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Sun May 15 18:54:31 BST 2005

Pret,

Thanks for having the patience to try.

For those of you vehemently advocating RSI for a pt. with a GCS or 15 and
some ETOH -

First of all I never saw this particular pt. so I don't know if I would have
put him down and scanned him or not.

However, there is ample literature on significant nuerosurgical injury and
"Minimal Head Injury". Why don't you read it and then tell us why you want
to subject everyone with GCS of 15 to paralyzation, intubation and scanning?
As Rick says, it's called science. Such as it is. 

I work(ed) in a very busy urban trauma center. The patient who is stone cold
sober and was shot/stabbed/hit in the head with a bat/run over while
bringing the groceries home to Grandma, is pretty darned rare. Unless it
actually is Grandma. Dr. Nagy may be able to tell you how many patients have
had delayed Dx of head injury over the years. Let alone significant or
missed. But this also would be very very rare.

My brothers in Emergency Medincine have excellent intubation skills. My
brothers in surgery have excellent surgical skills. Between them, nobody
dies without an airway, as they say. But that doesn't mean there are no
complications in the group of patients whose airways we take control of. 

C'mon already. You put all the patients in a big circle and you and the
residents and nurses watch them. If you don't watch them carefully then for
sure you will get burned. While you're watching them, if anyone doesn't
progress the way you want or you don't like what you're seeing, scan them.
Have a low threshold. But that's not EVERYBODY with a GCS of 15!

Lastly any time our resuscitation area had 10 - 20 unstable patients, we
would have impleneted our Disaster Plan at the highest level; shutting the
Trauma Unit and bringing in every able bodied worker. 

R. Smith, MD, MPH
Cook County Trauma

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