tag:blogger.com,1999:blog-2760353953251845523.post4068296030396121190..comments2024-02-10T02:14:39.898-05:00Comments on Buckeye Surgeon: Sid CrosbyJeffrey Parks MD FACShttp://www.blogger.com/profile/15650563299849196122noreply@blogger.comBlogger13125tag:blogger.com,1999:blog-2760353953251845523.post-20267595540441230592008-01-23T23:13:00.000-05:002008-01-23T23:13:00.000-05:00I'd hope this kid would have been operated anywher...I'd hope this kid would have been operated anywhere he was. Clearly you did right. And by golly, 15 minutes is as good as I could have done!<BR/><BR/>I've been known to put a few thin slices of spleen into the omentum of a young person. Anyone still doing that?Sid Schwabhttps://www.blogger.com/profile/14182853083503404098noreply@blogger.comtag:blogger.com,1999:blog-2760353953251845523.post-32070461417718690552008-01-23T13:11:00.000-05:002008-01-23T13:11:00.000-05:00That point came up during my trauma rotation in re...That point came up during my trauma rotation in residency (huge academic center), about operative versus observational management. The team looked at me funny when I claimed that we had "tons of people" to do serial exams on patients - until I pointed out that some hospitals don't have ANY doctors overnight. It definitely makes a difference in management.<BR/><BR/>Does your ED use their own ultrasound? FAST would have picked this up, probably the day of initial presentation, without the "ED duration of stay" or ionizing radiation concerns of a CT.DKVhttps://www.blogger.com/profile/15449584867334837982noreply@blogger.comtag:blogger.com,1999:blog-2760353953251845523.post-88617975520713990412008-01-23T05:49:00.000-05:002008-01-23T05:49:00.000-05:00dkv- Interesting point. But I'm sitting there loo...dkv- Interesting point. But I'm sitting there looking at a CT report that suggests a major hilar injury in a kid who's looking pretty pale. His BP was 100/70 in ER and those narrow pulse pressures make me nervous. Some labs that were sent from the OR showed that his hemoglobin had actually dropped to 5.7 during the case. In retrospect, I'm pretty sure the kid needed his spleen out, I don't care if you sent him to Johns Hopkins. The hospital where I work is designated level II trauma. We have all the resources (interventional radiology, neurosurgery) that a level I center has, other than the in-house manpower. If the kid was a little more stable, or the family was adamantly opposed to surgery, then I would have considered transferring. It's a judgment call, in the end, that every community surgeon has to be able to live with.Jeffrey Parks MD FACShttps://www.blogger.com/profile/15650563299849196122noreply@blogger.comtag:blogger.com,1999:blog-2760353953251845523.post-75712589946590713662008-01-22T22:40:00.000-05:002008-01-22T22:40:00.000-05:00Can the case be made that this patient should have...Can the case be made that this patient should have been transferred to a peds trauma center, for the reasons you cite?DKVhttps://www.blogger.com/profile/15449584867334837982noreply@blogger.comtag:blogger.com,1999:blog-2760353953251845523.post-1466605641338911712008-01-21T18:42:00.000-05:002008-01-21T18:42:00.000-05:00gaz, I missed that. :)gaz, I missed that. :)rlbateshttps://www.blogger.com/profile/15236331355857884458noreply@blogger.comtag:blogger.com,1999:blog-2760353953251845523.post-76559786143804125882008-01-21T17:58:00.000-05:002008-01-21T17:58:00.000-05:00good catch Gaz. Saved me HIPAA lawsuit!good catch Gaz. Saved me HIPAA lawsuit!Jeffrey Parks MD FACShttps://www.blogger.com/profile/15650563299849196122noreply@blogger.comtag:blogger.com,1999:blog-2760353953251845523.post-56376443020309015192008-01-21T16:39:00.000-05:002008-01-21T16:39:00.000-05:00Doctor Bates:I was actually referring to the origi...Doctor Bates:<BR/><BR/>I was actually referring to the original name of the file (it was a LASTNAME_FIRSTNAME.bmp but looks like it was changed). I got the Sid Crosby reference. :)Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-2760353953251845523.post-64975010818198421532008-01-21T16:14:00.000-05:002008-01-21T16:14:00.000-05:00you did the right thing for sure. but you don't ne...you did the right thing for sure. but you don't need me to tell you that. well done.Bongihttps://www.blogger.com/profile/12918640034313468627noreply@blogger.comtag:blogger.com,1999:blog-2760353953251845523.post-81238200903932581212008-01-21T15:06:00.000-05:002008-01-21T15:06:00.000-05:00gaz--Sid Crosby is a famous hockey star (http://en...gaz--Sid Crosby is a famous hockey star (http://en.wikipedia.org/wiki/Sidney_Crosby)<BR/><BR/>Thanks, Buckeye. I thought that was the case, but was unsure (didn't want to slight anyone who might be "good enough" to do it thru the scope).rlbateshttps://www.blogger.com/profile/15236331355857884458noreply@blogger.comtag:blogger.com,1999:blog-2760353953251845523.post-7055261294765903002008-01-21T14:52:00.000-05:002008-01-21T14:52:00.000-05:00Dr. Buckeye:Just wanted to point out real quick th...Dr. Buckeye:<BR/><BR/>Just wanted to point out real quick that the name of the file of the CT image may be considered a HIPAA violation (unless it's a joke I don't get).<BR/><BR/>I really enjoy reading your stories and seeing your images, so don't want anything to slip by that may get you in trouble.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-2760353953251845523.post-56222416557044950392008-01-21T14:36:00.000-05:002008-01-21T14:36:00.000-05:00doc bates-For traumatic splenic injuries, you're u...doc bates-For traumatic splenic injuries, you're usually operating under some duress. You want to get that thing out ASAP. Putting a scope in and trying to evacuate 5 liters of hematoma via a tiny lap suctioner would be pure torture. Not to mention time consuming and risky. The case took 15 minutes open. Any elective splenectomy (for sphereocytosis, leukemias, ITP) ought to be done laparoscopically is possible. <BR/><BR/>Surg res- They were fine with it.Jeffrey Parks MD FACShttps://www.blogger.com/profile/15650563299849196122noreply@blogger.comtag:blogger.com,1999:blog-2760353953251845523.post-40363590884742491722008-01-21T13:31:00.000-05:002008-01-21T13:31:00.000-05:00What did he and his parents think of your reasonin...What did he and his parents think of your reasoning for your management?Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-2760353953251845523.post-48795534049757771332008-01-21T13:25:00.000-05:002008-01-21T13:25:00.000-05:00Are these done open or with laproscope these days?...Are these done open or with laproscope these days? I know the blood obscures, but can it be "flushed" or "suctioned" through the scope so that if all else is okay the larger incision can be avoided? Remember my general surgery days were 20 years ago.rlbateshttps://www.blogger.com/profile/15236331355857884458noreply@blogger.com