Trauma lab panels

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Jed,

All of the tests you list can be reasonably (if light-heartedly) debated, as
can all that you don't.  Somewhere somebody's gonna want you to add coags or
ABG's to your panel, and somebody else is going to remark that a $300,
two-unit crossmatch on every trauma alert -- in the context of a 15%
transfusion rate -- is representative of what's wrong with modern western
healthcare.

As a fellow who has never once criticized a "baseline CBC" outside of the
rhetorical milieu, I'm comfortable asking you here: what do you expect the
H&H to do?  Go up?  

The term "baseline" suggests that relativity is relevant, which it simply
isn't.  It does not force transfusion, or laparotomy, or anything much apart
from the interval between CBC's.  It supports what we do, but it compels
nothing -- leaving one to wonder why we depend so much on a test whose basic
purpose is to make us more confident as we go about doing what we'd do
anyway.

Mind you, our trauma team nearly always runs about the same stuff Robin's
does; we just ask the surgeon to make each test a conscious decision.  The
selections are similar but not often identical from one patient to the next.
A little brain work and subtle accountability is good for the process.

Fun discussion.

Pret

-----Original Message-----
From: Jedidiah Peterson [mailto:jedpeterson at gmail.com] 
Sent: Wednesday, May 17, 2006 3:42 PM
To: Trauma &amp, Critical Care mailing list
Subject: Re: Trauma lab panels

Pret-
To me, Robin Powers' posting would make sense (CBC, T&S, if 55+ with hx add
chem-7, bHCG prn) with a caveat for flexibility. Does anyone want to jump in
and support something markedly different? (I'm not getting suckered into
defending the Major Trauma Panel any time soon...)

But I think it is worth reminding the list that most trauma does not report
to a major trauma center directly, and having spent some time fetching
traumas (and cardiacs, etc) from 17 or so regional hospitals in my area,
there are plenty of times when it is in the patient's best interest to get
objective data early, or to, in the case of the CBC, establish a baseline.

You make an excellent point that the useful data of an H&H is also able to
be estimated clinically, but that doesn't always translate over the
telephone or in the hands of a less practiced clinician.

So, in the absence of anyone else stepping up, Pret, I will allow you to
pull me in to the point of saying "crutches have a time and place" but I am
not going to defend a STAT sed rate...  ;-)

jed peterson rn
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