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Consider this Case Study

Terry Dinerman trauma-list@trauma.org
Wed, 5 Jun 2002 21:33:26 -0700 

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Doc,=20

Thanks for taking the time to cite a couple of studies and give =
additional illumination on this subject.  I shall look up your =
citations, but your common sense rings through without the need for =
them, really.

I cannot agree more fully with you, that a thorough head to toe, =
physical exam is far more important than all the "Bells and Whistles" =
put together.  I get the best clinical picture of my patient as time =
will allow and armed with that data, make my treatment and transport =
decisions.

Where patient assessment is concerned,  I am practicing much the same =
set of basic skills I learned when I sat for my first class, back in the =
days of Cadillac ambulances and funeral home ambulance operators.  I =
have added a lot of nuances over the years, based on the thousands of =
cases I've attended. But the basics remain the same.

You are absolutely, beyond debate, correct.

However, one thing that I can't avoid is the fact that when the Ortho =
guy came by to do his assessment on the "Midnight Biker", he pulled the =
ER's vintage Doppler out of the drawer and poked around as well!  Oh =
my.....

If I should find myself in YOUR ER,  and I allow the pull of the =
Techno-Goodies to get the better of me, please make me do 10 laps around =
the parking lot in MAST trousers, hauling a Pressure / Demand ventilator =
with me while reciting my ABC's.......

Thanks again!

Terry Dinerman EMTP


  ----- Original Message -----=20
  From: DocRickFry@aol.com=20
  To: trauma-list@trauma.org=20
  Sent: Wednesday, June 05, 2002 6:22 PM
  Subject: Re: Consider this Case Study


  In a message dated 6/5/2002 7:28:33 PM Eastern Standard Time, =
dinerman@computron.net writes:=20



    Since the Pt was transferred to definitive care, and the fracture =
successfully reduced with circulation restored, I feel the man was =
properly treated.  But if what you say is true, could I be held =
criminally or civilly liable for the use of a non-invasive tertiary =
examination instrument, even if the treatment works to the favor of the =
Patient?  I decided that the local ER was ill equipped for open =
reductions and vascular surgery, and the ER Doc was in agreement.  =20



  Terry--=20
  No, this is not what I said--read what was written, not what you want =
to see..IF you missed a vascualr injury based on your incorrect =
assessment of Doppler signals, you could be liable--I said--you lucked =
out here.  In the end, in fact, your assessment of a warm hand with flow =
did lead to the correct assessment of not that great an urgency, and you =
did realize the need for definitive care--no problem there.  You just =
need to realize the Doppler did not add to that--you're seeing it as too =
much of a crutch--learn to trust what you see and feel more, without =
feeling like you need a positive test to give you permission to make a =
clinical decision, and you will, as I said, be ahead of many physicians =
of the "modern" age=20
  Try Dennis et al, J Trauma Feb 1998, Frykberg ER, Surgical Clinics of =
North America, April 1995.=20
  ERF=20

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charset=3Diso-8859-1">
<META content=3D"MSHTML 6.00.2600.0" name=3DGENERATOR>
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<BODY bgColor=3D#ffffff>
<DIV><FONT face=3D"Comic Sans MS">Doc, </FONT></DIV>
<DIV><FONT face=3D"Comic Sans MS"></FONT>&nbsp;</DIV>
<DIV><FONT face=3D"Comic Sans MS">Thanks for taking the time to cite a =
couple of=20
studies and give additional illumination on this subject.&nbsp; I shall =
look up=20
your citations, but your common sense&nbsp;rings through without the =
need for=20
them, really.</FONT></DIV>
<DIV><FONT face=3D"Comic Sans MS"></FONT>&nbsp;</DIV>
<DIV><FONT face=3D"Comic Sans MS">I cannot agree more fully with you, =
that a=20
thorough head to toe, physical exam is far more important than all the =
"Bells=20
and Whistles" put together.&nbsp; I get the best clinical picture of my =
patient=20
as time will allow and armed with that data, make my treatment&nbsp;and=20
transport decisions.</FONT></DIV>
<DIV><FONT face=3D"Comic Sans MS"></FONT>&nbsp;</DIV>
<DIV><FONT face=3D"Comic Sans MS">Where patient assessment is =
concerned,&nbsp; I=20
am practicing much the same set of basic skills I learned when I sat for =
my=20
first class, back in the days of Cadillac ambulances and funeral home =
ambulance=20
operators.&nbsp; I have added a lot of nuances over the years, based on =
the=20
thousands of cases I've attended. But the basics remain the =
same.</FONT></DIV>
<DIV><FONT face=3D"Comic Sans MS"></FONT>&nbsp;</DIV>
<DIV><FONT face=3D"Comic Sans MS">You are absolutely, beyond debate,=20
correct.</FONT></DIV>
<DIV><FONT face=3D"Comic Sans MS"></FONT>&nbsp;</DIV>
<DIV><FONT face=3D"Comic Sans MS">However, one thing that I can't avoid =
is the=20
fact that when the Ortho guy came by to do his assessment on the =
"Midnight=20
Biker", he pulled the ER's vintage Doppler out of the drawer and poked =
around as=20
well!&nbsp; Oh my.....</FONT></DIV>
<DIV><FONT face=3D"Comic Sans MS"></FONT>&nbsp;</DIV>
<DIV><FONT face=3D"Comic Sans MS">If I should find myself =
in&nbsp;<U>YOUR</U>=20
ER,&nbsp;&nbsp;and I allow the pull of the Techno-Goodies to get the =
better of=20
me, please make me do 10 laps around the parking lot in MAST trousers, =
hauling a=20
Pressure / Demand ventilator with me while reciting my =
ABC's.......</FONT></DIV>
<DIV><FONT face=3D"Comic Sans MS"></FONT>&nbsp;</DIV>
<DIV><FONT face=3D"Comic Sans MS">Thanks again!</FONT></DIV>
<DIV><FONT face=3D"Comic Sans MS"></FONT>&nbsp;</DIV>
<DIV><FONT face=3D"Comic Sans MS">Terry Dinerman EMTP</FONT></DIV>
<DIV><FONT face=3D"Comic Sans MS"></FONT>&nbsp;</DIV>
<DIV><FONT face=3D"Comic Sans MS"></FONT>&nbsp;</DIV>
<BLOCKQUOTE=20
style=3D"PADDING-RIGHT: 0px; PADDING-LEFT: 5px; MARGIN-LEFT: 5px; =
BORDER-LEFT: #000000 2px solid; MARGIN-RIGHT: 0px">
  <DIV style=3D"FONT: 10pt arial">----- Original Message ----- </DIV>
  <DIV=20
  style=3D"BACKGROUND: #e4e4e4; FONT: 10pt arial; font-color: =
black"><B>From:</B>=20
  <A title=3DDocRickFry@aol.com=20
  href=3D"mailto:DocRickFry@aol.com">DocRickFry@aol.com</A> </DIV>
  <DIV style=3D"FONT: 10pt arial"><B>To:</B> <A =
title=3Dtrauma-list@trauma.org=20
  href=3D"mailto:trauma-list@trauma.org">trauma-list@trauma.org</A> =
</DIV>
  <DIV style=3D"FONT: 10pt arial"><B>Sent:</B> Wednesday, June 05, 2002 =
6:22=20
  PM</DIV>
  <DIV style=3D"FONT: 10pt arial"><B>Subject:</B> Re: Consider this Case =

  Study</DIV>
  <DIV><BR></DIV><FONT face=3Darial,helvetica><FONT lang=3D0 =
face=3DArial size=3D2=20
  FAMILY=3D"SANSSERIF">In a message dated 6/5/2002 7:28:33 PM Eastern =
Standard=20
  Time, <A =
href=3D"mailto:dinerman@computron.net">dinerman@computron.net</A>=20
  writes: <BR><BR><BR></FONT><FONT lang=3D0 face=3D"Comic Sans MS" =
color=3D#000000=20
  size=3D2 FAMILY=3D"SCRIPT">
  <BLOCKQUOTE=20
  style=3D"PADDING-LEFT: 5px; MARGIN-LEFT: 5px; BORDER-LEFT: #0000ff 2px =
solid; MARGIN-RIGHT: 0px"=20
  TYPE=3D"CITE">Since the Pt was transferred to definitive care, and the =

    fracture successfully reduced with circulation restored, I feel the =
man was=20
    properly treated. &nbsp;But if what you say is true, could I be held =

    criminally or civilly liable for the use of a non-invasive tertiary=20
    examination instrument, even if the treatment works to the favor of =
the=20
    Patient? &nbsp;I decided that the local ER was ill equipped for open =

    reductions and vascular surgery, and the ER Doc was in agreement. =
&nbsp;=20
  <BR></BLOCKQUOTE><BR></FONT><FONT lang=3D0 face=3DArial =
color=3D#000000 size=3D2=20
  FAMILY=3D"SANSSERIF"><BR>Terry-- <BR>No, this is not what I said--read =
what was=20
  written, not what you want to see..IF you missed a vascualr injury =
based on=20
  your incorrect assessment of Doppler signals, you could be liable--I =
said--you=20
  lucked out here. &nbsp;In the end, in fact, your assessment of a warm =
hand=20
  with flow did lead to the correct assessment of not that great an =
urgency, and=20
  you did realize the need for definitive care--no problem there. =
&nbsp;You just=20
  need to realize the Doppler did not add to that--you're seeing it as =
too much=20
  of a crutch--learn to trust what you see and feel more, without =
feeling like=20
  you need a positive test to give you permission to make a clinical =
decision,=20
  and you will, as I said, be ahead of many physicians of the "modern" =
age=20
  <BR>Try Dennis et al, J Trauma Feb 1998, Frykberg ER, Surgical Clinics =
of=20
  North America, April 1995. <BR>ERF</FONT> =
</FONT></BLOCKQUOTE></BODY></HTML>

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