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Fri May 20 15:26:48 BST 2005

Ron,

The only quibble I have is that ultrasound is a real-time diagnostic modality and CT is static.  

Doug

-----Original Message-----
From: trauma-list-bounces at trauma.org on behalf of Ronald Gross
Sent: Fri 5/20/2005 9:16 AM
To: trauma-list at trauma.org
Subject: RE: pre hospital fast reply to K and ERF

By the way - while you bring all of that pre-existing knowledge and clinical expertise to the table, what you don't bring is an insistence to repeat the study yet again, 'cause you didn't do it!  At least I hope you don't.......
And one more point; as the surgeon of record (and in my case the only PG-29 in house) you sure as Hell better read your own images - 'cause relying on the vast experience and clinical expertise of the PG1 or 2 radiology resident reading your images might be a problem.

>>> geehand at umkc.edu 5/20/2005 9:58:57 AM >>>
Ron,

This may be putting a fine point on it, but as the surgeon, I will review the actual images myself (can't say films any more...).  I bring my physical exam and clinical history to the CT scan.  This allows a more patient specific read.  Again, if the patient is UNSTABLE, won't you be in the OR independent of what the well-trained sonographer has told you??

Doug

-----Original Message-----
From: trauma-list-bounces at trauma.org on behalf of Ronald Gross
Sent: Fri 5/20/2005 6:16 AM
To: trauma-list at trauma.org 
Subject: Re: pre hospital fast reply to K and ERF

Oh come on Ken.....if the radiologist tells you that the CT shows a gangrenous gall bladder in a septic patient, are you going to repeat the CT yourself before you operate?  Au contraire - the surgeon will do the physical exam, correlate the patient's condition with that exam and the other ancilarry tests done (BY OTHERS) and make the decision to operate with all of that information in hand.  If I have an unstable patient in flight, and a WELL-TRAINED ultrasonographer has told me that I have a belly full of blood, I am going to book that OR.  Whether I go directly to OR will depend on the patient'c condition on arrival to the ED.
Ron

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pre hospital fast reply to K and ERF