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Consider this Case Study

trauma-list@trauma.org trauma-list@trauma.org
Wed, 05 Jun 2002 15:54:36 -0400


Terry Dinerman--
Shades of MAST trousers and spinal steroids!
Whoa just one minute.
You should become at least passing acquainted with the literature on Dopplers in assessing for extrremity vascular injury--you have a serious misunderstanding of its proven value and role!  Please let me know if you would like any of the volumes of refs on this?
It may interest you to know that Doppler flow does not at all exclude a vascular injury in an injured extremity--apparently you are under the misapprehension that it does.  Did you realize that Doppler flow can be present distal to a completely transected or occluded vessel?  Collaterals will be picked up by Doppler--but an absent pulse is a known hard sign of vascular injury that is well established as highly accurate--its absence in itself mandates immediate evaluation--following blunt trauma by arteriogram, follwoing penetrating trauma by direct operation.  This is again old and well established data.  The fact you appear to have gotten away with it in this presented case should NOT positively reinforce you--the simple phys exam is superior to any noninvasive testing for this purpose--and noninvasives have never yet been shown to have any benefit over and above the phys presence or absence of hard signs (absent pulse being only one of the five hard signs).  Don;t waste your money on these devices--and please, don't endanger your license by using it with your present level of understanding of its validity.  As an expert witness, I would do you in....
ERF