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Consider this Case Study

trauma-list@trauma.org trauma-list@trauma.org
Wed, 5 Jun 2002 21:14:26 EDT


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In a message dated 6/5/2002 7:28:33 PM Eastern Standard Time, 
dinerman@computron.net writes:


> NO- Doppler is not a panacea.  But it has a place in the decision making 
> tree even for us po' boys at the street level. After a good old fashioned 
> physical exam.  

Terry--
No it does not--tho admittedly there are those that say it does--however the 
available data refute that, and again--noninvasives have never been shown 
superior or to add any benefit whatsoever to the phys findings with respect 
to hard signs (absent pulses, active hemorrhage, large hematoma, bruit or 
thrill, signs of distal ischemia).  What do you really think the Doppler 
added to your assessment of a warm hand and arm with no pulse????  
Answer--nothing!  It is in fact reasonable to make a decision to delay some 
with the hand still warm--sure--and if ischemia is present, much more urgent 
evaluation/Rx is indicated.  Note--all the decisions can and should be made 
just on phys findings.  We've published on this and have approached it this 
way for 14 years.  
My point--don't fall into the oh so common trap of letting a cool 
techno-gadget replace common sense--and evidence!  In fact you DON't need 
it--and the longer you think you do, the more likely you will fall into one 
of the traps I mentioned.  Not using a gadget does NOT equate to being behind 
in medical skills--stay ahead of the medical community on this one! :))
ERF

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<HTML><FONT FACE=arial,helvetica><FONT  SIZE=2 FAMILY="SANSSERIF" FACE="Arial" LANG="0">In a message dated 6/5/2002 7:28:33 PM Eastern Standard Time, dinerman@computron.net writes:
<BR>
<BR>
<BR></FONT><FONT  COLOR="#000000" SIZE=2 FAMILY="SCRIPT" FACE="Comic Sans MS" LANG="0"><BLOCKQUOTE TYPE=CITE style="BORDER-LEFT: #0000ff 2px solid; MARGIN-LEFT: 5px; MARGIN-RIGHT: 0px; PADDING-LEFT: 5px">NO- Doppler is not a panacea. &nbsp;But it has a place in the decision making tree even for us po' boys at the street level. <U>After</U> a good old fashioned physical exam. &nbsp;The pain, MOI, lack of mobility,</BLOCKQUOTE>
<BR></FONT><FONT  COLOR="#000000" SIZE=2 FAMILY="SANSSERIF" FACE="Arial" LANG="0">
<BR>Terry--
<BR>No it does not--tho admittedly there are those that say it does--however the available data refute that, and again--noninvasives have never been shown superior or to add any benefit whatsoever to the phys findings with respect to hard signs (absent pulses, active hemorrhage, large hematoma, bruit or thrill, signs of distal ischemia). &nbsp;What do you really think the Doppler added to your assessment of a warm hand and arm with no pulse???? &nbsp;Answer--nothing! &nbsp;It is in fact reasonable to make a decision to delay some with the hand still warm--sure--and if ischemia is present, much more urgent evaluation/Rx is indicated. &nbsp;Note--all the decisions can and should be made just on phys findings. &nbsp;We've published on this and have approached it this way for 14 years. &nbsp;
<BR>My point--don't fall into the oh so common trap of letting a cool techno-gadget replace common sense--and evidence! &nbsp;In fact you DON't need it--and the longer you think you do, the more likely you will fall into one of the traps I mentioned. &nbsp;Not using a gadget does NOT equate to being behind in medical skills--stay ahead of the medical community on this one! :))
<BR>ERF</FONT></HTML>

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