravation for the patient and cost to<BR>> the health system is certainly justified.<BR>> <BR>> <BR>> <BR>> An opinion from the senior members of the list will be<BR>> appreciated.<BR>> <BR>> <BR>> <BR>> Sanjay<BR>> <BR>> <BR>> <BR>> --- Trauma Doc <miamitraumasurgeon@gmail.com> wrote:<BR>> <BR>> > Waiting 2 hours is not necessary and may be<BR>> > dangerous. PO contrast adds<BR>> > very little. Water soluble contrast down the NGT or<BR>> > taken PO within a few<BR>> > minutes of the scan is fine and may help identify a<BR>> > proximal duodenal<BR>> > injury, if present. As for waiting for a reading,<BR>> > that is also not<BR>> > necessary and may be dangerous. The high potential<BR>> > for rapid decompensation<BR>> > always exists. All CT imaging is read by us (trauma<BR>> > surgeons) as soon as<BR>> > the images are available, which is generally before<BR>> > the patient is even off<BR>> > the scanner. A radiologist reviews the scans at a<BR>> > later time. Although we<BR>> > may miss tiny injuries (a thoracic transverse<BR>> > process fracture for example),<BR>> > solid organ injury, free air, free fluid,<BR>> > pneumothoraces, and vascular<BR>> > injuries (thoracic and abdominal) are easily<BR>> > identified even by the<BR>> > neophyte. Additionally, a brief look at brain CT<BR>> > imaging will easily<BR>> > identify lesions that require emergent neugosurgical<BR>> > intervention.<BR>> > <BR>> > <BR>> > ><BR>> > > Today's Topics:<BR>> > ><BR>> > > 1. BAT (ccrone@charter.net)<BR>> > > 2. Re: BAT (SJASMD@aol.com)<BR>> > > 3. Re: BAT (Gad Shaked)<BR>> > > 4. Re: BAT (Ronald Gross)<BR>> > ><BR>> > ><BR>> > ><BR>> ><BR>> -----------------------------------------------------------------<BR>> -----<BR>> > ><BR>> > > Message: 1<BR>> > > Date: Mon, 24 Dec 2007 21:37:46 -0800<BR>> > > From: <ccrone@charter.net><BR>> > > Subject: BAT<BR>> > > To: trauma-list@trauma.org<BR>> > > Message-ID:<BR>> > <20071225003746.SVITD.115026.root@fepweb13><BR>> > > Content-Type: text/plain; charset=utf-8<BR>> > ><BR>> > > I work at a small, rural ER (about 18, 000 annual<BR>> > ED volume). We have no<BR>> > > FAST/Ultrasound immediately available at all<BR>> > times. If we have a case of<BR>> > > blunt abdominal trauma & order a CT scan, our<BR>> > radiologist demands that we<BR>> > > have the patient drink oral contrast & wait 2<BR>> > hours for the CT to be<BR>> > > performed. It then takes another 30 minutes for<BR>> > the report to be<BR>> > > obtained. What do other institutions currently<BR>> > do regarding the use of<BR>> > > oral contrast when obtaining abdominal/pelvic CT's<BR>> > for blunt abdominal<BR>> > > trauma in a hemodynamically stable patient-- with<BR>> > suspected internal<BR>> > > injuries?<BR>> > ><BR>> > > Thanks<BR>> > ><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>> > <BR>> <BR>> <BR>> Sanjay Gupta<BR>> Tel: 412 335 6304<BR>> <BR>> <BR>> <BR>> ____________________________________________________________________________________Be a better friend, newshound, and <BR>> know-it-all with Yahoo! Mobile. Try it now. <BR>> http://mobile.yahoo.com/;_ylt=Ahu06i62sR8HDtDypao8Wcj9tAcJ <BR>> <BR>> --<BR>> trauma-list : TRAUMA.ORG<BR>> To change your settings or unsubscribe visit:<BR>> http://www.trauma.org/index.php?/community/