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Mon, 28 Apr 2003 14:37:37 -0500

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Quit, beating on them, it won't work.  Invite them to your mortality and
morbidity conferences.  Let them see that you know how to care for
trauma patients.  Let them see that you can and do make mistakes but you
work together to fix the mistakes or problems.  This will take months.
Then present them with the paper that Drs. Mattox and Wall published
several years ago which looks at complex cardiac procedures in trauma.
If you have to some thing fancy then those patients don't do well.  As a
matter of fact they do very poorly.  

As an aside, for the most part you don't bypass for most cardiac
injuries.  You can repair the major damage and stabilize the patient
then transport later if needed.  Most of the time a couple of well
placed sutures is all you need. 

E

Errington C. Thompson, MD
Trauma Surgeon
Trinity Mother Frances
Tyler, Tx
ecthompson@tyler.net

Don't think you are
Know you are
                            - Morpheus (The Matrix)

-----Original Message-----
From: trauma-list-admin@trauma.org [mailto:trauma-list-admin@trauma.org]
On Behalf Of Andrew J Bowman
Sent: Sunday, April 27, 2003 11:00 PM
To: Trauma List
Subject: Penetrating Chest Trauma

Well, they did it again.  

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 

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<div class=3DSection1>

Quit, =
beating on
them, it won&#8217;t work.&nbsp; =
Invite
them to your mortality and morbidity conferences.&nbsp; Let them see that you know how =
to care
for trauma patients.&nbsp; Let =
them see
that you can and do make mistakes but you work together to fix the =
mistakes or
problems.&nbsp; This will take
months.&nbsp; Then present them =
with the
paper that Drs. Mattox and Wall published several years ago which looks =
at
complex cardiac procedures in trauma. &nbsp;If you have to some thing fancy =
then those
patients don&#8217;t do well. &nbsp;As a
matter of fact they do very poorly.&nbsp;
<o:p></o:p>

<p class=3DMsoNormal><font size=3D3 color=3Dnavy face=3D"Times New =
Roman"><span
style=3D'font-size:12.0pt;mso-bidi-font-family:Arial;color:navy'><o:p>&nb=
sp;</o:p></span></font></p>

As an =
aside, for
the most part you don&#8217;t bypass for most cardiac injuries.&nbsp; You can repair the major damage =
and
stabilize the patient then transport later if needed.&nbsp; Most of the time a couple of =
well placed
sutures is all you need. <o:p></o:p>

<p class=3DMsoNormal><font size=3D3 color=3Dnavy face=3D"Times New =
Roman"><span
style=3D'font-size:12.0pt;mso-bidi-font-family:Arial;color:navy'><o:p>&nb=
sp;</o:p></span></font></p>

<p class=3DMsoNormal><font size=3D3 color=3Dnavy face=3D"Times New =
Roman"><span
style=3D'font-size:12.0pt;mso-bidi-font-family:Arial;color:navy'>E<o:p></=
o:p></span></font></p>

<p class=3DMsoNormal><font size=3D3 color=3Dnavy face=3D"Times New =
Roman"><span
style=3D'font-size:12.0pt;mso-bidi-font-family:Arial;color:navy'><o:p>&nb=
sp;</o:p></span></font></p>

<div>

<p class=3DMsoAutoSig><st1:PersonName><font size=3D3 color=3Dnavy
 face=3D"Times New Roman"><span =
style=3D'font-size:12.0pt;color:navy;mso-no-proof:
 yes'>Errington</span></font></st1:PersonName><font color=3Dnavy><span
style=3D'color:navy;mso-no-proof:yes'> C. Thompson, =
MD<o:p></o:p></span></font></p>

<p class=3DMsoAutoSig><font size=3D3 color=3Dnavy face=3D"Times New =
Roman"><span
style=3D'font-size:12.0pt;color:navy;mso-no-proof:yes'>Trauma =
Surgeon<o:p></o:p></span></font></p>

<p class=3DMsoAutoSig><font size=3D3 color=3Dnavy face=3D"Times New =
Roman"><span
style=3D'font-size:12.0pt;color:navy;mso-no-proof:yes'>Trinity Mother =
Frances<o:p></o:p></span></font></p>

<p class=3DMsoAutoSig><font size=3D3 color=3Dnavy face=3D"Times New =
Roman"><span
style=3D'font-size:12.0pt;color:navy;mso-no-proof:yes'>Tyler, =
Tx<o:p></o:p></span></font></p>

<p class=3DMsoAutoSig><st1:PersonName><font size=3D3 color=3Dnavy
 face=3D"Times New Roman"><span =
style=3D'font-size:12.0pt;color:navy;mso-no-proof:
 yes'>ecthompson</span></font></st1:PersonName><font color=3Dnavy><span
style=3D'color:navy;mso-no-proof:yes'>@tyler.net<o:p></o:p></span></font>=
</p>

<p class=3DMsoAutoSig><font size=3D3 color=3Dnavy face=3D"Times New =
Roman"><span
style=3D'font-size:12.0pt;color:navy;mso-no-proof:yes'><o:p>&nbsp;</o:p><=
/span></font></p>

<p class=3DMsoAutoSig><font size=3D3 color=3Dnavy face=3D"Times New =
Roman"><span
style=3D'font-size:12.0pt;color:navy;mso-no-proof:yes'>Don't think you =
are<o:p></o:p></span></font></p>

<p class=3DMsoAutoSig><font size=3D3 color=3Dnavy face=3D"Times New =
Roman"><span
style=3D'font-size:12.0pt;color:navy;mso-no-proof:yes'>Know you =
are<o:p></o:p></span></font></p>

<p class=3DMsoAutoSig><font size=3D3 color=3Dnavy face=3D"Times New =
Roman"><span
style=3D'font-size:12.0pt;color:navy;mso-no-proof:yes'><span
style=3D'mso-spacerun:yes'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbs=
p;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp=
;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
</span>- Morpheus (The Matrix)<o:p></o:p></span></font></p>

</div>

<p class=3DMsoNormal><font size=3D3 color=3Dnavy face=3D"Times New =
Roman"><span
style=3D'font-size:12.0pt;mso-bidi-font-family:Arial;color:navy'><o:p>&nb=
sp;</o:p></span></font></p>

<p class=3DMsoNormal style=3D'margin-left:.5in'><font size=3D2 =
face=3DTahoma><span
style=3D'font-size:10.0pt;font-family:Tahoma'>-----Original =
Message-----<br>
<b><span style=3D'font-weight:bold'>From:</span></b> =
trauma-list-admin@trauma.org
[mailto:trauma-list-admin@trauma.org] <b><span =
style=3D'font-weight:bold'>On
Behalf Of </span></b>Andrew J Bowman<br>
<b><span style=3D'font-weight:bold'>Sent:</span></b> Sunday, April 27, =
2003 11:00
PM<br>
<b><span style=3D'font-weight:bold'>To:</span></b> Trauma List<br>
<b><span style=3D'font-weight:bold'>Subject:</span></b> Penetrating =
Chest Trauma</span></font></p>

<p class=3DMsoNormal style=3D'margin-left:.5in'><font size=3D3 =
face=3D"Times New Roman"><span
style=3D'font-size:12.0pt'><o:p>&nbsp;</o:p></span></font></p>

<div>

<p class=3DMsoNormal style=3D'margin-left:.5in'><strong><b><font =
size=3D2
face=3DTahoma><span style=3D'font-size:10.0pt;font-family:Tahoma'>Well, =
they did it
again.&nbsp; </span></font></b></strong><o:p></o:p></p>

</div>

<div>

<p class=3DMsoNormal style=3D'margin-left:.5in'><font size=3D3 =
face=3D"Times New Roman"><span
style=3D'font-size:12.0pt'>&nbsp;<o:p></o:p></span></font></p>

</div>

<div>

<p class=3DMsoNormal style=3D'margin-left:.5in'><strong><b><font =
size=3D2
face=3DTahoma><span style=3D'font-size:10.0pt;font-family:Tahoma'>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).&nbsp; Emergency
departments are staffed the same, board certified emergency medicine =
physicians
and experienced nursing staffs.&nbsp; Any after hours surgery requires a =
call
in of surgeon, anesthesia and staff (they have 1 hour to =
arrive).</span></font></b></strong><o:p></o:p></p>

</div>

<div>

<p class=3DMsoNormal style=3D'margin-left:.5in'><font size=3D3 =
face=3D"Times New Roman"><span
style=3D'font-size:12.0pt'>&nbsp;<o:p></o:p></span></font></p>

</div>

<div>

<p class=3DMsoNormal style=3D'margin-left:.5in'><strong><b><font =
size=3D2
face=3DTahoma><span style=3D'font-size:10.0pt;font-family:Tahoma'>Friday =
night, GSW
to the chest, unstable and near arrest in the field.&nbsp; medics drove =
right
past the non bypass hospital to get to the hospital with bypass.&nbsp; =
Patient
died in the ER shortly after arrival.&nbsp; (by the way, at 12 midnight, =
the
cardiac suite is closed!)</span></font></b></strong><o:p></o:p></p>

</div>

<div>

<p class=3DMsoNormal style=3D'margin-left:.5in'><font size=3D3 =
face=3D"Times New Roman"><span
style=3D'font-size:12.0pt'>&nbsp;<o:p></o:p></span></font></p>

</div>

<div>

<p class=3DMsoNormal style=3D'margin-left:.5in'><strong><b><font =
size=3D2
face=3DTahoma><span style=3D'font-size:10.0pt;font-family:Tahoma'>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 =
&quot;maybe&quot;
needing&nbsp;bypass (big maybe).&nbsp; Most (far and away most) trauma =
patients
will not need bypass and patient may die getting to the other =
place.</span></font></b></strong><o:p></o:p></p>

</div>

<div>

<p class=3DMsoNormal style=3D'margin-left:.5in'><font size=3D3 =
face=3D"Times New Roman"><span
style=3D'font-size:12.0pt'>&nbsp;<o:p></o:p></span></font></p>

</div>

<div>

<p class=3DMsoNormal style=3D'margin-left:.5in'><strong><b><font =
size=3D2
face=3DTahoma><span style=3D'font-size:10.0pt;font-family:Tahoma'>Any =
suggestions
for how to proceed?????</span></font></b></strong><o:p></o:p></p>

</div>

<div>

<p class=3DMsoNormal style=3D'margin-left:.5in'><font size=3D3 =
face=3D"Times New Roman"><span
style=3D'font-size:12.0pt'>&nbsp;<o:p></o:p></span></font></p>

</div>

<div>

Andrew =
J. Bowman,
RN, CEN, CCRN, NREMT-P 
Patient Care
Coordinator 
Education
Coordinator (Trauma &amp; Emergency Cardiovascular =
Care) 
Emergency
Department 
Home =
Hospital
Campus 
Greater Lafayette
Health Services, Inc. 
2400 =
South Street 
Lafayette,
Indiana&nbsp; 47904 =
<o:p></o:p>

</div>

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Penetrating Chest Trauma