List Archives

Tue Dec 19 20:18:46 GMT 2006

Rob,

Than was  not the scenario presented.  If I received the case you
mentioned, GSW to the head that arrests IN THE ED (presumedly from
herniation), then I would proceed with ACLS while I determine that the
GSW was transcranial, at which point I would do what I mentioned earlier
- FAST the epicardium, and declare the patient dead.  What good is an
open chest gonna do for a closed head injury with a 100% mortality?

Ron

>>> "Robert F Smith" <rfsmithmd at comcast.net> 12/19/2006 3:06 PM >>>
Ron and Dr. Wolfer,

Could you guys expand on this a little bit? I'm confused. So say you
have a
young male single GSW to head and you are absolutely sure this is the
only
injury. They arrest in the resuscitation area. Would you do more than
a
"short" course of ACLS?

Rob

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] 
On Behalf Of Ronald Gross
Sent: Tuesday, December 19, 2006 12:19 PM
To: trauma-list at trauma.org 
Subject: Re: head injury- termi ation of resuscitative efforts

I treat the family.  The patient is dead, and will stay dead,
regardless
of what you do.  Now is the time to help the family honor the
patient's
wishes, if known, and to call the organ donation service in your
region.
 Lastly, thoracotomy IS indicated - to procure the heart and lungs for
transplantation. (so there - I did come forward and admit it!)

Take care,
Ron
>>> "oded private" <tangentcarrot at hotmail.com> 12/19/2006 11:47 AM >>>
Hello list

I'd like to hear your opinion about deciding to terminate treatment
for

isolated TBI resulting in cardiac arrest.

What if the pateint is still in PEA? Will you attempt to defibrilate
VF, if 
it happened for some reason?

If you do treat him- what will you do?  ET intubation and ventilation
alone? 
CPR? Does anybody here practice thoractomy in the scenario and is
ready
to 
"come forward" and admit to it?

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head injury- termi ation of resuscitative efforts