Comments on: Splenic Injury and Hemoperitoneum in Blunt Trauma http://www.unboundedmedicine.com/2006/08/03/splenic-injury-and-hemoperitoneum-in-blunt-trauma/ Fri, 12 Mar 2010 14:32:44 -0500 http://wordpress.org/?v=2.8.4 hourly 1 By: Jon Mikel Iñarritu http://www.unboundedmedicine.com/2006/08/03/splenic-injury-and-hemoperitoneum-in-blunt-trauma/#comment-97651 Jon Mikel Iñarritu Sun, 12 Aug 2007 18:13:53 +0000 http://www.unboundedmedicine.com/2006/08/03/splenic-injury-and-hemoperitoneum-in-blunt-trauma/#comment-97651 Pooya Iranpour, Children have more physiologic reserve, when they are hemodynamically unstable they are really ill. Why don't you read the chapter of Trauma in Children in the ATLS manual? There is also a chapter of this in the textbook Trauma by Mattox and Feliciano. Pooya Iranpour,

Children have more physiologic reserve, when they are hemodynamically unstable they are really ill. Why don’t you read the chapter of Trauma in Children in the ATLS manual? There is also a chapter of this in the textbook Trauma by Mattox and Feliciano.

]]> By: Pooya Iranpour http://www.unboundedmedicine.com/2006/08/03/splenic-injury-and-hemoperitoneum-in-blunt-trauma/#comment-94051 Pooya Iranpour Thu, 26 Jul 2007 14:46:37 +0000 http://www.unboundedmedicine.com/2006/08/03/splenic-injury-and-hemoperitoneum-in-blunt-trauma/#comment-94051 Hello, I am a medical student trying to understand why splenic injuries heal faster in children than in adults. Hemodynamic instability does not occur as much in children as it does in adults (after splenic injury/rupture). Can you suggest literature to read or do you have any theories as to why this is the case. Thank you. Hello, I am a medical student trying to understand why splenic injuries heal faster in children than in adults. Hemodynamic instability does not occur as much in children as it does in adults (after splenic injury/rupture). Can you suggest literature to read or do you have any theories as to why this is the case.

Thank you.

]]> By: Mexico Medical Student » Grand Rounds Vol 2. No. 46 http://www.unboundedmedicine.com/2006/08/03/splenic-injury-and-hemoperitoneum-in-blunt-trauma/#comment-5145 Mexico Medical Student » Grand Rounds Vol 2. No. 46 Tue, 08 Aug 2006 11:41:17 +0000 http://www.unboundedmedicine.com/2006/08/03/splenic-injury-and-hemoperitoneum-in-blunt-trauma/#comment-5145 [...] Speaking of Mexican medical economics, while Unbounded Medicine shows different ways to asses hemoperitoneum, the other salient feature is the disparity between the “haves” and “have nots” in terms of private practice vs. public/charity medicine. I’ve seen both, and as scary/antiquated as the latter seems to be, one does learn quite a bit as a trainee forced to improvise and get the job done in spite of top-notch equipment/supplies. [...] [...] Speaking of Mexican medical economics, while Unbounded Medicine shows different ways to asses hemoperitoneum, the other salient feature is the disparity between the “haves” and “have nots” in terms of private practice vs. public/charity medicine. I’ve seen both, and as scary/antiquated as the latter seems to be, one does learn quite a bit as a trainee forced to improvise and get the job done in spite of top-notch equipment/supplies. [...]

]]> By: JonMikel, M.D. http://www.unboundedmedicine.com/2006/08/03/splenic-injury-and-hemoperitoneum-in-blunt-trauma/#comment-4678 JonMikel, M.D. Fri, 04 Aug 2006 06:21:44 +0000 http://www.unboundedmedicine.com/2006/08/03/splenic-injury-and-hemoperitoneum-in-blunt-trauma/#comment-4678 Jon: In splenic injuries you can divide its treatment in two major groups: 1. Operative treatment 2. Non-operative treatment. Just in the Non-operative management cases of spleen bleeding (or hepatic bleeding), you could use the benefits of the angioembolization (like Gelfoam) in order to gain time. The primary requirement for nonoperative treatment is hemodynamic stability. The complications (missed abdominal injuries, parenchymal infarction, infection, aseptic infarcts, infected hematomas, etc.) of nonoperative therapy for blunt splenic and hepatic injuries, occur in 2% to 5% of patients. In fact, the presence of ischemia, hematoma, and/or tissue injury secondary to trauma could increase the risk of secondary infection in the use of transcatheter gelfoam embolization. As you say, nonoperative measures are usefull just in minor trauma. Thanks for your comment. Jon:

In splenic injuries you can divide its treatment in two major groups:
1. Operative treatment
2. Non-operative treatment.

Just in the Non-operative management cases of spleen bleeding (or hepatic bleeding), you could use the benefits of the angioembolization (like Gelfoam) in order to gain time.

The primary requirement for nonoperative treatment is hemodynamic stability.

The complications (missed abdominal injuries, parenchymal infarction, infection, aseptic infarcts, infected hematomas, etc.) of nonoperative therapy for blunt splenic and hepatic injuries, occur in 2% to 5% of patients.

In fact, the presence of ischemia, hematoma, and/or tissue injury secondary to trauma could increase the risk of secondary infection in the use of transcatheter gelfoam embolization.

As you say, nonoperative measures are usefull just in minor trauma.

Thanks for your comment.

]]> By: Jon http://www.unboundedmedicine.com/2006/08/03/splenic-injury-and-hemoperitoneum-in-blunt-trauma/#comment-4567 Jon Thu, 03 Aug 2006 11:54:28 +0000 http://www.unboundedmedicine.com/2006/08/03/splenic-injury-and-hemoperitoneum-in-blunt-trauma/#comment-4567 I was once consulted as a case manager regarding a liver biopsey that would not stop bleeding. CT was down. I thought gelfoam which is what they did. Epo and progesterone was also discussed. In the case of third world medicine (where I sometime lecture and work) and it's limitations, would epo and progesterone which works in GI bleeds also work for minor liver trauma as well. This to buy time to stablize. I was once consulted as a case manager regarding a liver biopsey that would not stop bleeding. CT was down. I thought gelfoam which is what they did. Epo and progesterone was also discussed.

In the case of third world medicine (where I sometime lecture and work) and it’s limitations, would epo and progesterone which works in GI bleeds also work for minor liver trauma as well. This to buy time to stablize.

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