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<font size=3>Perhaps I didn't communicate it well, but the case I was
thinking of was reviewed and autopsy performed by a University Level I
Trauma Center who said that the patient I sent there only had one
significant injury - his torn AO.<br>
This was MANY years ago.<br>
He presented with BP 60/P after hitting a tree snow skiing.
Otherwise exam unremarkable. We fluid resuscitated at the ski
patrol facility until helicopter got there. After 3 liters of
saline, BP 100/60, immediately to 40/P and THEN lost breath sounds and
about 15 minutes later became pulseless in the helo - admittedly, the
helo crew (against my advice since by then I was suspicious of what was
happening) also tried to treat the absent breath sounds with McSwain
Darts, and of course the hemothorax was no longer contained. <br>
Had we not fluid loaded him (as most would NOT today), the thought
was he might well have survived. The dissection was probably stable
(had been for ~20 minutes) with his BP=60.<br>
However, he presented severely hypotensive, BP responded and then went to
40 (and zero when no longer contained) and ruptured AO dissection at
ligamentum arteriosum was the reported cause after the post.<br>
Although somewhat different, not clear why that scenario wouldn't fit
here, particularly if he had any other injury. <br><br>
Lorick<br><br>
<br>
At 07:32 PM 2/24/2008, you wrote:<br>
<blockquote type=cite class=cite cite="">Contained mediastinal hemotoma
is NOT responsible for hypotension. <br>
<br>
k<br>
<br>
<br>
In a message dated 2/24/2008 11:25:08 A.M. Central Standard Time,
<br>
Lorick@Lorick.org writes:<br><br>
If a deceleration injury, could have had AO dissection at
ligamentum <br>
arteriosum and with the increased pressure totally ruptured the aneurysm
so what <br>
blood hadn't leaked was lost at that point.<br><br>
<br><br>
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