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Fri, 1 Mar 2002 08:27:22 -0500

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Jeff,

Tough scene, sounds on the surface like good work; but with all respect to
the challenge of encapsulating it all in e-mail, I smell a trap.

[Who's worse? #1 or #2?]  #1, of course, unless there's something you didn't
see, or aren't telling us.  When you put "normal" in quotation marks, I lost
interest in speculating.

[Should the calm, docile mental status of a pregnant woman with possible
rupture worry us (i.e. should she be more
upset, or is this a possible head injury we missed?)]  Well, you say she
"appears" pregnant, and go on to guess at gestation.  Did anybody talk to
her, ask if she's pregnant, with how many, for how long, had any before, got
names picked?  She is "calm and docile," but you shouldn't be as worried
about her mood as her neurologic status: what's the GCS?  She senses leaking
fluid, but nobody LOOKED?  This poor woman was seriously under-evaluated.
Immobilize, tip the board to the left, and get her to someone who'll do a
better assessment.  Quick.

[Had patient #2 been easily accessed, should he have been given first
priority?]  See "Who's worse?"  Ten to twelve minutes isn't bad for an open
tib-fib in an otherwise stable young adult.  What aren't you telling us?

[Can one trauma hospital handle all 4 patients?]  Depends on the trauma
hospital, of course.  What are your alternatives?  This is a local systems
issue which, if you didn't have it sorted out before this crash, you should
look into sorting out before the next one.  Less a question for the
Trauma-List than one for you and your local medical control.

[Any problem with not immobilizing #4?]  Would there have been any problem
WITH immobilizing him?  If you've got the board, and the personnel, then I'm
betting your local protocol says to board him--and I never discourage folks
from following local protocols.  Absent such a directive, you can play the
odds, which are probably something like 1000:1 against spinal injury (and
surely much higher against risk to the cord); but no matter what you call
it, you're still simply playing the odds.  The bigger the disaster, the
greater the likelihood that one of these "limping wounded" will have an
occult injury waiting to bite you on the ass.  That's what standards of care
are for.

I look forward to hearing how these patients turned out.

Pret 

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Jeff, Tough scene, 
sounds on the surface like good work; but with all respect to the challenge of 
encapsulating it all in e-mail, I smell a 
trap. [Who's worse? #1 
or #2?]&nbsp; #1, of course, unless there's something you didn't see, or aren't 
telling us.&nbsp; When you put "normal" in quotation marks, I lost interest in 
speculating.
[Should the calm, docile mental status of a 
pregnant woman with possible rupture worry us (i.e. should she be more upset, 
or is this a possible head injury we missed?)]&nbsp; Well, 
you say she "appears" pregnant, and go on to guess at gestation.&nbsp; Did 
anybody talk to her, ask if she's pregnant, with how many, for how long, had any 
before, got names picked?&nbsp; She is "calm and docile," but you shouldn't 
be&nbsp;as worried about her mood as her neurologic status: what's the 
GCS?&nbsp; She senses leaking fluid, but nobody LOOKED?&nbsp; This poor woman 
was seriously under-evaluated.&nbsp; Immobilize, tip the board to the left, and 
get her to someone who'll do a better assessment.&nbsp; 
Quick.
[Had patient #2 been easily accessed, should he 
have been given first priority?]&nbsp; See "Who's 
worse?"&nbsp; Ten to twelve minutes isn't bad for an open tib-fib in an 
otherwise stable young adult.&nbsp; What aren't you telling 
us?
[Can one trauma hospital handle all 4 
patients?]&nbsp; Depends on the trauma hospital, of 
course.&nbsp; What are your alternatives?&nbsp; This is a local systems issue 
which, if you didn't have it sorted out before this crash, you should look into 
sorting out before the next one.&nbsp; Less a question for the Trauma-List than 
one for you and your local medical control.
[Any problem with not immobilizing #4?]&nbsp; Would there have been any problem WITH immobilizing 
him?&nbsp; If you've got the board, and the personnel, then I'm betting your 
local protocol says to board him--and I never discourage folks from following 
local protocols.&nbsp; Absent such a directive, you can play the odds, which are 
probably something like 1000:1 against spinal injury (and surely much higher 
against risk to the cord); but no matter what you call it, you're still simply 
playing the odds.&nbsp; The bigger the disaster, the greater the likelihood that one of 
these "limping wounded" will have an occult injury waiting to bite you on the 
ass.&nbsp; That's what standards of care are for.
I look forward to hearing how these 
patients turned out.
Pret </BODY></HTML>

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