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Tue Jan 17 20:14:36 GMT 2006

Another place to go is the Practice Management Guidelines on the EAST website--www.east.org--and hit on the penetrating extremity injury topic, a portion of which is devoted to this topic with a pretty full list of refs.
ERF 

-----Original Message-----
From: rwolfer at aol.com
To: trauma-list at trauma.org
Sent: Tue, 17 Jan 2006 13:22:34 -0500
Subject: mangeled extremity

 Does anyone know of any good references on the management of mangeled 
extremity, especially on the use of antibiotics and infectious complications. 
thanks in advance.  RW

-----Original Message-----
From: Shane Moore <EMS-Shane at comcast.net>
To: 'Trauma & Critical Care mailing list' <trauma-list at trauma.org>
Sent: Tue, 17 Jan 2006 07:12:19 -0800
Subject: RE: Taser Deaths

Working as a Sheriff's Deputy and medic at a Detox facility, I see many
patients arrive at our facility who have been tased and some who get tased
while in our custody.  Currently, we carry ONLY the standard 10% Oleoresin
Capsicum 'pepper spray' commonly carried by law enforcement.  TASER use
falls in the same use of force continuum level as pepper spray for most of
the local departments we serve.  Of course, the use of force is based on the
subject's behavior.  Once the subject becomes compliant or is subdued, the
use of force must stop.  Even w/ proper care and treatment, the effects of
pepper spray continue for some while (not to mention affecting the medical
personnel, the ambulance or police vehicle and your ED as well as making pt.
assessment even more difficult).  Having been exposed to both, I laughed at
Matt from England's post.  I'm w/ you, Matt.  During my time as a police
officer, I was pretty certain I didn't need to be shot w/ my own sidearm to
'appreciate the effects' of deadly force.  Around here, it is not required
to be tased prior to carrying a TASER, but the logic goes along the lines of
being able to make a stronger statement in court (remember, we Americans are
litigious).  I much prefer pt. care w/ someone who has been tased vs.
someone who has been pepper sprayed, batoned, bean-bagged (another less
lethal device- think hackey sack fired out of a shotgun) or shot.  I also
will do my part as a healthcare provider to insist that the issue be
monitored, improving training (local officers are now trained to position
subjects so that the risks for positional asphyxia are minimized), education
and pt. care.  
    An additional ??... So far, all the posts have discussed the tasing
in regard to the probes; the models mentioned are also designed for 'touch'
tasing, which works on the pain compliance school of thought.  Are the TASER
studies noting which is which?  Does it matter?  Just my two cents... 
Great thread!

Shane Moore
OR EMT-I
"I never think of the future.  It comes soon enough."
    A. Einstein

-----Original Message-----
From: Hardcastle Tim, Dr <tch at sun.ac.za> [mailto:tch at sun.ac.za] 
Sent: Sunday, January 15, 2006 9:16 PM
To: Trauma & Critical Care mailing list
Subject: RE: Taser Deaths

Ken

One additional side issue: Has anyone looked at myoglobin release and
subsequent renal failure, similar in nature to a flogging injury crush-like
syndrome? It may explain the later death thing--renal failure, high potasium
and sudden cardiac death????

Tim
Dr T C Hardcastle
M.B.,Ch.B.(Stell); M.Med(Chir); FCS(SA)
Senior Surgeon / Senior Lecturer: Surgery (Trauma and ICU)
ATLS  instructor and DSTC Cape Town Course Director
Intern program Coordinator: Surgery
Program Manager: Emergency Medicine (U.S.)
Clinical Head (Director): Diana Princess of Wales Trauma Unit
Department of Surgery Room 4064
Tygerberg Hospital / University of Stellenbosch
PO Box 19063
Tygerberg 7505
Western Cape
South Africa

2 Lorient Close
Vredekloof, Brackenfell
7560, Western Cape,
South Africa
e-mail: tch at sun.ac.za
Cell: +27824681615
Office: +27219389281 or 4911 pager 0302
Home: +27219813098

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