I actually had a similar case last year, my patient had a moderate sized
hematoma with no pulsatile mass, no bruit, papable carotid pulse. After
around 30 minutes it seemed to be expanding slightly. After a discussion
with the trauma surgeon I RSI'd him, his cords were actually deviated off
to the contralateral side, I think if we had waited longer it might have
been difficult. Turned out he had a A-V fistula on angio with carotid and
int jugular. What we would have done without some real or imagined
progression to push for RSI likely would have been to just watch. Kid did
great in the OR and had uncomplicated post-op course.
On Sun, 21 Jun 1998, Jay Pershad, M.D. wrote:
> Had a case last PM that I was wondering how the list would manage in the ED?
> 14 yr old with a BB GSW with entrance wound to the left anterior triangle of
> the neck? No exit wound. Hematoma at entrance site present. No respiratory
> difficulty, stableVSS & no dysphonia, dysphagia, neurologic deficit,
> parasthesias or neck crepitus. Alert and awake. Radiographs reveal bullet to
> be in the prevertebral soft tissue at the level of C3-C4.
> Would you do full spinal precautions?
> Would you do a prophylactic RSI in the ED on arrival prior to surgical
> evaluation/OR exploration?
> Jay Pershad
> Jay Pershad, M.D.
> "We care for wee folks"
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