Login
Site Search
Trauma-List Subscription

Subscribe

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

Modify

Home > List Archives

Penetrating Chest Trauma

Nick Nudell trauma-list@trauma.org
Tue, 29 Apr 2003 14:00:00 -0700


This is a multi-part message in MIME format.

--Boundary_(ID_bTxDLrX5u8qR2kOST75SwA)
Content-type: text/plain; charset=iso-8859-1
Content-transfer-encoding: 7BIT

Since I am new to the 'real' trauma world since my relocation it has been very interesting for me to see the differences. Before, there was no surgeon available for at least 30 minutes no matter what. The patients would get the appropriate treatment (short of surgery) for all trauma. There were very few deaths in the ED from this, perhaps due to the lower volume of trauma scene in rural areas. This care was provided by Family Practice physicians, most of which had attended ATLS sometime in the past.

Now, in a busy Level 2 center I have seen several arrests, but they all were presented in an arrest. The medical patients are arresting, while the trauma patients are not. When the Trauma Team is activated, everyone comes... the trauma surgeon is there upon patient arrival to receive report from the medics. In the rare instance when they are not, the ED doc proceeds with assessment but there is a definite 'pause' in the mood as everyone anticipates the arrival. The surgeon and ED doc work together to form the treatment plan, particularly in the case of multitrauma or 'no holes' to be plugged. CT is done after the initial assessment and treatments. The initial impression is definitely formed by the hands on assessments performed and CT is only used as a supplement. 

It is quite evident that everyone is involved in the trauma care.

As another note, it is quite common for the ground ambulances to transport trauma patients past other closer hospitals to get to our trauma center. From subjective evidence, it appears that this may sometimes add 20 minutes to the transport. Recently there was a left axillary 5th ICS stabbing that rode nearly 30 minutes to get to us. The patient was fortunately stable and the trauma team only was needed for about 15 minutes till we stapled him and cleaned up the dried blood. If he was unstable then things would have probably been a little different. 

Regards
Nick



____________________________________________
Nick Nudell, NREMT-P, CCEMT-P
California
nudell@prehospital-perspective.com

"Perception is reality" - Wise Old Paramedic




  ----- Original Message ----- 
  From: KMATTOX@aol.com 
  To: trauma-list@trauma.org 
  Sent: Tuesday, April 29, 2003 11:31 AM
  Subject: Re: Penetrating Chest Trauma


  In a message dated 4/29/2003 1:24:49 PM Central Daylight Time, sumieb@compuserve.com writes:


    Surgeons have little to no involvement in pre-hospital/ER trauma decisions (by their own decision).  Several years ago when I was in the beginnings of developing a "Trauma Team" for our ED the surgeons were invited to the proceedings from the very beginning.  They (as a group) left it to the ED to plan and implement.
      
    Even now, their approach is for ED physician stabilization and call when the CT is ready (for stable patients) and come in quickly when called for unstable (with many, not all, grumbling about it).  Very few times has a surgeon come in when called by the EDP based on EMS report, "Call me when he gets there and you see him".



  I am truly sorry that your surgeons are not committed to quality care for the patients that your serve.   Every document that I have read about systems approach to trauma care, mandates that the surgeon be involved at all levels.  The ACS requires that patients meeting your local trauma activation criteria, be present upon the patients arrival at the EC.    To want to be called AFTER CTs are performed is simply to not understand the problem.   I do not know what community you represent, but I also now know what community I do not want to be traumatized in.    Thanks for sharing some of the issues which beg for a trauma system  solution.  

  k 

--Boundary_(ID_bTxDLrX5u8qR2kOST75SwA)
Content-type: text/html; charset=iso-8859-1
Content-transfer-encoding: 7BIT

<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.0 Transitional//EN">
<HTML><HEAD>
<META http-equiv=Content-Type content="text/html; charset=iso-8859-1">
<META content="MSHTML 6.00.2800.1170" name=GENERATOR>
<STYLE></STYLE>
</HEAD>
<BODY style="COLOR: #000000; FONT-FAMILY: Tahoma" bgColor=#ffffff>
<DIV><FONT size=2>Since I am new to the 'real' trauma world since my relocation 
it has been very interesting for me to see the differences. Before, there was no 
surgeon available for at least 30 minutes no matter what. The patients would get 
the appropriate treatment (short of surgery) for all trauma. There were very few 
deaths in the ED from this, perhaps due to the lower volume of trauma scene in 
rural areas. This care was provided by Family Practice physicians, most of which 
had attended ATLS sometime in the past.</FONT></DIV>
<DIV><FONT size=2></FONT>&nbsp;</DIV>
<DIV><FONT size=2>Now, in a busy Level 2 center I have seen several arrests, but 
they all were presented in an arrest. The medical patients are arresting, while 
the trauma patients are not. When the Trauma Team is activated, everyone 
comes... the trauma surgeon is there upon patient arrival to receive report from 
the medics. In the rare instance when they are not, the ED doc proceeds with 
assessment but there is a definite 'pause' in the mood as everyone anticipates 
the arrival. The surgeon and ED doc work together to form the treatment plan, 
particularly in the case of multitrauma or 'no holes' to be plugged. CT is done 
after the initial assessment and treatments. The initial impression is 
definitely formed by the hands on assessments performed and CT is only used as a 
supplement. </FONT></DIV>
<DIV><FONT size=2></FONT>&nbsp;</DIV>
<DIV><FONT size=2>It is quite evident that everyone is involved in the trauma 
care.</FONT></DIV>
<DIV><FONT size=2></FONT>&nbsp;</DIV>
<DIV><FONT size=2>As another note, it is quite common for the ground ambulances 
to transport trauma patients past other closer hospitals to get to our trauma 
center. From subjective evidence, it appears that this may sometimes add 20 
minutes to the transport. Recently there was a left axillary 5th ICS stabbing 
that rode nearly 30 minutes to get to us. The patient was fortunately stable and 
the trauma team only was needed for about 15 minutes till we stapled him and 
cleaned up the dried blood. If he was unstable then things would have probably 
been a little different. </FONT></DIV>
<DIV><FONT size=2></FONT>&nbsp;</DIV>
<DIV><FONT size=2>Regards</FONT></DIV>
<DIV><FONT size=2>Nick</FONT></DIV>
<DIV><FONT size=2></FONT>&nbsp;</DIV>
<DIV><FONT size=2></FONT>&nbsp;</DIV>
<DIV><BR><FONT size=2>____________________________________________<BR>Nick 
Nudell, NREMT-P, CCEMT-P<BR>California<BR></FONT><A 
href="mailto:nudell@prehospital-perspective.com"><FONT 
size=2>nudell@prehospital-perspective.com</FONT></A></DIV>
<DIV><FONT size=2></FONT>&nbsp;</DIV>
<DIV><FONT size=2>"Perception is reality" - Wise Old Paramedic</FONT></DIV>
<DIV><FONT size=2></FONT>&nbsp;</DIV>
<DIV>&nbsp;</DIV>
<DIV>&nbsp;</DIV>
<DIV>&nbsp;</DIV>
<BLOCKQUOTE 
style="PADDING-RIGHT: 0px; PADDING-LEFT: 5px; MARGIN-LEFT: 5px; BORDER-LEFT: #000000 2px solid; MARGIN-RIGHT: 0px">
  <DIV style="FONT: 10pt arial">----- Original Message ----- </DIV>
  <DIV 
  style="BACKGROUND: #e4e4e4; FONT: 10pt arial; font-color: black"><B>From:</B> 
  <A title=KMATTOX@aol.com href="mailto:KMATTOX@aol.com">KMATTOX@aol.com</A> 
  </DIV>
  <DIV style="FONT: 10pt arial"><B>To:</B> <A title=trauma-list@trauma.org 
  href="mailto:trauma-list@trauma.org">trauma-list@trauma.org</A> </DIV>
  <DIV style="FONT: 10pt arial"><B>Sent:</B> Tuesday, April 29, 2003 11:31 
  AM</DIV>
  <DIV style="FONT: 10pt arial"><B>Subject:</B> Re: Penetrating Chest 
  Trauma</DIV>
  <DIV><BR></DIV><FONT face=arial,helvetica><FONT lang=0 face=Arial size=2 
  FAMILY="SANSSERIF">In a message dated 4/29/2003 1:24:49 PM Central Daylight 
  Time, <A href="mailto:sumieb@compuserve.com">sumieb@compuserve.com</A> 
  writes:<BR><BR>
  <BLOCKQUOTE 
  style="PADDING-LEFT: 5px; MARGIN-LEFT: 5px; BORDER-LEFT: #0000ff 2px solid; MARGIN-RIGHT: 0px" 
  TYPE="CITE"></FONT><FONT lang=0 style="BACKGROUND-COLOR: #ffffff" 
    face=Tahoma color=#000000 size=2 FAMILY="SANSSERIF"><B>Surgeons have little 
    to no involvement in pre-hospital/ER trauma decisions (by their own 
    decision).&nbsp; Several years ago when I was in the beginnings of 
    developing a "Trauma Team" for our ED the surgeons were invited to the 
    proceedings from the very beginning.&nbsp; They (as a group) left it to the 
    ED to plan and implement.</FONT><FONT lang=0 
    style="BACKGROUND-COLOR: #ffffff" face=Arial color=#000000 size=3 
    FAMILY="SANSSERIF"></B><BR>&nbsp; <BR></FONT><FONT lang=0 
    style="BACKGROUND-COLOR: #ffffff" face=Tahoma color=#000000 size=2 
    FAMILY="SANSSERIF"><B>Even now, their approach is for ED physician 
    stabilization and call when the CT is ready (for stable patients) and come 
    in quickly when called for unstable (with many, not all, grumbling about 
    it).&nbsp; Very few times has a surgeon come in when called by the EDP based 
    on EMS report, "Call me when he gets there and you see him".</FONT><FONT 
    lang=0 style="BACKGROUND-COLOR: #ffffff" face=Arial color=#000000 size=3 
    FAMILY="SANSSERIF"></B><BR></BLOCKQUOTE><BR></FONT><FONT lang=0 
  style="BACKGROUND-COLOR: #ffffff" face=Arial color=#000000 size=2 
  FAMILY="SANSSERIF"><BR>I am truly sorry that your surgeons are not committed 
  to quality care for the patients that your serve.&nbsp;&nbsp; Every document 
  that I have read about systems approach to trauma care, mandates that the 
  surgeon be involved at all levels.&nbsp; The ACS requires that patients 
  meeting your local trauma activation criteria, be present upon the patients 
  arrival at the EC.&nbsp;&nbsp;&nbsp; To want to be called AFTER CTs are 
  performed is simply to not understand the problem.&nbsp;&nbsp; I do not know 
  what community you represent, but I also now know what community I do not want 
  to be traumatized in.&nbsp;&nbsp;&nbsp; Thanks for sharing some of the issues 
  which beg for a trauma system&nbsp; solution.&nbsp; <BR><BR>k</FONT> 
</FONT></BLOCKQUOTE></BODY></HTML>

--Boundary_(ID_bTxDLrX5u8qR2kOST75SwA)--