Login
Site Search
Trauma-List Subscription
Modify Your Subscription
Home >
List Archives
Penetrating Chest Trauma
Nick Nudell trauma-list@trauma.orgTue, 29 Apr 2003 14:00:00 -0700
- Previous message: Penetrating Chest Trauma
- Next message: Penetrating Chest Trauma
- Messages sorted by: [ date ] [ thread ] [ subject ] [ author ]
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> </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> </DIV> <DIV><FONT size=2>It is quite evident that everyone is involved in the trauma care.</FONT></DIV> <DIV><FONT size=2></FONT> </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> </DIV> <DIV><FONT size=2>Regards</FONT></DIV> <DIV><FONT size=2>Nick</FONT></DIV> <DIV><FONT size=2></FONT> </DIV> <DIV><FONT size=2></FONT> </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> </DIV> <DIV><FONT size=2>"Perception is reality" - Wise Old Paramedic</FONT></DIV> <DIV><FONT size=2></FONT> </DIV> <DIV> </DIV> <DIV> </DIV> <DIV> </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). 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.</FONT><FONT lang=0 style="BACKGROUND-COLOR: #ffffff" face=Arial color=#000000 size=3 FAMILY="SANSSERIF"></B><BR> <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). 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. 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. <BR><BR>k</FONT> </FONT></BLOCKQUOTE></BODY></HTML> --Boundary_(ID_bTxDLrX5u8qR2kOST75SwA)--
- Previous message: Penetrating Chest Trauma
- Next message: Penetrating Chest Trauma
- Messages sorted by: [ date ] [ thread ] [ subject ] [ author ]
