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Home > List Archives

Penetrating Chest Trauma

Andrew J Bowman trauma-list@trauma.org
Sun, 27 Apr 2003 22:59:50 -0500


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Well, they did it again. =20

A while back I presented a case of penetrating chest trauma in a =
community with 2 corporate sister hospitals (1 with cardiac bypass and 1 =
without).  Emergency departments are staffed the same, board certified =
emergency medicine physicians and experienced nursing staffs.  Any after =
hours surgery requires a call in of surgeon, anesthesia and staff (they =
have 1 hour to arrive).

Friday night, GSW to the chest, unstable and near arrest in the field.  =
medics drove right past the non bypass hospital to get to the hospital =
with bypass.  Patient died in the ER shortly after arrival.  (by the =
way, at 12 midnight, the cardiac suite is closed!)

I have talked with EMS and their director until blue in face that there =
is no evidence that support driving past 1 ER to another just for the =
sake of "maybe" needing bypass (big maybe).  Most (far and away most) =
trauma patients will not need bypass and patient may die getting to the =
other place.

Any suggestions for how to proceed?????

Andrew J. Bowman, RN, CEN, CCRN, NREMT-P
Patient Care Coordinator
Education Coordinator (Trauma & Emergency Cardiovascular Care)
Emergency Department
Home Hospital Campus
Greater Lafayette Health Services, Inc.
2400 South Street
Lafayette, Indiana  47904=20

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<DIV><STRONG><FONT face=3DTahoma size=3D2>Well, they did it again.&nbsp; =

</FONT></STRONG></DIV>
<DIV><STRONG><FONT face=3DTahoma size=3D2></FONT></STRONG>&nbsp;</DIV>
<DIV><STRONG><FONT face=3DTahoma size=3D2>A while back I presented a =
case of=20
penetrating chest trauma in a community with 2 corporate sister =
hospitals (1=20
with cardiac bypass and 1 without).&nbsp; Emergency departments are =
staffed the=20
same, board certified emergency medicine physicians and experienced =
nursing=20
staffs.&nbsp; Any after hours surgery requires a call in of surgeon, =
anesthesia=20
and staff (they have 1 hour to arrive).</FONT></STRONG></DIV>
<DIV><STRONG><FONT face=3DTahoma size=3D2></FONT></STRONG>&nbsp;</DIV>
<DIV><STRONG><FONT face=3DTahoma size=3D2>Friday night, GSW to the =
chest, unstable=20
and near arrest in the field.&nbsp; medics drove right past the non =
bypass=20
hospital to get to the hospital with bypass.&nbsp; Patient died in the =
ER=20
shortly after arrival.&nbsp; (by the way, at 12 midnight, the cardiac =
suite is=20
closed!)</FONT></STRONG></DIV>
<DIV><STRONG><FONT face=3DTahoma size=3D2></FONT></STRONG>&nbsp;</DIV>
<DIV><STRONG><FONT face=3DTahoma size=3D2>I have talked with EMS and =
their director=20
until blue in face that there is no evidence that support driving past 1 =
ER to=20
another just for the sake of "maybe" needing&nbsp;bypass (big =
maybe).&nbsp; Most=20
(far and away most) trauma patients will not need bypass and patient may =
die=20
getting to the other place.</FONT></STRONG></DIV>
<DIV><STRONG><FONT face=3DTahoma size=3D2></FONT></STRONG>&nbsp;</DIV>
<DIV><STRONG><FONT face=3DTahoma size=3D2>Any suggestions for how to=20
proceed?????</FONT></STRONG></DIV>
<DIV><STRONG><FONT face=3DTahoma size=3D2></FONT></STRONG>&nbsp;</DIV>
<DIV><STRONG><FONT face=3DTahoma size=3D2>Andrew J. Bowman, RN, CEN, =
CCRN,=20
NREMT-P<BR>Patient Care Coordinator<BR>Education Coordinator (Trauma =
&amp;=20
Emergency Cardiovascular Care)<BR>Emergency Department<BR>Home Hospital=20
Campus<BR>Greater Lafayette Health Services, Inc.<BR>2400 South=20
Street<BR>Lafayette, Indiana&nbsp; 47904 =
</FONT></STRONG></DIV></BODY></HTML>

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