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trauma-list digest, Vol 1 #1662 - 22 msgsDunn Matthew Dr. (RJC) ACCIDENT & EMERGENCY - SwarkHosp-TR email@example.com
Mon, 6 Jan 2003 10:44:28 -0000
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I'd say a good reason for not using hetastarch (or indeed any colloid) is that they are ineffective. I accept that absence of evidence is not the same thing as evidence of absence; but there is a sufficient body of good quality research on the crystalloid/ coloid debate showing no evidence of benefit from colloid that I think we can pretty much close the debate. Despite possible arguments for why colloids should work for volume replacement, they don't. Any colloid, any circumstance, If you want to fiddle about saying paediatric cases with a combinination of head injury and septic shock have not been studied, then fine- consider colloids an experimental treatment in such cases. But as part of routine clinical practice, they have had their day. BTW, while I personally agree with the concept of permissive hypotension, I disagree with Dr Mattox on the strength of evidence. As far as I'm aware, that stands at different interpretations of pathophysiology and conflicting animal studies and computer models with the only study showing benefit in patients being confined to penetrating thoracic trauma. The evidence is not there one way or the other and extrapolation from this one study to raise implications for all forms of trauma is not warranted. > If they are going to such lengths to preserve the orthodoxy > that they will > disbar anyone who questions it, how long before the system > becomes ossified > (if it hasn't already) and what should be done about it? It ossified several years ago. there are sufficient vested interests in maintaining the status quo. A major weakness of ATLS, ALS etc. is the policy of not recommending for instructor status those candidates who question the orthodoxy. As much of what is within these courses goes against the available evidence, this ensures that instructors are either ignorant of recent advances in the area they are supposed to be teaching; or teaching what they do not practice. Unfortunately, difficult to change from within the advanced life support circle. Easier to work from outside (but very much within the broader medical community)- continue to emphasise the importance of evidence based medicine and working to individual competence over didactic teaching and 'badge collecting'. Challenge the orthodoxy and support your juniors who do the same. Matt Dunn Warwick This email has been scanned for viruses by NAI AVD however we are unable to accept responsibility for any damage caused by the contents. The opinions expressed in this email represent the views of the sender, not South Warwickshire General Hospitals NHS Trust unless explicitly stated. If you have received this email in error, please notify the sender.