Chest Xray as protocol

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In our Level I trauma center a GSW to the femur is always a Trauma I.

Claudia Burrows

-----Original Message-----
From: trauma-list-bounces at trauma.org =
[mailto:trauma-list-bounces at trauma.org]
On Behalf Of Green, Brian
Sent: Friday, April 08, 2005 12:45 PM
To: Trauma & Critical Care mailing list
Subject: RE: Chest Xray as protocol


ACS Field Triage Decision Scheme, page 14, Gold Book
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"All penetrating injuries to head, neck, torso, and extremities proximal =
to
elbow and knee"
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We have this as a code two trauma, which activates a senior surgical
resident with the ED doctor, in addition to ER nurses, radiology etc.
(Tiered response used here - Code 1, 2, 3 with different response for =
each).
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It would entirely suck, if a patient presented with this type of injury =
with
a vascular injury.  We activate based on EMS pre-notification.  And yes, =
I
agree that the majority of these are bread and butter cases that an ER =
doc
could handle.  But every once in a while it's more than meets the eye to =
the
pre-hospital folks.
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B
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-----Original Message-----
From: Lorick Fox, PA-C [mailto:Lorick at Lorick.org]
Sent: Friday, April 08, 2005 12:58 PM
To: Trauma & Critical Care mailing list
Subject: RE: Chest Xray as protocol
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Can we go back one step?  I admit I've been out of the trauma business =
for a
while, but WHY would a trauma team be activated for a stable patient =
with
injury limited to a single limb? OK, you will need orthopaedic surgeon, =
who
might want a vascular surgeon, but this sounds like a bread and butter =
ER
patient that an ER physician can manage with a single consultant.  In =
the
"good old days", you would have been laughed out the hospital for =
calling a
trauma for this patient. I will admit, if this is "trauma", then, IMHO, =
Dr.
Green is quite correct to question the universality of protocols.=20

Lorick

At 10:55 AM 4/8/2005 -0400, you wrote:


Under what imaginable conditions would a patient come into a Trauma =
Center,
have the Trauma Team activated, and not have "an indication" for CXR?
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How about a through and through GSW to the thigh, normal vital signs.  =
Meets
criteria for a code two trauma.  Just a thought....but....it would seem =
like
a total waste to do a chest x-ray in this circumstance.
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BJG
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-----Original Message-----
From: Lorick Fox, PA-C [  <mailto:Lorick at Lorick.org>
mailto:Lorick at Lorick.org]
Sent: Friday, April 08, 2005 10:26 AM
To: Trauma & Critical Care mailing list
Subject: Chest Xray as protocol
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While neither surgeon nor anesthesiologist, I thought no one with any =
trauma
ever went to the O.R. without a CXR; to r/o Pneumo, unknown pre-existing
pulmonary disease, provide a baseline for future films post op, catch
injuries missed because of distraction, etc. Under what imaginable
conditions would a patient come into a Trauma Center, have the Trauma =
Team
activated, and not have "an indication" for CXR? If the answer is "Well =
I
can concoct some bizarre scenario, but it's never happened", then why =
NOT
make it "protocol?  If someone takes time to worry about whether a CBC, =
CXR,
etc are "indicated", that takes some time and effort away from the =
critical
thinking required AND slows the process, as someone has to wait for the
decision to be made and the order given - which was always the reason =
for
"protocols" in the first place.




Lorick
Lorick Fox, PA-C
SEAVIN/GSC
USAF Peace Vector IV www.gscfamily.com <http://www.gscfamily.com/>  <
http://www.gscfamily.com/>=20
Gianaclis Egyptian Air Force Base
Gianaclis, Egypt
+(20)3-338-2335 or FAX +(20)3-448-2339
www.lorick.org <http://www.lorick.org/>  <  <http://www.lorick.org/>
http://www.lorick.org/>=20



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