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are the ed docs taking over?...

Ben Reynolds aneurysm_42 at yahoo.com
Sun Apr 23 01:05:20 BST 2006


The real issue for me ultimately, whether necessity is
or isn't proven not withstanding is one of
responsibility.  The decision to operate or observe is
more nuanced than every before.  Admitting a trauma
patient with a critical injury in the subsequent hours
after admission isn't laid out in such a flowchart
manner as what the initial encounter might be.  

Who manages the volume resuscitation?  Who decides
that we've failed nonoperative management of a spleen
or liver injury?  Does the surgeon operate simply
because the ED physician tells him to?  Would the
surgeon have operated five units of blood and untold
amounts of crystalloid earlier had he been at the
bedside?  Who decides whether the patient is stable
enough for orthopedic fixation?  Who manages the
subsequent coagulopathy?  Who decides that the patient
is adequately resuscitated six hours later in the ICU,
assuring the family that no operation is necessary? 

The answer in my mind is the surgeon, the one person
out of everyone involved who both wields the fickle
scalpel of fate over the injured torso and whose name
ends up on the top of the discharge summary.

Trauma is a surgical disease with medical aspects.

Ben Reynolds, PA-C
Pittsburgh, PA


--- joe.nemeth at staff.mcgill.ca wrote:

> At our institution (level 1 care) half of all trauma
> leader calls are 
> taken by emergentologists...
> I also am aware of the paucity of lit. regarding the
> necessity of 
> surgeon presence in acute trauma care...the lit. is
> even more 
> convincing in the pediatric blunt trauma victim...
> soooo, having said all of this, let's just agree to
> agree that there is 
> more then one way to skin a cat...non-operative
> trauma patients can be 
> equally well managed by well trained
> emergentologists as by trauma 
> surgeons...(remember, EM residency training is 5
> years!! in Canada, 
> that's 5 years of preparing for just this sort of
> patient population...
> joe
> -- 
> Dr. Joe Nemeth
> Assistant Professor
> Emergency Medicine
> Montreal General Hospital
> Montreal Children's Hospital
> McGill University Health Center
> --
> trauma-list : TRAUMA.ORG
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