View Full Version : Surg Chat: Trauma

03-21-2005, 08:16 PM
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[tunemedic45] hi
[tunemedic45] anyone awake
[arian] hi there!
[RussianJoo] hello
[RussianJoo] any one out there
[monterusca] hi everyone
[monterusca] where r u russian?
[drsamba] hi all..
[drsamba] i am a 1st timer here...wondering what happens here :)
[wael19664u] hi
Now entering USMLE_Step_2 subroom.
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[megs] hi dua
[dua_frank] himegs
[megs] hi sammy
[megs] everybody is ontime today...
[megs] thats good
[dua_frank] yeah
[dua_frank] shall we begin?
[samantha] hi megs and dua
[dua_frank] hi sammy
[megs] yeah sure dua
[dua_frank] what are indications for cricothyroidectomy?
[samantha] maxillary fractures?
[megs] strider
[dua_frank] problems where intubation cannot be done
[megs] on field dua
[dua_frank] like fractures of neck, massive facial trauma, acute laryngeal obstruction, epiglottitis, laryngeal trama or ludwig's angina
[megs] you always try intubation in hospital set up
[dua_frank] yeah but i asked for in general
[megs] ok
[dua_frank] do you ever do cricothyroidectomy in kids?
[megs] not herad dua
[megs] heard
[dua_frank] yeah never
[samantha] why dua?
[megs] whats the reason dua???
[dua_frank] contraindications to NGI?
[dua_frank] no reason
[dua_frank] just don't for peds
[dua_frank] unless as last resort
[dua_frank] sorry
[dua_frank] CI to nasotracheal intubation
[dua_frank] ?
[samantha] same as the other
[samantha] dua
[dua_frank] contraindications sammy, not indications
[dua_frank] they are any suspicion of basilar fracture, csf otorrhea, or maxillofacial injury
[megs] dunno dua
[megs] thanx dua
[ash] hi all
[dua_frank] welcome
[dua_frank] hi ash
[megs] hi ash
[samantha] thanx dua
[ash] have u guys started?
[dua_frank] welcome sammy
[samantha] hi ash
[ash] hi all
[dua_frank] yeah we decided to start on time and leave on time ash
[ash] oops sorry
[dua_frank] no problem :)
[dua_frank] we just couldn't afford to wait for all to come here, hope you didn't mind that
[ash] not atall
[ash] continue
[dua_frank] how do you control bleeding?
[dua_frank] pressure or tourniquet?
[ash] of?
[dua_frank] any trauma ash
[dua_frank] trauma today
[ash] ok
[samantha] pressure dua
[dua_frank] right sammy
[ash] tourniquet
[dua_frank] never tourniquet
[ash] ok
[megs] in case of cervical spine injury what will be the choice for establishing airway???
[dua_frank] dunno
[samantha] criothyroidectomy ?
[dua_frank] oops
[dua_frank] right
[dua_frank] cricothyroidectomy
[dua_frank] got confused there a minute
[megs] its ..endotracheal intubation
[dua_frank] thats a contraindication to ETI megs, isn't it?
[megs] u may think that ...
[megs] therefore i raised it dua
[dua_frank] the book says that :(
[ash] why megs
[megs] there is a q in uw...
[ash] hmmm
[megs] they say u can intubate without extension of neck
[dua_frank] oh
[dua_frank] thanks megs
[megs] lying flat ...
[samantha] thanx megs
[dua_frank] its conflicting to what kaplan says though
[dua_frank] what blood would you give if you wanted to give immediate transfusion?
[megs] o negative
[samantha] o neg
[dua_frank] right
[dua_frank] what drugs do you give to a patient of trauma with loss of consiousness immediately?
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[megs] dua i didnt get the q
[megs] can u tell more
[megs] mannitol to teduce ict???
[samantha] cortisol or epi?
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[samantha] sorry wrong
[dua_frank] what are the 3 most probably reasons for loss of consciousness?
[dua_frank] in trauma or otherwise?
[samantha] in trauma?
[dua_frank] its hypoglycemia, opiate intoxication and wernickes
[dua_frank] right?
[dua_frank] and these are reversible
[megs] intracraniel h rrahge
[dua_frank] so you can always give dextrose, thiamine and naloxone
[dua_frank] no harm
[samantha] i thought trauma pt
[dua_frank] after you have the patient stabilized, what kind of tests would you order?
[megs] do umean dua in a pt of truma with unconciousness u should give these drugs???
[megs] *) *) *)
[dua_frank] sammy, trauma could have resulted even with those 3 reasons
[dua_frank] yeah megs
[ash] megs thats what kaplan says
[dua_frank] trial drugs
[ash] but i have a doubt
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[megs] i agree that with unconcious pt...u give that
[samantha] ok thanx dua
[ash] what if it is a hyperosmolar coma?
[dua_frank] no harm except sometimes there might be reversal and a patient may become conscious
[ash] then dextrose will make it worse
[megs] but unconcious with thrauma..think about..other cause
[dua_frank] ash hehe you always take past history, diabetic or not,thats the first thign you ask
[samantha] yes u think of injury as the cause dua
[ash] dua what if there is unconscious pt on the road
[ash] blood should be sent immediately for analysis esp for glucose
[dua_frank] i asked that question to my professor once ash, and he told me that giving 50 ml of dextrose to a HODC patient will not harm him but might be life saving to a diabetic hypoglycemic coma patient
[dua_frank] because hypoglycemic coma is more common than Hyperosmolar coma
[ash] oh ok thanks dua
[samantha] agree dua
[ash] i really had that doubt
[megs] agree dua
[dua_frank] ofcourse after the blood works come, you can always stop dextrose and give insulin
[ash] right
[samantha] life saving comes first
[dua_frank] right
[megs] pt with head truma looses conciousness what will be next step???
[dua_frank] ABCs
[megs] after that???
[ash] ct?
[dua_frank] imaging
[megs] yes
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[dua_frank] yeah ct
[ash] what if a convex shadow?
[megs] if ct shows lenticular haematoma whats dx???
[dua_frank] epidural
[samantha] epi dural he
[ash] hehe megs same question
[megs] yup
[dua_frank] lol
[samantha] subdural hema
[ash] right samantha
[dua_frank] epi is concave?
[ash] subdural is right
[dua_frank] i always get confused
[ash] yes dua
[ash] yeah me too
[samantha] subdural has semilunar
[megs] epi is convex like lens
[samantha] agree megs
[megs] subdural is semilunar ...cresent shaped
[ash] subdural is convex like lens
[dua_frank] ash asked convex
[ash] acc. to kaplan
[ash] epi is concave
[megs] disagree ash
[megs] its opp
[samantha] epi is convex ash
[megs] epi is convex like lense...acc to kaplan...
[ash] someone please check kaplan
[ash] i am reading it now and in my book it says subdural is convex
[megs] its on page 3 right in front of me
[ash] and epidural is concave
[megs] dua , sammy u help pl
[dua_frank] checking
[ash] megs probably my book is old but in 2 places it is saying subdural lentiform and convex
[megs] ash lets clarify..with 3 rd opinian...its better to that
[ash] megs i am searching on the net.there it says what u r saying
[megs] so that our doubt will be clear
[dua_frank] ollections tend to conform to the shape of the brain and the cranial vault, exhibiting concave inner margins and convex outer margins
[dua_frank] this is subdural hematoma
[dua_frank] see dura is thick so anything below that will push the brain in and collect there
[dua_frank] so the inner margin will be concave and outer convex
[megs] old pt severe alcoholic came with mental detioration since past few weeks..whats dx???
[ash] well i checked on the net ,it says chronic subdural hematoma is convex and acute is concave
[megs] thanx dua
[dua_frank] oops opposite
[dua_frank] concave inner and convex outer
[dua_frank] ash *)
[dua_frank] be right back
[dua_frank] ack
[dua_frank] i mean back
[dua_frank] not ack
[ash] megs if your book is new then i am ready to blindly follow it.what does it say?
[dua_frank] lol ash
[dua_frank] wernickes megs
[ash] well guys kaplan is the bond
[dua_frank] thiamine deficiency
[dua_frank] or korsakoffs with confusion
[megs] dua its chronic subdural haematoma
[dua_frank] :O why?
[dua_frank] coz he doesn't remember the trauma?
[dua_frank] why can't it be wernickes megs?
[megs] few weeks history...and very old pt....atrophy..of brain...
[megs] dua exactly u got it
[megs] he fergets about trauma
[dua_frank] ah
[dua_frank] thanks
[dua_frank] nice q
[ash] agree
[samantha] is it subdural megs?
[megs] yes sammy
[ash] where do you see lucid interval?
[dua_frank] what kind of shock does acute pancreatitis have?
[dua_frank] epidural
[samantha] epi ash
[ash] right dua samantha
[samantha] hypo volumic dua
[megs] hypovolemic dua???
[dua_frank] right megs
[dua_frank] what electrolyte imbalance woudl you find in hypovolumic shock?
[dua_frank] explain why
[megs] pt with head truma...dies suddenly...can haemoorrhagic shock be reason for that???
[ash] unlikely
[megs] metabolic acidosis
[dua_frank] yes megs
[megs] correct ash
[dua_frank] can you explain why MA megs?
[ash] what condition will give a pt. the worst headache of his life?
[dua_frank] SAH
[samantha] subdural
[ash] right dua
[megs] not now dua...as i thnik of electolytes...my head 'becomes hot
[ash] hehe
[megs] really///we will do..electolyes on a seperate day
[dua_frank] lol
[dua_frank] i'll tell you anyway
[dua_frank] hypovolemia tends to have low perfusion coz of less blood
[dua_frank] so patient tries to hyperventilate
[dua_frank] in the process losing co2
[megs] yes go on dua
[dua_frank] causing MA
[megs] thanx dua
[dua_frank] hyperventilates to correct hypoxia
[dua_frank] welcome
[ash] trauma to what structures causes surgical emphysema?
[samantha] in pts with severe trauma to the neck what xray will u take?
[megs] history of neck injury...upper neck...what investigations will u do???
[dua_frank] subcutaneous tissues
[dua_frank] c7 to t1
[samantha] oesphagus ash?
[megs] ap and laeral both sammy
[dua_frank] x rays
[ash] right sammy and dua
[samantha] exploratory megs
[ash] what else
[ash] ?
[dua_frank] all views and levels
[samantha] and odontoid megs
[dua_frank] dunno ash, tell us
[ash] open mouth
[megs] ok sammy
[megs] thats nice ash...
[ash] also trauma to the apex of the lung and trachea and larynx
[dua_frank] thanks ash, nice q
[megs] open mouth....how will it cause emphysem...
[dua_frank] lol megs
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[megs] i want to know...lol really
[dua_frank] she was answering for x ray
[dua_frank] open mouth x ray for your q
[dua_frank] lol
[dua_frank] i think
[megs] i am lost lol
[dua_frank] lol
[ash] :)
[dua_frank] how will you rx septic shock?
[megs] iv antibiotics,dopamine,
[ash] megs open mouth for your q. and the rest were for mine
[dua_frank] right and fluids megs
[megs] got it ash...
[ash] agree megs
[samantha] rt all :o
[dua_frank] mc organisms responsible for septic shock?
[ash] gram negative
[megs] e coli
[dua_frank] yes gram negative bacilli
[megs] it a pt with fall from 4 th floor what type of injury u expect??/
[megs] tell me which #??/
[ash] fractures
[dua_frank] roadkill megs :)
[dua_frank] lol
[ash] ribs most common
[dua_frank] femur?
[dua_frank] dunno
[ash] talus ,femur.
[megs] compression #of spine,pelvis, femur, calcenium
[dua_frank] thanks
[ash] oh thanks
[megs] compression # of thorasic and lumbar vertebra are more common
[dua_frank] do you give fluids in cardiogenic shock?
[ash] ok i have to go .good night all
[dua_frank] good night ash
[megs] u restrict fluid in cardiogenic shock dua
[megs] u give fluids acc to CVP monitering
[dua_frank] right
[dua_frank] very good
[dua_frank] hypotension with bradycardia' what kind of shock?
[megs] vasovagal dua
[dua_frank] right in other words neurogenic
[dua_frank] how will you rx?
[megs] atropine dua
[dua_frank] works through vegus
[dua_frank] right?
[dua_frank] what is moa of atropine?
[megs] in case of truma if ct head thorax and and are normal...
[megs] where is bledding???
[dua_frank] belly
[megs] what will u suspect??/
[megs] nope dua
[dua_frank] rupture
[dua_frank] not abdomen?
[megs] they say its femoral hematoma
[dua_frank] oh
[dua_frank] is that common?
[dua_frank] more than rupture ulcers?
[dua_frank] oh hemorrhage
[dua_frank] you're right
[megs] wanted to add i typed and...instead of abd
[dua_frank] for neurogenic you give loads of fluids and vasoconstrictor drugs like meraraminol and dopamine
[megs] therefore u got confused
[megs] what is meraraminol dua??
[samantha] in which condition u don't overhydrate?
[dua_frank] ollections tend to conform to the shape of the brain and the cranial vault, exhibiting concave inner margins and convex outer margins
[dua_frank] oops
[dua_frank] sympathetic amine megs
[megs] ohh
[megs] thanx
[samantha] i mean shock?
[megs] in blunt trauma of abd which organ get injured most commonly
[megs] liver or spleen??/
[samantha] spleen
[megs] liver sammy
[samantha] oh..
[dua_frank] i need to rememer liver
[dua_frank] i would pick spleen always, like sammy for some reason
[samantha] i thought spleen was more fragile
[dua_frank] maybe we were taught that in medical college and it stuck in our heads
[megs] sammy liver occupies moe area so more prone for injury
[samantha] ok megs
[dua_frank] thanks megs
[megs] after operating on a # femur for long time..in post op pt developed edema of leg and severe pain...what dx???
[samantha] racoon eyes rhinorrhea, otorrhea ecchymosis behind ear?
[megs] basal skull fracure 'sammy
[samantha] rt megs
[megs] clue for my q is long time of surgery...now ans???
[samantha] compartment synd?
[megs] its campartment syndrome...sammy u got it
[megs] ishemia...followed by reperfusion
[samantha] so what is the tx megs?
[megs] fasciotomy sammy
[samantha] rt
[megs] decompress the vessels and nerve..
[dua_frank] :gun
[megs] what happened dua???
[samantha] :congrats:
[dua_frank] we're doing trauma
[megs] he he lol
[samantha] :gu
[dua_frank] what do you give within 8 hrs of neurogenic shock?
[dua_frank] what drug might help
[samantha] just a break megs
[dua_frank] breaks are good
[megs] gunshot injury to the lateral thigh and medial thigh..what will be the diff in management???
[dua_frank] lanny can't seem to come into chat for some reason, he wrote me a mail informing me about that
[samantha] dunno dua
[dua_frank] i asked him to contact the moderator of this site and let them know about the problem
[dua_frank] immediate surgery megs? for medial
[megs] yes dua...due to femoral vessels
[dua_frank] methyprednisolone
[megs] what is ans to ur q dua
[megs] why dua???
[dua_frank] neurogenic shock is due to trauma to brainstem
[dua_frank] or spinal cord
[dua_frank] pred reduces that inflammation and edema
[dua_frank] within 8 hrs though
[megs] so prophylactically u give this
[dua_frank] yes
[megs] good to know dua
[dua_frank] i tell you CO and SVR , you tell me which shock
[dua_frank] ok?
[samantha] to improve neurological function dua
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[dua_frank] inc dec
[megs] cardiogenic
[dua_frank] septic
[megs] what is svr dua??
[dua_frank] svr dec due to vasodilatation
[dua_frank] systemic vascular resistance megs
[samantha] ok dua
[dua_frank] dec dec
[dua_frank] neurogenic
[dua_frank] agree?
[megs] :( :( :(
[dua_frank] awwww
[megs] AGREE DUA
[samantha] sort of
[dua_frank] i knew we wouldn't get it right thats why i thought it was important for me to tell this
[dua_frank] dec inc
[dua_frank] now comes cardio and hypovolemic shock
[samantha] cardio
[megs] HYPOVOL
[dua_frank] both yes
[megs] GOOD Q DUA
[megs] THANX
[dua_frank] welcome
[samantha] yea
[dua_frank] whats diff between concussion and contusion?
[dua_frank] ok megs
[dua_frank] surgery? :O
[megs] angiography..to rule out vessel injuty
[megs] middle neck.trauma
[dua_frank] x ray
[megs] always explore...
[dua_frank] oh
[samantha] exploratory
[megs] lower neck trauma
[samantha] osophago laryngo and
[megs] yes sammy
[dua_frank] concussion is diffuse and contusion focal neuro injur
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[samantha] artiography megs
[dua_frank] nice q, thanks megs
[megs] rib # what is management??/
[samantha] conserv pain relief
[megs] local nerve block for pain..yup sammy
[samantha] thanx megs
[megs] why rib # is dagerous ???in old
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[samantha] lower rib
[megs] i mean to ask sammy what danger can rib # can cause
[dua_frank] resp paralysis?
[megs] trauma to lowe ribs will cause injury to spleen and liver
[samantha] i can puncture the liver?
[dua_frank] oh
[megs] and 1 more imp
[dua_frank] whcih vessel is damaged in epi dural hemotoma?
[dua_frank] kidney?
[samantha] pneumothorax megs?
[megs] rib # cause pain.....so hypoventilation ..atelectsisi
[dua_frank] oh
[samantha] agree megs
[megs] its high yield..there fore pain relief is management for rib #
[samantha] middle meningeal dua
[megs] in sternal injury u suspect myocardial contusion...for diagnose that what will u choose???
[megs] agree middle'meningeal for epi
[samantha] ct
[samantha] xray megs
[uniteus] sorry for being so late...had to work late
[megs] contusion can not be seen by CT OR X RAY SAMMY
[samantha] cardiac enzymes is not conclusive
[megs] yes sammy...so EKG IS THE ANS...
[samantha] megs because is can cause generalised muscle injury
[samantha] yes
[megs] AS arrythmias are the common manifestation of cardiac contusion
[dua_frank] yes
[samantha] oh..yes
[megs] what is flail chest??/
[dua_frank] open air entry into IP space
[megs] what type of respiration is seen in it???
[dua_frank] due to rib fracture
[samantha] part of the chest wall is seperate
[samantha] and moves by itself
[dua_frank] lungs cannot expand during normal inspiration
[megs] yes dua paradoxical respiration
[megs] what is management of flail chest??
[samantha] due to fracture
[dua_frank] cpap
[samantha] tx/
[megs] no cpap dua
[uniteus] peep n intubate
[dua_frank] peep
[dua_frank] hey uni :)
[uniteus] hi dua
[megs] i dont think there is need for cpap or peep
[megs] its just place bilat chest tubes
[megs] to prevent pneumothorax
[dua_frank] no megs, we do give peep
[megs] i will check dua
[dua_frank] oh ok with established pneumothorax
[uniteus] agree dua
[dua_frank] without just bilateral chest tubes yes
[samantha] iv fluids respirator and look for trans of aorta
[uniteus] but they deteriorate ..that is y peep is done
[dua_frank] thats true too uni
[dua_frank] we always gave peep to all flail chests
[dua_frank] don't know what kaplan says about that
[dua_frank] its an effort for the lungs to expand so we have to give forced respiration which is peep
[megs] ok checked ..if respiratory insufficiency then mechanical ventilation
[megs] thanx dua
[dua_frank] there usually always is resp insufficiency with flial chest
[dua_frank] welcome
[dua_frank] they lose their negative IPP pressure
[megs] truma to scapul,sternum first rib what do u suspect???
[samantha] cardiac contusion aortic rupture
[dua_frank] collapsed upper lobe?
[megs] yes sammy
[dua_frank] oh
[samantha] TX/
[dua_frank] mid scapula you mean?
[megs] spine os scapula dua
[dua_frank] ok
[dua_frank] what is death due to in subdural hematoma?
[uniteus] surgery sammy to repair the rupture
[megs] what is treatment of subcut emphysema???
[uniteus] herniation on uncal
[dua_frank] right uni
[samantha] rt megs
[dua_frank] surgical
[dua_frank] tube
[uniteus] supportive megs for emphysema
[samantha] dunno megs
[megs] yes uni
[megs] if in lowe neck...intubate to maintain breathing...
[uniteus] tx of uncomplicated rib fracture?
[megs] elsewhere..conserve generally esolves on its own...
[uniteus] thx megs
[megs] nothing uni...for uncomplicated rib #
[megs] pain rilef
[samantha] Tx for air embolism?
[megs] immediate headlow sammy
[dua_frank] yeah
[megs] then cpr
[uniteus] rt megs..pain relief...n sometimes intercostal nerve blocks
[samantha] yes trendlenberg position megs
[megs] what is threatment of pelvic hematoma???
[samantha] external fixation
[uniteus] penetrating injury to neck..zone 1 , tx?
[uniteus] if d hematoma is enlarging..to sugery tx..else leave it alone
[megs] yes uni
[samantha] rt uni
[megs] zone one...we do angiography
[samantha] gun shot injury to abdo TX?
[uniteus] exploratory lap sammy
[samantha] and repair of intra abd injury megs
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[uniteus] yeah...always do surgical tx for all zone 1 injury...
[samantha] sorry uni
[uniteus] its ok...
[uniteus] what r the landmarks for the neck? zone dat is?
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[samantha] zone 1 2 and 3 uni
[dua_frank] cricoid cartilage
[dua_frank] clavicle
[dua_frank] base of skull
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[uniteus] rt sammy n dua....zone 1= supraclavi to cricoid cartilag, 2= cricoid cartilage to angle of mandible, 3 is angle of mandible to base of skull
[samantha] thanx uni
[uniteus] wen putting CVP line, what test done after procedure?
[dua_frank] cxray?
[megs] check x ray
[uniteus] rt dua n megs...looking for what?
[dua_frank] pneumothorax
[megs] agree dua
[uniteus] rt
[dua_frank] also for peep
[uniteus] n proper place of cvp
[uniteus] ok..thx dua
[dua_frank] welcome
[dua_frank] whats becks triad?
[dua_frank] and what is it for
[megs] pericardial temponade
[dua_frank] yes
[megs] hupotension,low pithch heart sounds
[dua_frank] distant heart sounds, inc JVP and hypotension
[dua_frank] right megs
[megs] andincr jvp
[dua_frank] rx?
[megs] pericardiocentesis
[dua_frank] that is if the patient is stable
[dua_frank] if unstable go for thoractomy
[dua_frank] widening of mediastenum dx?
[megs] that is for hemothorax dua
[dua_frank] Aortic dissection
[megs] widening mediastinum...suspect aoric i njury
[dua_frank] yes
[shreya] traumativ rupture of aorta.
[uniteus] cardiac tamponade
[uniteus] oops...
[dua_frank] hydronemothorax, pneumomediatenim, mediastenal widening and pleural effusion, dx?
[megs] penetrating chest truma dua???
[megs] not sure
[shreya] diapragm rupture??
[dua_frank] esophageal rupture
[megs] wow
[dua_frank] its boerhaaves syndrome
[samantha] why plueral effusion dua?
[dua_frank] goes everywhere sammy
[megs] agree dua
[uniteus] common in chronic alcholic abuser
[dua_frank] rupture can be anywhere i mean
[dua_frank] into mediastenum, pleua
[dua_frank] air or water can leak into them
[dua_frank] causing all those
[samantha] ok dua
[dua_frank] megs kaplan says spleem most commonly injured in blunt trauma
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[dua_frank] penetrating trauma mc organ injured?
[dua_frank] in abdomen that is
[shreya] liver?
[uniteus] duodenum
[dua_frank] small bowel
[uniteus] was close dua :)
[megs] significant truma is caused most commonly by spleen truma dua
[dua_frank] right uni
[megs] but otherwise...liver injury is common than spleen
[dua_frank] how will we differentiate significant from other kind of traumas megs?
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[megs] liver injury...can be managed conservatively if minor dua...
[dua_frank] oh ok
[dua_frank] contraindications to peritoneal lavage
[dua_frank] ?
[megs] but spleen being fragile.gives serious intraabd bleed
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[dua_frank] thanks megs
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[uniteus] complication after postsplenectomy?
[megs] capsulated organ inf n uni
[megs] organisms
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[uniteus] rt megs..what else..late compl?
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[megs] dunno uni'
[dua_frank] some blood thing
[dua_frank] jaundice?
[shreya] hyperviscosity ??
[dua_frank] dunno
[megs] immunity prb in children?/?
[samantha] thrombocytosis
[uniteus] rt dua...delayed bleeding...but other late are pancreatitis n subphrenic abscess
[megs] tell us uni
[dua_frank] pregnancy, peritonitis, unstable patient, significant hemorrage
[dua_frank] :D thanks uni
[uniteus] rt sammy for ealry
[dua_frank] nice q
[uniteus] thx
[megs] ok guys got to go
[megs] bye all
[uniteus] bye megs
[megs] thanx all
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[dua_frank] bye megs
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[samantha] shall we leave too
[dua_frank] ok sammy
[dua_frank] lets meet tomorrow
[uniteus] thx...bye
[samantha] ok bye all
[dua_frank] uni
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[dua_frank] read the chat transcript for today after 5 minutes
[dua_frank] bye
[uniteus] ok..will do thx dua
[shreya] bye.
[dua_frank] welcome
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04-14-2005, 10:55 PM
what is becks triad

06-07-2005, 04:05 PM
hi is there anyone to help me?

01-03-2006, 12:37 PM
high venous pressure leading to JVD, a low arterial pressure, and decreased heart sound = cardiac tamponade

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