Wednesday, April 27, 2005

Tales from the Trauma Service IX......
20-ish female in a multi-vehicle MVC. Arrives to the ED in the midst of a grand-mal seizure. Intubated and given sedatives and anti-seizure medications. Gets a CT of head, c-spine, and abdomen pelvis with the following images of note:

This was read out as "unusual attenuation of small bowel which could represent bleeding or inflammation" and "free fluid within pelvis". I can buy the free fluid. The solid organs were "without traumatic injury".
While getting better the main weakness of abdominal CT is the ability to detect small bowel injuries. If this patient had not been intubated and head injured I probably would have done the old "serial exam" routine. Her WBC's were 14.5k and her amylase was at the high end of normal.
Off to the OR.....
Found about 200cc of old-looking blood. Bowel run from the LOT to the rectum without any signs of injury. Liver OK, stomach and pancreas OK, looked at the spleen and:

Left it alone since it was no longer bleeding. I felt guilty about exploring her but I would have felt more guilty about missing the injury.


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