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Wed Jul 7 09:08:41 BST 2004

Hi.
Italian anesthesiologist/critical and neurocritical care/emergency physician
Alpine rescue physician

Well, it's a uncertain matter, but i (and my colleagues) believe that if
unconscious and hypotensive the patient has to be put horizontally and
generous fluids and even vasopressors given, in fact after a severe
traumatic brain injury, as you know, mortality and morbidity doubles even a
single episode of hypotension (national traumatic coma data bank, Guidelines
for severe head injury, Brain Trauma Foundation).

Alessandro Rigobello
Anesthesiology and Critical Care Department
Vicenza Regional Hospital
Italy
alessandro.rigobello at ulssvicenza.it

----- Original Message -----
From: "mark forrest" <atacc.doc at virgin.net>
To: <trauma-list at trauma.org>
Sent: Wednesday, July 07, 2004 12:07 AM
Subject: RE: Suspension trauma dilemma

> I have been concerned for sometime about the various guidelines for the
> management of 'suspension trauma' in harness wearers. This issue has
> been highlighted and well covered in the latest Technical Rescue Journal
> (No. 41, pgs 56-58).
>
> For prolonged suspension (>5mins) they state that the victim:
> - must not be allowed to lie down during rescue
> - must remain in the sitting position for at least 30 minutes on 100%
> oxygen
>
> Whilst I understand the pathological mechanisms and the concerns of the
> specialists in this area about ignorant medics producing rapid wash-out
> of anaerobic metabolites and rapid death, I remain concerned about these
> guidelines.
>
> The main issue centres around leaving an unconscious victim upright. He
> will have lost consciousness because of reduced venous return and
> subsequently cardiac output and cerebral perfusion. In every other
> situation we would be lying this man down to restore blood flow to the
> brain.
>
> So what do we do about the washout of potentially lethal metabolites?
> In crush injury we would consider staged release with tourniquets,
> bicarbonate, generous fluids (yes, even I give fluids occasionally),
> antiarrhythmics....but what about the construction and rescue guys on
> the frontline?
> Any thoughts from the pre-hospital guys out there??
>
> Regards
> Mark F
>
> -----Original Message-----
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> Sent: 06 July 2004 12:00
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> Subject: trauma-list Digest, Vol 13, Issue 8
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Suspension trauma dilemma