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Sun Aug 20 15:47:17 BST 2006

I am impressed that some of you seem to have enough anesthesiologists to respond to trauma activations. We intubate somewhere in the vicinity of 10% of all patients who arrive in the resuscitation bay - the overwhelming majority of these do not go to the operating room. Our ED attendings and residents do the intubations. Most meet or exceed the Anesthesiologists technical abilities and most are much more comfortable with a combative, full-stomached, intoxicated patient with a mouth full of blood spitting teeth. Where do these extra anesthesiologists come from?

Mike Sise

-----Original Message-----
From: Avi Roy Shapira [mailto:avir at bgumail.bgu.ac.il] 
Sent: Saturday, August 19, 2006 11:21 PM
To: Trauma &amp; Critical Care mailing list
Subject: Re: Anesthesia and Trauma

Dear Errington, 

Anesthesia has two roles in the trauma team. First they are the airway experts, and take care of this part.  Second if the patient needs to go to the OR they actually put him to sleep in the ER. 

Avi 

 On Sat, 19 Aug 2006,
Errington Thompson wrote:

> Ok, help me with this one.  When a Code Trauma (highest level of 
> activation) is called should anesthesia be a part of the team?  Once 
> the patient is evaluated and if found to need to go to the OR urgently 
> should the patient be taken to anesthesia holding.  If so how long in 
> holding is too long?
> 
> The bottom-line to all of my questions is the role of anesthesia in 
> the trauma service.
> 	 
> thanks,
> 
> Errington C. Thompson, MD, FACS, FCCM
> Trauma/Surgical Critical Care
> Mission Hospital
> Asheville, NC
> Author - A Letter to America
> www.whereistheoutrage.net
> 
>  
> Everyone deserves to make an informed decision
>                                 - Errington Thompson, MD
> 
> 
> -----Original Message-----
> From: trauma-list-bounces at trauma.org 
> [mailto:trauma-list-bounces at trauma.org]
> On Behalf Of Ronald Gross
> Sent: Thursday, August 17, 2006 4:58 PM
> To: trauma-list at trauma.org
> Subject: Re: Alcohol Screening
> 
> "We need to worry less about the insurance response, and more about 
> injury prevention and address the risk taking behaviors of these 
> drivers!"
> 
> Thank you, Laura.......I couldn't have said it better!
> 
> Ron
> 
> >>> "LAURA STEPHENS" <LSTEPH at parknet.pmh.org> 08/17/06 3:03 PM >>>
> Working in a level one trauma center, I have often drawn both legal 
> blood alcohol levels, as well as diagnostic BAC's.  The legal blood 
> alcohol levels were always drawn, and placed in blood tubes provided 
> by the officer, after obtaining consent  from the patient.  Betadine 
> was used in place of alcohol, as to not affect the results, and 
> careful documentation was completed for the chain of custody,  to 
> include which officer took posession of the tube, and badge number.  
> It was also clearly documented that betadine was was used in lieu of 
> alcohol, and allowed to air dry before the venipuncture was completed.  
> This was to allow for better prosecution of the case.  When it came to 
> blood alcohol levels drawn as part of the trauma lab panel, it was not 
> treated as carefully as legal blood alcohol's were.  Alcohol pads were 
> and are routinely used to draw labs, which are generally drawn at the same time
> the IV was placed.   We routinely send BAC's and urine tox on all trauma
> patients, to identify those with potential alcohol or drug  related 
> problems.  You cannot address problems, unless you know they exist, 
> and even though there may be enough  non-laboratory evidence of 
> alcohol intoxication, i.e. smell,  or self report,  that without hard 
> evidence the patient may not be willing to discuss or admit to  the 
> alcohol related trauma.  In the 8 1/2 years I have worked in this 
> trauma center, I can only recall 2-3 payment denials due to positive 
> testing of ETOH. We need to worry less about the insurance response, 
> and more about injury prevention and address the risk taking behaviors 
> of these drivers!  I applaud the ACS mandate, and I think the medical 
> community should embrace this mandate, and put in place  interventions 
> and injury prevention programs, so maybe we will have fewer alcohol 
> related traumas.
> 
> LStephens, RN, CEN
> Dallas, TX
> 
> >>> bryanboling at gmail.com 8/17/06 9:47 AM >>>
> When I was a tech in the ED, we used to draw tubes for the police.
> However,
> they were ADDITIONAL tubes drawn for the purpose of evidence collection,
> not
> our regular labs, and it was with the patient's "consent."  I put
> consent in
> quotes because we have an implied consent law here that says if a police
> officer suscpects someone of driving under the influence, he can request
> they give a blood/breath/urine sample (most times they get the choice -
> breath is free, blood or urine they MIGHT have to pay for - but if
> they're
> in the ED for treatment, blood test is free too, and dependending on the
> nature and injuries, might be the "required" way, but I digress...). 
> They
> can refuse, but refusal gets their license suspended.  So, I never ahd a
> patient refuse when it was put to them like that.
> 
> We drew the labs into special tubes with the officer observing and 
> then had to sign a form saying we'd drawn it from the right patient 
> and the tubes were covered (sealed I suppose) with a label that the 
> officer had to cosign
> with us.  I suppose that prevents tampering down the line?  Then they
> took
> the tubes to some other lab they didn't go to the hospital lab.
> 
> We routinely drew BALs on trauma patients and typically ran a urine 
> drug screen if there was any indication they might have anything on 
> board. But this was simply to know what we were dealing with 
> pharmacologically (and the
> occasional ED game "guess the BAL") and not for any kind of legal
> proceeding.
> 
> bryan
> 
> 
> On 8/17/06, Lorick Fox, PA-C <lorick at lorick.org> wrote:
> >
> >
> > Since there is no chain of custody, I would be surprised if a blood 
> > alcohol obtained in the hospital was admissible for criminal 
> > prosecution. On the other hand, I have heard of police officers 
> > watching blood
> tubes
> > drawn and then seizing them as evidence.
> >
> > Anyone actually KNOW:
> > (1) if hospital labs are admissible and
> > (2) if the "seizure of blood tubes" is anything more than urban
> legend?
> >
> > BTW, I am leaving Egypt next month to join Cardiovascular 
> > Associates,
> LLC
> > in
> > the Norfolk, Virginia area www.cval.org (doing EP).  However, I will
> be
> > returning to volunteer EMS as well, so I'll actually see more 
> > trauma.
> >
> > Lorick Fox, MPAS, PA-C
> > SEAVIN Medical
> > Gianaclis Support Complex
> > 011-20-3-448-2335x2001 or 2207
> > www.Lorick.org
> >
> >
> >
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==========================================================================
Aviel Roy-Shapira, M.D.              Soroka University Hospital &
Dept. of Surgery A. and              Ben-Gurion University Medical School 
the Critical Care Unit               POB 151, Beer Sheva, Israel

email:avir at bgumail.bgu.ac.il         Fax:972-7-6403260 voice:972-7-6403390

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