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Sun Mar 13 19:09:43 GMT 2005

Hello Ken,

1st - It is Yoram Klein and not Yoram Kluger that you quoted (We have 2
trauma Yorams in Israel)

2nd - I have to echo the words of Dr Klein and Dr Shapira (as well as
others) about the problems we encounter during ATLS courses.  Don't read me
wrong.  I think this is the best Trauma Course ever designed and I have been
teaching it for the last 15 years or so.  However, the three issues
mentioned: Initial fluid boluses, Needle thoracostomy for Tension Ptx, and
Pericardiocenthesis for cardiac tamponade, cause us to twist and turn in an
uneasy fashion during classes and sometimes even when supervising the
written tests.  The students (some of them comming from hospital where we
work and manage trauma patients) claim that we say one thing in the hospital
and another during ATLS class.  See, we are a small country and many of the
students know the instructors personally and sometimes work with them.

3rd - I have never seen a heart herniate from it's pericard in a LIVE blunt
trauma patient that needed an ED thoracotomy.  I saw it once, in a DOA.  The
chest was already open by the force of the blunt trauma (it was torn).

4th - We were eagerly waiting (as I believe many of us around the world) for
some changes in the new ATLS edition so we could settle these differences,
but we were somewhat disappointed.  However, it is still the best course in
the neighborhood, so I will bear with it with some more explanations to the
students about EBM and common sense, untill we will see the next edition.
As for the written tests, the students are instructed to answer ONLY
according to material in the ATLS BOOK.  At least in my classes I specify
the differences we mentioned above, so they will not flunk their test
because of questions related to these "controvertial" issues.  One thing is
good about it.  I tell them that if they didn't read the book thoroughly
they can never pass the written test.

Mickey Stein

*************************************************
Michael Stein MD
Chirman, Israel Trauma Society
Director of Trauma, Attending Surgeon,
Department of Surgery,
The Rabin Medical Center, Beilinson Campus,
Petach-Tikva, 49100
Israel
Cellular: +972  50-763-7752
Tel:  +972  3-937-7043
Fax:  +972  3-937-7042
E-Mail:  mshtein at clalit.org.il
*************************************************

----- Original Message ----- 
From: <KMATTOX at aol.com>
To: <trauma-list at trauma.org>
Sent: Sunday, March 13, 2005 9:14 PM
Subject: Re: ATLS is out of date - EC thoracotomy for cardiac herniation ??

>
> In a message dated 3/13/2005 11:32:55 A.M. Central Standard Time,
> Ekuhnrn at aol.com writes:
>
> Okay,  probably a stupid question, but why wouldn't you want to do a
> thoracotomy?  i should say that I've never audited an ATLS class but
common
> sense would
> dictate that if your reasonably sure of the injury and  can attempt to fix
> it,
> you should, right?  Enlighten me,  please.
>
>
> I was responding to a question and statement from Dr. Yorum Kluger of
> Israel, that the NEW ATLS course was teaching that for post traumatic
arrest
> following BLUNT trauma.   I was raising a question about an obvious
indication for
> EC thoracotomy in blunt trauma.
>
> k
> --
> trauma-list : TRAUMA.ORG
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ATLS is out of date - EC thoracotomy for cardiac herniation ??