trauma and gastroparesis

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Recent reviews on intraop aspiration show that it does happen (relatively) frequently, and the associated mortality is almost 'nil.

Judgement call, sorry this happened. I've personally extended my "trauma" NPO to at least 24h in most circumstances. The issue is what defines a "trauma". Herein lies more judgement.

I think it is important to point out the early bronch findings versus late. The pneumonitis takes a little while to fully manifest. A clean bronch early on doesn't mean a healthy lung in an hour or two.

How many of you are routinely bronching, lavaging or starting abx after suspected aspiration?

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How many of you are routinely bronching, lavaging or starting abx after suspected aspiration?

Depends on what was aspirated and what evolves. Nothing done "routinely".

-copro
 
How many of you are routinely bronching, lavaging or starting abx after suspected aspiration?

There is no evidence that any of these interventions actually improves the prognosis.
I still do a bronchoscopy every time there is aspiration and suction whatever I find, I don't do lavage because it could be more harmful than helpful and I don't do prophylactic ATBX.
If they are hypoxic after extubation (if they get extubated) I give steroids although there is no evidence to support it.
 
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There is no evidence that any of these interventions actually improves the prognosis.
I still do a bronchoscopy every time there is aspiration and suction whatever I find, I don't do lavage because it could be more harmful than helpful and I don't do prophylactic ATBX.
If they are hypoxic after extubation (if they get extubated) I give steroids although there is no evidence to support it.

Maduri at UT Memphis published a protocol using steroids for early ARDS which showed a huge mortality benefit. Granted, later studies did not show the same results, and Maduri's paper did have some methological flaws, but steroids for ALI/ARDS does have some evidence behind it.
 
Maduri at UT Memphis published a protocol using steroids for early ARDS which showed a huge mortality benefit. Granted, later studies did not show the same results, and Maduri's paper did have some methological flaws, but steroids for ALI/ARDS does have some evidence behind it.

I don't think the debate about steroids in ARDS will ever be resolved.
 
Stopped in to check on the pt this morning and he is extubated, sitting up in bed .
Are you kidding me that an attorny used info obtained from a physician forum !!

That's ridiculous! That shouldnt even be able to be brought in. How does he know it's not a nurse/CRNA or the like making some stuff up!

On the contrary, we hear are giving these sharks info. If attorneys realize that docs are not in agreement over something, that's where they enter and try to take advantage over teh situation.

Again, that's why I feel this whole forum or "M and Ms " should be posted EXCLUSIVELY on the private forum.
 
Are you kidding me that an attorny used info obtained from a physician forum !!

That's ridiculous! That shouldnt even be able to be brought in. How does he know it's not a nurse/CRNA or the like making some stuff up!

It usually goes like this:
Mr sleezbag JD: Dr. sleepisgood, I found this statement on an internet forum that is frequented by anesthesiologists, do you agree with this statement?
Defense attorney objects but you still have to answer the question.
If you agree or disagree this means you have given validity to that statement and opened the door for more questions.
You should probably say:Mr. Sleezbag, I don't recognize this web site to be an authority on the subject and therefore I have no opinion to offer.
 
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