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Mon Aug 28 09:48:03 BST 2006

We had a patient recently, who was an in patient. It was decided that were
she to arrest, a crash section would NOT be done. And that was in good
conditions, with lots of staff around.
Nick Macartney 

> -----Original Message-----
> From: trauma-list-bounces at trauma.org 
> [mailto:trauma-list-bounces at trauma.org] On Behalf Of KMATTOX at aol.com
> Sent: 27 August 2006 22:26
> To: trauma-list at trauma.org
> Subject: Re: pre-hospital C-section
> 
> Crisis C-Sections are emotional and technical challenges.   
> Let  us say for 
> just arguments sake that a family had even discussed this 
> issue and  that a 
> couple had tried for years to produce an heir and had been  
> unsuccessful.   Now 
> the woman was in the last 2 weeks of her pregnancy  and had a 
> fatal GSW to the head, was immediately intubated and arrived 
> at the  hospital hypotensive, but with good blood gases,  was 
> brought into an  operating room where the people present knew 
> how to do a c-section,  should  they do it, if she arrested 5 
> minutes after arrival?  What about if she  arrested at the 
> time of arrival, or 
> maybe just 5 minutes prior to  arrival?    Emotion would push 
> each of to strongly 
> consider doing  it, and I have been there and done that.   
>  
> Now is there science for doing a stat c-section in the 
> emergency center, with people that really know how to do it, 
> have been trained to be decisive and  
> where all the gadgets are present to do a good job.   What 
> are the  results?   
> Terrible,   Often WORSE THAN  TERRIBLE.   There has been an 
> extremely rare 
> isolated good result, but  reportable as an isolated event 
> only.   A very busy 
> trauma surgeon, or  obstetrician, in such an institution 
> would average LESS 
> THAN ONE during two  lifetimes.    
>  
> Every time such is done in any trauma center I know of, there 
> is a  detailed 
> internal review and QA review.    Most of the time the  
> conclusion is that one 
> should NOT do it next time, but with the passage of  several 
> years, someone 
> does then try it, thinking they are better than their  
> predicissors.     New QA 
> same results. 
>  
> NOW,,, move this to the pre-hospital area with the surgeon, 
> obstetrician,  
> etc. there, the results would be the same.    NOW   let  us 
> make the cutter a 
> Paramedic or EMT...........
> You draw the conclusions,,   EVEN if you had the  
> instruments,  which most 
> ambulances do not  have.      Bad outcome-and lots of  questions......
>  
> k
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pre-hospital C-section