Site Search
Trauma-List Subscription


Would you like to receive list emails batched into one daily digest?
No Yes
Modify Your Subscription


Home > List Archives

Opiates & the Acute Abdomen

Richard Wigle MD FACS trauma-list@trauma.org
Fri, 11 Apr 2003 00:45:54 -0700 (PDT)

I'm with you Caesar

I realize that once again you and I are going to be called
Nazis, some one is going to write and say they hope never
to see you or me, or have their relatives, friends, distant
cousins etc etc see us in the emergency department. 

If we examine the responses that this discussion has
generated in the past almost all "medicate" responses are
from specialties where they don't have to deal with the
long term care of the victim.

R Wigle
--- caesar ursic <cmursic@yahoo.com> wrote:
> This month's lead article in the American Journal of
> Surgery (Nissman SA, Kaplan LJ, Mann BD. Critically
> reappraising the literature-driven practice of
> analgesia administration for acute abdominal pain in
> the emergency room prior to surgical evaluation. Am J
> Surg 2003;185:291-96) addresses the once (still?)
> controversial practice of administering narcotics to
> patients suspected of harboring intraabdominal
> pathology before the arrival of the consulting
> surgeon.  I know this issue has been discussed on this
> board before, but these authors present a nice
> critique of the very same literature that is often
> quoted (mainly by Emergency medicine doctors, in my
> experience) to support this practice.  At best the
> supporting evidence comes from four studies that were
> flawed in design and/or examined insufficient numbers
> of patients.  Based on my reading of the paper, it
> seems that surgeons who still get upset when they are
> asked to see a patient with a possible surgical
> abdomen who has already been narcotized should not be
> dismissed as crusty curmudgeons who fail to adapt to
> the times or who are ignorant of the latest
> "literature."  Has this practice, then, become the
> "standard of care" without a sufficient body of
> supporting evidence?  I believe this is a relevant
> issue in trauma care as well, given the significant
> numbers of patients we are asked to see by the ER
> service who did not initially meet full trauma
> activation criteria yet in whom there is a question of
> intraabdominal injury.  I plan to show this paper to
> our Director of Emergency Medicine, who is a staunch
> advocate of pre-surgical consult narcomedication.  I'd
> be interested in everybody's thoughts as well.
> C.M. Ursic, M.D.
> Dept. of Surgery
> UCSF-East Bay
> Oakland, California
> __________________________________________________
> Do you Yahoo!?
> Yahoo! Tax Center - File online, calculators, forms, and
> more
> http://tax.yahoo.com
> --
> trauma-list : TRAUMA.ORG
> To change your settings or unsubscribe visit:
> http://www.trauma.org/traumalist.html

Do you Yahoo!?
Yahoo! Tax Center - File online, calculators, forms, and more