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Tue Dec 26 20:01:02 GMT 2006

I agree - it seems very unusual.  But it could have been a peri-articular (i.e. knee) femoral injury.  Otherwise it's a case of nail it first and ask questions later!

  Sunil

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Today's Topics:

1. Re: Merry Christmas (MARK FORREST)
2. Merry Christmas (Andrew J Bowman)
3. Re: Brain dead and bleeding (Ronald Gross)
4. RE: Arnold Schwarzenegger breaks his leg ?????? (Ronald Gross)
5. price-25-Dec-2006 (Jacobjns)
6. Re: cooling down the heat stroke victim (Krin135 at aol.com)
From: MARK FORREST <atacc.doc at btinternet.com>
Subject: Re: Merry Christmas
Date: Mon, 25 Dec 2006 12:24:12 +0000 (GMT)
To: "Trauma &amp; Critical Care mailing list" <trauma-list at trauma.org>

A very Merry Christmas and Happy New Year to all list members the world over.
Best wishes
Mark F
ATACC UK

----- Original Message ----
From: susanna mathews 
To: "Trauma & Critical Care mailing list" 
Sent: Monday, 25 December, 2006 1:40:34 AM
Subject: Re: Arnold Schwarzenegger breaks his leg ??????

A few months back we had a teenager who broke her femur while in New Orleans on a church mission to repair homes (stack of drywall fell on her). She arrived in Indiana 2 days post-injury wearing a serious long leg cast with a bag of painkillers riding in a minivan! Gutty kid. Oh, and no foley catheter ...
At least Arnold will probably get to fly home.
Susanna 
----- Original Message ----- 
From: Chester Brown 
To: ccm-l at ccm-l.org 
Cc: trauma-list at trauma.org 
Sent: Sunday, December 24, 2006 2:04 PM
Subject: Arnold Schwarzenegger breaks his leg ??????

OK I am confused. All the news reports say California Gov Arnold
Schwarzenegger broke his FEMUR while skiing. The reports say he was checked
out and X-Rayed then sent home. He is not in a cast according to news
reports. He will need surgery when he returns to Los Angeles. Am I missing
something here? Broken Femur and sent home. I know I have been out of the
field for awhile but....

Chet

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From: "Andrew J Bowman" <andrewj.bowman at gmail.com>
Subject: Merry Christmas
CC: 
Date: Mon, 25 Dec 2006 07:54:13 -0500
To: "Trauma List" <trauma-list at trauma.org>,
"Trauma-AAST" <trauma-l at lists.aast.org>,
"Critical Care Medicine Listserv" <ccm-l at ccm-l.org>,
"EMED List" <EMED-L at ITSSRV1.UCSF.EDU>

Merry Christmas from Lafayette, Indiana, USA

Andrew Bowman
From: "Ronald Gross" <Rgross at harthosp.org>
Subject: Re: Brain dead and bleeding
Date: Mon, 25 Dec 2006 08:01:14 -0500
To: <trauma-list at trauma.org>

>"In my humane world, if I could not be restored to my family in a
productive way, I would consider myself brain dead and would wish to
die."
>"We all have different values, depending upon the situation, which are
dictated by theological, legal, moral, and ethical standards which are
culturally based that define what is humane. I am sure that we differ
here, but probably only somewhat, and it does not make any one of us
bad people."

DB,
Your two quotes above, are, to me, the crux and essence of this entire
thread; on those, and almost everything else in your post, you and I are
in the same church and same pew.

So, as to the last suggestion, first round is on me, and we certainly
will continue to see how close you and I are in our approach, mine
being, I believe, governed just a bit more by the "legalistic" approach
of our brain death protocols here.

Merry Christmas,
Ron
>>> 12/24/2006 4:02 PM >>>
Ron,

Daily, neurosurgeons across the globe deide that patients unsalvigable
and decline to operate. In that case as it was presented, I was left to
assume that the surgeon was competent to make that decision. I fairly
sure that I disagree with you, in that I do not believe that operating
on a patient with known severe brain injury is a humane act. But, what
is humane? If one of my closest friends, Ben the dog, was is the same
situation, it would be considered humane to euthanize the animal. If a
platoon is faced with leaving a severely injured Marine who cannot be
evacuated to the whims of an advancing vicious enemy, or, shooting him
in the head, most Marines that I know would suggest that the latter is
the humane act. We all have different values, depending upon the
situation, which are dictated by theological, legal, moral, and ethical
standards which are culturally based that define what is humane. I am
sure that we differ here, but probably only somewhat, and it does not
make 
any on
e of us bad people.

Defining brain dead on-the-spot is not an easy clinical task, and is
probably more philosophical as opposed to scientific. Those clinical
standards on which we rely (persistent apnea and lack of responsiveness,
fixed and dilated pupils, lack of cerebral blood flow, CT evidence of
herniation, presence of gray-white on the stretcher, ad nauseum) are
fairly succinct, however, subtler injury is not. Injury to neurons
vulnerable to ischemia (CA1 pyramidal cell layer of the hippocampal
gyrus, the Purkinje cell layer of the cerebellar cortex, and layer V of
the sensorimotor cortex) will leave the patient mostly unresponsive,
unable to care for self, but not apneic. We agree, I believe, that this
is not brain dead. But, is it brain life? I suspect that we may have
different views, but our disagreement here is purely philisophical.

As for anecdotes, we all have those. But, if I practiced that way,
based upon anecdotes and my experience in the lab, I'd open the chest of
everybody suffering a cardiac arrest, fill the area nursing homes with
unfortunates, and wouldn't be able to sleep at night (not that I do,
anyway).

So, allow me to rephrase: In my humane world, if I could not be
restored to my family in a productive way, I would consider myself brain
dead and would wish to die. That is not how I practice medicine,
however, and I guarantee you that I give everybody the benefit of the
doubt. That being said, I'm not sure if resuscitating a man with a known
down time of 20 minutes is the right thing, I'm not sure if placing a
high-spinal cord injury on a ventilator is the right thing, and I'm not
sure if obtaining an operation for a patient who has evidence of brain
injury is the right thing, but I do it. And I pray. I know that I've
backed myself into a corner here: If I am allowed to define humane as
what I would want for myself, then why don't I treat my patients the
same? Again, I pray a lot.

I do believe that, if I am lucky, I won't die in a nursing home with
brain injury. I also believe that if I am lucky, I will be able to buy
you a tall pint of ale sometime and continue this discussion well into
the night.

Merry Christmas

DB
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From: "Ronald Gross" <Rgross at harthosp.org>
Subject: RE: Arnold Schwarzenegger breaks his leg ??????
Date: Mon, 25 Dec 2006 08:04:13 -0500
To: "Trauma &amp; Critical Care mailing list" <trauma-list at trauma.org>

>"who cares? I could give a rip less."

Yikes! Looks like Roy got some coal in his stocking and is a bit outta
sorts for it! ;-)

Merry Christmas, Roy - and all on the list!

>>> Roy Danks 12/24/2006 9:34 PM >>>
Here is the more vexing question re: Gov. Terminator...who cares? I
could give a rip less. Sorry. Apparently he fractured something. Is
it worth it to spend any more time on this subject? And, since when did
the media get anything, medical or otherwise, correct?

Merry Christmas
_________________________________________________________________
Fixing up the home? Live Search can help.
http://imagine-windowslive.com/search/kits/default.aspx?kit=improve&locale=en-US&source=wlmemailtaglinenov06--

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From: "Jacobjns" <jacobjns at yahoo.com>
Subject: price-25-Dec-2006
CC: 
Date: Mon, 25 Dec 2006 16:19:51 -0500
To: "Trauma-list" <Trauma-list at trauma.org>

From: Krin135 at aol.com
Subject: Re: cooling down the heat stroke victim
Date: Mon, 25 Dec 2006 10:46:23 EST
To: trauma-list at trauma.org

In a message dated 12/25/2006 3:57:45 AM Central Standard Time, 
jboel at ozemail.com.au writes:

How do you define laypersons? In my paid capacity in a Medical Centre,
as well as in two volunteer capacities that I am involved in, heat
related injuries feature strongly in protocols and training. Are you
talking about those who have had no first aid training? Or is your
comment directed to your own specific military environment? 

One of the tricks to treating heat casualties in austere environments is to 
remember that if you don't have excess water available to cool the patient, 
then you need to recycle the water rather than use up your fresh drinking 
water, which you may need yourself.

As I told the folks at the US Army Field Artillery Training Center so many 
years ago...."If the General is out there and dying of heat stroke, and you are 
short on water, then piss on him...I'll be happy to testify at any Court 
Martial that the General is at least alive to complain."

ck
Charles S. Krin, DO FAAFP

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