List Archives

Wed Oct 11 02:24:25 BST 2006

Where's your evidence?

On 10/11/06, Juan Duchesne <JDuchesne at surgery.umsmed.edu> wrote:
>
> ATLS save lives.......end of discussion guys!......this is not about a
> certificate, audit, CME or waste of time.....this is about personal
> commitment in doing what is best for patient care.......We need to stop
> this attitude about what ATLS really means.........I will like to read
> any LEVEL I EVIDENCE THAT ANY residency ED,SURGERY..... IS EQUAL OR
> BETTER THAN ATLS TRAINING........if any question place YOURSELF OR YOUR
> FAMILY in a rural environment where your first responder is not ATLS
> trained.......I HAVE BEEN THERE!!!.....AND IS NOT FUN OR
> FAIR!........END OF DISCUSSION!
> Let's move on.
> juan
>
> Juan C Duchesne, M.D.
> University of Mississippi Medical Center
> Assistant Professor of Surgery/Trauma and Critical Care
> Louisiana ATLS State Faculty
> 2500 North State Street
> Jackson MS 39216
> >>> Rick.Moore at TriadHospitals.com 10/10/06 12:55 PM >>>
> Since when is an off-duty physician who happens to be driving by or
> otherwise in the neighborhood "duty bound" to respond and assist?
> REM
>
> -----Original Message-----
> From: trauma-list-bounces at trauma.org
> [mailto:trauma-list-bounces at trauma.org] On Behalf Of Patrick
> Greiffenstein
> Sent: Tuesday, October 10, 2006 12:42 PM
> To: trauma-list at trauma.org
> Subject: Re: ATLS training
>
> I agree with Dr Duchesne.  ATLS is a basic skills course that is not
> very demanding to take and would benefit ANYONE being involved with any
> patient.
> Given the fact that we might come accross a trauma scene outside of the
> hospital (I've counted three since I graduated med school four years
> ago!) and the fact that we as physicians are duty-bound to respond, it
> is a course that every physician should take in an ideal world.  One
> would think that practicing MDs would be well acquainted with most of
> the basics covered by ATLS.  As an ATLS instructor I can tell you that
> it is absolutely frightening how many general surgeons and ED-program
> graduates, not to mention orthopods, FP's, internists and others who
> have opted to take our course that have clearly no clue what the basics
> are (this is AFTER several hours of lecture on the subject).
>
> I believe that too much rides on a smoothly-working trauma team and that
> redundancy, when feasible, can avert disaster.  If everyone knows what
> everyone else is supposed to be doing, things might be missed or
> overlooked less often.  Given the stakes and the time-constraints, I
> think a little weekend course twice every decade is a miniscule price to
> pay.
>
> my 1.5 cent's worth
>
> -Patrick Greiffenstein
> Resident, General Surgery
> LSUHSC, New Orleans
> pgreif at lsuhsc.edu
>
>
>
>
> On 10/6/06, trauma-list-request at trauma.org
> <trauma-list-request at trauma.org >
> wrote:
> >
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> > than "Re: Contents of trauma-list digest..."
> >
> >
> > Today's Topics:
> >
> >   1. Re: ATLS for consultants... (Juan Duchesne)
> >   2. Re: ATLS for consultants... (Ronald Simon)
> >   3. Re: ATLS for consultants... (Jago Miloguz)
> >   4. RE: ATLS for consultants... (Hotz, Heidi, RN)
> >   5. Re: ATLS for consultants... (Ronald Gross)
> >   6. Re: ATLS for consultants... (Ronald Gross)
> >   7. NoM Spleen Returns (Bjorn, Pret)
> >
> >
> >
> > ---------- Forwarded message ----------
> > From: "Juan Duchesne" <JDuchesne at surgery.umsmed.edu><~!B*+R^&>> To:
> <rfsmithmd at comcast.net>, <trauma-list at trauma.org><~!B*+R^&>> Date: Fri,
> 06 Oct 2006 08:59:51 -0500
> > Subject: Re: ATLS for consultants...
> > I strongly disagree with your statement  Dr. Smith. I work in that
> > same enviroment you are describing were our ED staff refuse to do
> > ATLS, their explanation is that ED training (3-4 years) and recert (q
> > 10 years) equalls ATLS (2 days q 4 years)......we are just asking 2
> DAYS for cert.
> > and one day for recert.!!!! how bad can that be for GOD
> > sake!!!.............. This is not about MD ego's Dr Smith........this
> > is very simple and clinically demostrated: ATLS DEFINITIVELY IMPACT
> > PATIENT CARE!!....let all jump on the boat and work as a
> > team!........As for consultants even if they are not first responders
> > to activation we still mandate they get their ATLS.
> > juan
> >
> > Juan C Duchesne, M.D.
> > University of Mississippi Medical Center Assistant Professor of
> > Surgery/Trauma and Critical Care 2500 North State Street Jackson MS
> > 39216
> > >>> rfsmithmd at comcast.net 10/06/06 2:32 AM >>>
> > I am a huge fan of ATLS but I am curious as to the rational for
> > requiring consultants OR primary trauma providers to have taken ATLS.
> > How will this positively impact the care of the injured patient?
> > Hopefully the consultants will not be directing the resuscitation or
> > initial evaluation of the patient. Conversely ATLS will not have a
> > meaningful impact on the experience of trauma providers compared to a
> > full residency in either surgery or emergency medicine.
> >
> > R. Smith MD
> >
> > -------------- Original message --------------
> > From: Ronald Simon <Traumamd at nyc.rr.com><~!B*+R^&>><~!B*+R^&>> > We
> are currently having a debate in our State Trauma Advisory
> > Committee
> > > about whether trauma related consultants (neurosurg, ortho, ent,
> > > etc) should be required to have taken ATLS to care for a trauma pt.
> > > The question is whether this should be part of the requirements for
> > > trauma
> >
> > > center designation. No question that members of the trauma service
> > > and
> >
> > > the ED should but what about the subspecialists? Sure its a good
> > concept
> > > but actually getting them to take it is another thing. What is the
> > > practice of other trauma systems?
> > > Thanks
> > > Ron Simon, MD
> > > Jacobi Medical Center
> > > Bronx, NY
> > >
> > > --
> > > trauma-list : TRAUMA.ORG <http://trauma.org/> To change your
> > > settings or unsubscribe visit:
> > > http://www.trauma.org/traumalist.html
> > --
> > trauma-list : TRAUMA.ORG <http://trauma.org/> To change your settings
> > or unsubscribe visit:
> > http://www.trauma.org/traumalist.html
> >
> >
> >
> >
> >
> > ---------- Forwarded message ----------
> > From: Ronald Simon <Traumamd at nyc.rr.com><~!B*+R^&>> To: "Trauma &
> Critical Care mailing list" <
> > trauma-list at trauma.org>
> > Date: Fri, 06 Oct 2006 11:15:20 -0400
> > Subject: Re: ATLS for consultants...
> > The thoughts behind requiring consultants to take the course is for
> > them to understand how we prioritize and why we may ask them to go
> > away and come back later.
> > ron simon
> >
> > rfsmithmd at comcast.net wrote:
> >
> > >I am a huge fan of ATLS but I am curious as to the rational for
> > >requiring
> > consultants OR primary trauma providers to have taken ATLS. How will
> > this positively impact the care of the injured patient? Hopefully the
> > consultants will not be directing the resuscitation or initial
> > evaluation of the patient. Conversely ATLS will not have a meaningful
> > impact on the experience of trauma providers compared to a full
> > residency in either surgery or emergency medicine.
> > >
> > >R. Smith MD
> > >
> > >-------------- Original message --------------
> > >From: Ronald Simon <Traumamd at nyc.rr.com><~!B*+R^&>> >
> > >
> > >
> > >>We are currently having a debate in our State Trauma Advisory
> > >>Committee about whether trauma related consultants (neurosurg,
> > >>ortho, ent, etc) should be required to have taken ATLS to care for a
>
> > >>trauma pt. The question is whether this should be part of the
> > >>requirements for trauma center designation. No question that members
>
> > >>of the trauma service and the ED should but what about the
> > >>subspecialists? Sure its a good concept but actually getting them to
>
> > >>take it is another thing. What is the practice of other trauma
> systems?
> > >>Thanks
> > >>Ron Simon, MD
> > >>Jacobi Medical Center
> > >>Bronx, NY
> > >>
> > >>--
> > >>trauma-list : TRAUMA.ORG <http://trauma.org/> To change your
> > >>settings or unsubscribe visit:
> > >>http://www.trauma.org/traumalist.html
> > >>
> > >>
> > >--
> > >trauma-list : TRAUMA.ORG <http://trauma.org/> To change your settings
>
> > >or unsubscribe visit:
> > >http://www.trauma.org/traumalist.html
> > >
> > >
> > >
> >
> > --
> > Ronald Simon, MD
> > Dir of Trauma/SICU
> > Jacobi Medical Center, Rm 1213
> > Bronx, NY 10461
> > 718 918 5598 phone
> > 718 918 5593 fax
> >
> >
> >
> >
> >
> > ---------- Forwarded message ----------
> > From: "Jago Miloguz" < japrak at gmail.com>
> > To: "Trauma &, Critical Care mailing list"
> <trauma-list at trauma.org><~!B*+R^&>> Date: Fri, 6 Oct 2006 17:58:49 +0200
> > Subject: Re: ATLS for consultants...
> > well it would be ideal to have everybody who gets in touch with trauma
>
> > patient pass the ATLS but obviously it is quite irrational to wish,
> > but l think it should be officialy mandatory for all personal dealing
> > with to intiative managment of trauma patients to pass ATLS(EM docs
> > and acute care and trauma surgeons).if every hospital has those docs
> > with passed ATLS then patients would probably do just fine with
> > consultants not passing ATLS.
> > just my opinion
> > ante
> >
> >
> > 2006/10/6, Ronald Simon <Traumamd at nyc.rr.com>:<~!B*+R^&>> >
> > > The thoughts behind requiring consultants to take the course is for
> > > them
> >
> > > to understand how we prioritize and why we may ask them to go away
> > > and come back later.
> > > ron simon
> > >
> > > rfsmithmd at comcast.net wrote:
> > >
> > > >I am a huge fan of ATLS but I am curious as to the rational for
> > requiring
> > > consultants OR primary trauma providers to have taken ATLS. How will
> > this
> > > positively impact the care of the injured patient? Hopefully the
> > consultants
> > > will not be directing the resuscitation or initial evaluation of the
>
> > > patient. Conversely ATLS will not have a meaningful impact on the
> > experience
> > > of trauma providers compared to a full residency in either surgery
> > > or emergency medicine.
> > > >
> > > >R. Smith MD
> > > >
> > > >-------------- Original message --------------
> > > >From: Ronald Simon <Traumamd at nyc.rr.com >
> > > >
> > > >
> > > >
> > > >>We are currently having a debate in our State Trauma Advisory
> > Committee
> > > >>about whether trauma related consultants (neurosurg, ortho, ent,
> > > >>etc) should be required to have taken ATLS to care for a trauma
> > > >>pt. The question is whether this should be part of the
> > > >>requirements for trauma center designation. No question that
> > > >>members of the trauma service and
> >
> > > >>the ED should but what about the subspecialists? Sure its a good
> > concept
> > > >>but actually getting them to take it is another thing. What is the
>
> > > >>practice of other trauma systems?
> > > >>Thanks
> > > >>Ron Simon, MD
> > > >>Jacobi Medical Center
> > > >>Bronx, NY
> > > >>
> > > >>--
> > > >>trauma-list : TRAUMA.ORG <http://trauma.org/> To change your
> > > >>settings or unsubscribe visit:
> > > >>http://www.trauma.org/traumalist.html
> > > >>
> > > >>
> > > >--
> > > >trauma-list : TRAUMA.ORG <http://trauma.org/> To change your
> > > >settings or unsubscribe visit:
> > > >http://www.trauma.org/traumalist.html
> > > >
> > > >
> > > >
> > >
> > > --
> > > Ronald Simon, MD
> > > Dir of Trauma/SICU
> > > Jacobi Medical Center, Rm 1213
> > > Bronx, NY 10461
> > > 718 918 5598 phone
> > > 718 918 5593 fax
> > >
> > > --
> > > trauma-list : TRAUMA.ORG <http://trauma.org/> To change your
> > > settings or unsubscribe visit:
> > > http://www.trauma.org/traumalist.html
> > >
> >
> >
> >
> >
> > ---------- Forwarded message ----------
> > From: "Hotz, Heidi, RN" <Heidi.Hotz at cshs.org><~!B*+R^&>> To: 'Trauma
> &' < trauma-list at trauma.org>
> > Date: Fri, 6 Oct 2006 09:11:36 -0700
> > Subject: RE: ATLS for consultants...
> > Ron,
> >
> > All of our EM physicians have completed ATLS once in their lifetime
> > (thus, we adhere to the ACS Gold Book criteria.) With regards to our
> > consultants from Ortho and Neurosurgery, it is not a formal
> > requirement, but we have some of them become ATLS Instructors because
> > they want to; believe it is their duty working at a Level I trauma
> > hospital; etc, etc. We have two orthopedic trauma surgeons that are
> > Instructors. We run two ATLS courses per year, so they only need to
> > teach once yearly.
> >
> > Our County trauma contract and State Regs do not require them to have
> > ATLS.
> >
> > Hope this helps.
> >
> > Best of luck.
> >
> > Heidi
> >
> > Heidi A. Hotz, RN, Trauma Program Manager Department of Surgery
> > Cedars-Sinai Medical Center 8700 Beverly Blvd.
> > Los Angeles, CA 90048
> >
> > Office: 310-423-8732
> > Cell: 310-430-2649
> > Pager: 310-960-6341
> > Fax: 310-423-0139
> >
> > -----Original Message-----
> > From: trauma-list-bounces at trauma.org
> > [mailto:trauma-list-bounces at trauma.org
> > ]
> > On Behalf Of Ronald Simon
> > Sent: Thursday, October 05, 2006 6:16 PM
> > To: trauma-list at trauma.org
> > Subject: ATLS for consultants...
> >
> > We are currently having a debate in our State Trauma Advisory
> > Committee about whether trauma related consultants (neurosurg, ortho,
> > ent, etc) should be required to have taken ATLS to care for a trauma
> > pt. The question is whether this should be part of the requirements
> > for trauma center designation. No question that members of the trauma
> > service and the ED should but what about the subspecialists? Sure its
> > a good concept but actually getting them to take it is another thing.
> > What is the practice of other trauma systems?
> > Thanks
> > Ron Simon, MD
> > Jacobi Medical Center
> > Bronx, NY
> >
> > --
> > trauma-list : TRAUMA.ORG <http://trauma.org/> To change your settings
> > or unsubscribe visit:
> > http://www.trauma.org/traumalist.html
> >
> >
> >
> >
> > ---------- Forwarded message ----------
> > From: "Ronald Gross" < Rgross at harthosp.org>
> > To: <trauma-list at trauma.org><~!B*+R^&>> Date: Fri, 06 Oct 2006
> 12:20:12 -0400
> > Subject: Re: ATLS for consultants...
> > Ron,
> >
> > We require that ortho and neurosurgeons take ATLS at least once.
> >
> > Please note that the ACS COT "Optimal Resourses" document states that,
>
> > "At a minimum, orthopaedic surgeons on the trauma team should be
> > encouraged to successfully complete an ATLS Student Course."  The same
>
> > statement is repeated in the neurosurgical chapter: "At a minimum,
> > neurosurgeons on the trauma team should be encouraged to successfully
> > complete an ATLS Student Course."
> >
> > Best wishes,
> > Ron
> >
> > >>> Ronald Simon <Traumamd at nyc.rr.com> 10/5/2006 9:16 PM >>>
> > We are currently having a debate in our State Trauma Advisory
> > Committee
> >
> > about whether trauma related consultants (neurosurg, ortho, ent, etc)
> > should be required to have taken ATLS to care for a trauma pt. The
> > question is whether this should be part of the requirements for trauma
> >
> > center designation. No question that members of the trauma service and
> >
> > the ED should but what about the subspecialists? Sure its a good
> > concept but actually getting them to take it is another thing. What is
>
> > the practice of other trauma systems?
> > Thanks
> > Ron Simon, MD
> > Jacobi Medical Center
> > Bronx, NY
> >
> > --
> > trauma-list : TRAUMA.ORG <http://trauma.org/> To change your settings
> > or unsubscribe visit:
> > http://www.trauma.org/traumalist.html
> >
> >
> >
> >
> >
> >
> >
> >
> > ---------- Forwarded message ----------
> > From: "Ronald Gross" < Rgross at harthosp.org>
> > To: "Trauma & Critical Care mailing list"
> <trauma-list at trauma.org><~!B*+R^&>> Date: Fri, 06 Oct 2006 12:25:41
> -0400
> > Subject: Re: ATLS for consultants...
> > The concept is to ensure that the subspecialists see, learn about and
> > understand the overall picture of trauma care, how the concept of a
> > systems/team approach to trauma care actually includes them, and that
> > they should incorporate it into their lexicon.......
> >
> > >>> <rfsmithmd at comcast.net> 10/6/2006 3:32 AM >>>
> > I am a huge fan of ATLS but I am curious as to the rational for
> > requiring consultants OR primary trauma providers to have taken ATLS.
> > How will this positively impact the care of the injured patient?
> > Hopefully the consultants will not be directing the resuscitation or
> > initial evaluation of the patient. Conversely ATLS will not have a
> > meaningful impact on the experience of trauma providers compared to a
> > full residency in either surgery or emergency medicine.
> >
> > R. Smith MD
> >
> > -------------- Original message --------------
> > From: Ronald Simon < Traumamd at nyc.rr.com>
> >
> > > We are currently having a debate in our State Trauma Advisory
> > Committee
> > > about whether trauma related consultants (neurosurg, ortho, ent,
> > > etc)
> >
> > > should be required to have taken ATLS to care for a trauma pt. The
> > > question is whether this should be part of the requirements for
> > trauma
> > > center designation. No question that members of the trauma service
> > and
> > > the ED should but what about the subspecialists? Sure its a good
> > concept
> > > but actually getting them to take it is another thing. What is the
> > > practice of other trauma systems?
> > > Thanks
> > > Ron Simon, MD
> > > Jacobi Medical Center
> > > Bronx, NY
> > >
> > > --
> > > trauma-list : TRAUMA.ORG <http://trauma.org/> To change your
> > > settings or unsubscribe visit:
> > > http://www.trauma.org/traumalist.html
> > --
> > trauma-list : TRAUMA.ORG <http://trauma.org/> To change your settings
> > or unsubscribe visit:
> > http://www.trauma.org/traumalist.html
> >
> >
> >
> >
> >
> >
> >
> >
> > ---------- Forwarded message ----------
> > From: "Bjorn, Pret" <pbjorn at emh.org><~!B*+R^&>> To: <
> trauma-list at trauma.org>
> > Date: Fri, 6 Oct 2006 12:18:52 -0400
> > Subject: NoM Spleen Returns
> > Adult female MVC.  Left rib fx's 10-12, known splenic inj, read as
> > Grade I in spite of contrast blush (not intended as the thrust of this
>
> > thread).
> >
> > The patient was admitted for two nights, stable throughout, and
> > discharged with her cooperation and enthusiasm.  She was prescribed
> > house arrest for a week, drastically limited activity, and an office
> > visit to follow.
> >
> > As fate would have it, on post-injury day 6 she suffered a sudden
> > sharp LUQ pain with what sounds like a brief vagal response.  She
> > reported immediately to her local ED, where another CT shows both a
> > persistent blush plus intraperitoneal hemorrhage (second image).
> >
> > At the local hospital, vitals were stable (she was in fact
> > hypertensive consistent with her medical history) and her labs were
> > unremarkable (H&H
> > 12 and 35, roughly identical to previous discharge numbers).  She was
> > admitted to the local hospital for observation, but her counts slipped
>
> > overnight (10 & 27), and so she was transferred back to us.  She
> > arrives stable and without any major complaints.  Even a little
> hungry.
> >
> > Interested in what others would plan for her.  Observe?  Coil?  Both?
> > Other?
> >
> > Pret Bjorn, RN
> >
> >
> > <<FirstImage.jpg>>
> <<SecondImage.jpg>><~!B*+R^&>><~!B*+R^&>><~!B*+R^&>> --
> > trauma-list : TRAUMA.ORG <http://trauma.org/> To change your settings
> > or unsubscribe visit:
> > http://www.trauma.org/traumalist.html
> >
> >
> >
> --
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