List Archives

Fri Apr 27 13:01:14 BST 2007

hi fiona
    individual responses are highly variable to certain drugs-
  as anaesthetist i know pts. arrested following a half tab of domperidol,1mg of midazolam iv.
  morphine deaths were too often and the same has gone out of usage in our country-
     Dr ARREDDY chief of nuro anaesthesiology. sks nuro hospital .hyderabad india.

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Today's Topics:

1. RE: advice (Hardcastle, Tim, Dr )
2. RE: Rabid bears (Bryan Karla)
3. Damage Control (Claudia Baptista)
4. Re: Damage Control (kmattox at aol.com)
5. FW: Trauma legislation update (Bjorn, Pret)
6. RE: Damage Control (Robert F. Smith)
7. RE: Trauma legislation update (Robert F. Smith)
8. Gov Corzine & TRAUMA CENTERS (KMATTOX at aol.com)
From: "Hardcastle, Tim, Dr <tch at sun.ac.za>" <tch at sun.ac.za>
Subject: RE: advice
CC: "Trauma &amp; Critical Care mailing list" <trauma-list at trauma.org>
Date: Fri, 13 Apr 2007 13:05:02 +0200
To: <plklopper at webmail.co.za>

Peter

Was the hernia repair open or laparoscopic? Did he look "bled out" - one of the possibilities is a femoral arterial injury with retroperitoneal blood tracking causing this pain picture.

Let us know what the autopsy shows!

Since you are also from South Africa, feel free to mail me off-list if there is "local" related issues you may need advice on in this case.

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
M.Med (Emergency Medicine) Executive Committee member
Clinical Head (Director): Diana Princess of Wales Trauma Unit
Division of Surgery (General) Room 4064
Department of Surgical Sciences
Tygerberg Hospital / University of Stellenbosch
PO Box 19063
Tygerberg 7505
Western Cape
South Africa
e-mail: tch at sun.ac.za
Cell: +27824681615
Office: +27219389281 or 4911 pager 0302

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org]On Behalf Of Peter Klopper
Sent: Friday, April 13, 2007 7:14 AM
To: 'Trauma & Critical Care mailing list'
Subject: RE: advice

Hi Fiona
I am a 100% sure it was morphine . all drugs that get administerd gets
double chek and also the schedule 7 drugs are counted cheked and written in
to the habirforming register with 2 nurses signing , one who is a rnpost
mortem was done yesterday so we will know what the results of he death was.
-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of fiona wallace
Sent: 12 April 2007 10:20 PM
To: Trauma & Critical Care mailing list
Subject: RE: advice

Are they 100% certain it was morphine given?

Could it have been a drug mix up?

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org]On Behalf Of Jenny Moncur
Sent: 11 April 2007 11:43
To: Trauma & Critical Care mailing list
Subject: Re: advice

pulmonary embolus?

----- Original Message -----
From: "Peter Klopper" 

To: "'Trauma & Critical Care mailing list'" 
Sent: Wednesday, April 11, 2007 3:25 PM
Subject: advice

> Hi every one I need some advise and would appreciate all input I can get.
> I
> am nurse in a private hospital. I was called to a resus in one of the
> wards,
> young male patient , 20 years old. Had an inguinal hernia repair
> yesterday,
> complained of back pian associate with hypoxia and also abdominal pian, 15
> mg morphine given imi as prescribed by he surgeon, ten minuts later he was
> in full arress no signs of anaphalaxis or rash noted, he had morphine in
> theatre for pain. Do you think it can be anephalixis or even a aortic
> aneurism. Hes mother is a nurse and also a friend. I advise her to have a
> post mortem , to have closure to this unfortunate incedent. Please give me
> your input I would appreciate aal.
>
> Thank you
>
> Peter
>
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From: "Bryan Karla" <Karla.Bryan at HCAhealthcare.com>
Subject: RE: Rabid bears
Date: Fri, 13 Apr 2007 08:35:16 -0500
To: "Trauma &amp; Critical Care mailing list" <trauma-list at trauma.org>

Dr. Hardcastle,

Thank you for all your help. I do understand that the information is for
rabies in general. I agree, unfortunately, our society is forcing us to
do the CYA more and more. I think you'll be interested to know that when
I presented the information I've received from you and our state
epidemiologist to the trauma surgeon involved, he completely blew my
off. His comment was something to the effect that it was overkill to
treat this patient as he's never heard of a rabid bear before.

I did access the CDC website and printed the information available
there. 

I saw in the paper yesterday that it wasn't an elk carcass but a moose
carcass that was nearby. The patient didn't know it was around. Fish and
Game said it looked like a natural death.

The patient had a degloving scalp injury, lacerations on the forehead,
back and buttocks from claw marks. The patient apparently curled up and
played dead. The bear went away after the initial mauling and he got up
to go back to the house, but the bear apparently wasn't too far away and
came after him and mauled him again. He was smart enough to play dead
again, and when the bear was finished with him, he belly crawled back to
the house.

Karla 

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of Hardcastle, Tim, Dr

Sent: Thursday, April 12, 2007 23:00
To: Trauma & Critical Care mailing list
Subject: RE: Rabid bears

Karla

My pleasure to assist. Realise the references are NOT specific to bears
- just rabies - the virus is the same anyhow! Unlike Charles Krin, I
cannot access the CDC site (semi-restricted for non US-subscribers?), so
could not get you that data. I agree with Pret - if in doubt, give the
prophylaxis. I don't think the issue here is that they know it is
rabies, rather they are being cautious -it may just be good old CYA!

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 M.Med (Emergency Medicine) Executive Committee
member Clinical Head (Director): Diana Princess of Wales Trauma Unit
Division of Surgery (General) Room 4064 Department of Surgical Sciences
Tygerberg Hospital / University of Stellenbosch PO Box 19063 Tygerberg
7505 Western Cape South Africa
e-mail: tch at sun.ac.za
Cell: +27824681615
Office: +27219389281 or 4911 pager 0302

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org]On Behalf Of Bryan Karla
Sent: Thursday, April 12, 2007 8:43 PM
To: Trauma & Critical Care mailing list
Subject: RE: Rabid bears

Thank you Dr. Hardcastle,

I will look up the reference. This was a grizzly bear. A man heard his
dog barking, went out to check on it, and there was the bear! The bear
attacked and did not leave, even when EMS got there. Apparently, there
was a fresh elk kill nearby that he was protecting. Fish & Game left the
kill and set a trap. We haven't yet heard if the bear has been trapped.

I spoke with our state epidemiologists--one an MD, the other a vet. Both
agreed that the patient should be treated prophylactically until the
bear is caught and tested (even though there have been no known cases in
Idaho or Wyoming). I passed the information on to the trauma surgeon
involved.

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of Hardcastle, Tim, Dr

Sent: Thursday, April 12, 2007 08:14
To: Trauma & Critical Care mailing list
Subject: RE: Rabid bears

Karla

Did a Medline search - surprisingly little re: protocols, but
identifying the virus early is possible by rapid PCR testing. This can
identify infected patients early.

The swab DNA needs to go to the conservation service research labs - to
identify the bear - they should have such laboratories!

Look also at: Vet Clin North Am Small Anim Pract. 2001 May;31(3):557-72,
Rabies postexposure prophylaxis. Human and domestic animal
considerations, by Fearneyhough MG. This may help.

Regards
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 M.Med (Emergency Medicine) Executive Committee
member Clinical Head (Director): Diana Princess of Wales Trauma Unit
Division of Surgery (General) Room 4064 Department of Surgical Sciences
Tygerberg Hospital / University of Stellenbosch PO Box 19063 Tygerberg
7505 Western Cape South Africa
e-mail: tch at sun.ac.za
Cell: +27824681615
Office: +27219389281 or 4911 pager 0302

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org]On Behalf Of Bryan Karla
Sent: Thursday, April 12, 2007 3:30 PM
To: trauma-list at trauma.org
Subject: Rabid bears

Last night we had a patient come in who had been mauled by a grizzly
bear--no, not the first we've ever had. Today we had a call from a fish
and game conservation officer who asked us if we have a policy for
testing for rabies on these patients (we do not). He also stated that
there are pending lawsuits all over the country on behalf of patients
who have been mauled by rabid bears and died. Families are suing fish
and game and the hospitals because their loved one was not tested for
rabies. He would also like us to swab these patients for possible DNA
testing to help them in identifying the bears when/if they are caught.
My questions: how soon can a patient be tested for rabies and have a
positive test? What type of test is there (other than IgG)? Does anyone
have any kind of policy or protocol for testing these patients that they
would share? If you swab the wounds, to whom do you send the swabs for
analysis? Any other suggestions you can give me would be greatly
appreciated.
Karla Bryan, RN, BSN
Trauma Services Coordinator
Eastern Idaho Regional Medical Center
3100 Channing Way
Idaho Falls, ID. 83403-2077
208-227-2027
Fax: 208-227-2032
This e-mail and any files transmitted with it may contain PRIVILEGED or
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immediately purge it and all attachments and notify the sender by reply
e-mail or contact the sender at the number listed.

Karla Bryan, RN, BSN
Trauma Services Coordinator
Eastern Idaho Regional Medical Center
3100 Channing Way
Idaho Falls, ID. 83403-2077
208-227-2027
Fax: 208-227-2032

This e-mail and any files transmitted with it may contain PRIVILEGED or
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From: "Claudia Baptista" <claudiabaptista at hotmail.com>
Subject: Damage Control
Date: Fri, 13 Apr 2007 13:50:16 +0000
To: trauma-list at trauma.org

  Hello everybody!

   I´m working at a presentation about Damage Control Surgery.
   I´m a Anesthesiology resident, so i´d like to get some information about specific aspects of the intra-operative period. I found a lot of papers about the surgery, but only one about the anesthesia (Of course, I have thousand about the lethal triade!).

   Could you advise me some of the latest articles?

   Thank You!!

---------------------------------
  MSN Busca: fácil, rápido, direto ao ponto. Encontre o que você quiser. Clique aqui. From: kmattox at aol.com
Subject: Re: Damage Control
Date: Fri, 13 Apr 2007 14:12:41 +0000
To: "Trauma &amp; Critical Care mailing list" <trauma-list at trauma.org>

For anesthesia and damage control, avoid giving pressors and crystalloids to falsely elevate the Blood Pressure and pop the clot. Anesthesiologist like to see a highish BP on their record and for Damage control surgery, I like to see a systemic BP of 80/- or below. 

K

Sent via BlackBerry, return via KMattox at aol.com

-----Original Message-----
From: "Claudia Baptista" 
Date: Fri, 13 Apr 2007 13:50:16 
To:trauma-list at trauma.org
Subject: Damage Control

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From: "Bjorn, Pret" <pbjorn at emh.org>
Subject: FW: Trauma legislation update
Date: Fri, 13 Apr 2007 10:15:48 -0400
To: "Trauma &amp; Critical Care mailing list" <trauma-list at trauma.org>

For U.S. trauma care providers: please contact your legislative
delegates. Contact info below.

Pret Bjorn, RN

Bangor, ME USA

TO: Coalition for American Trauma Care Advisory Council Organizations
and HRSA Stakeholders 

FROM: Marcia Mabee, MPH, PhD; Executive Director, CATC

Please see the message below from Adrienne Roberts at the American
College of Surgeons (ACS). An advocacy letter urging House and Senate
Appropriators to provide $12 million in FY 2008 appropriations for the
Trauma-EMS program is now posted on the ACS legislative action site.
The link to the site is provided below. Please forward to your members
and please use this opportunity to send a letter to your Senators and
Representative!!! ALSO, please review the attached ACS letter urging
for sign on by your organization -- DEADLINE COB APRIL 17TH. 

______________________ 

Just wanted everyone to know that the College has posted a letter of
support for $12 million for the Trauma-EMS Program in the FY 2008
L-HHS-E approps bill on our Legislative Action Center. Please feel free
to direct any of your members to this site as well to send letters to
the Hill. Thanks!! The link is http://www.capitolconnect.com/acspa/ 

From: "Robert F. Smith" <rfsmithmd at comcast.net>
Subject: RE: Damage Control
Date: Fri, 13 Apr 2007 12:04:18 -0400
To: "'Trauma &amp; Critical Care mailing list'" <trauma-list at trauma.org>

I know there are several anesthesiologists on the list. I don't understand
why they use pressors, ever. I would think it just gives a false sense of
security and makes it hard for the surgeon to know where the patient is,
phyisiologically. In fact it might obscure the decision to move to damage
control mode if that wasn't initially the thought.

R. Smith

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of kmattox at aol.com
Sent: Friday, April 13, 2007 10:13 AM
To: Trauma & Critical Care mailing list
Subject: Re: Damage Control

For anesthesia and damage control, avoid giving pressors and crystalloids to
falsely elevate the Blood Pressure and pop the clot. Anesthesiologist like
to see a highish BP on their record and for Damage control surgery, I like
to see a systemic BP of 80/- or below. 

K

Sent via BlackBerry, return via KMattox at aol.com

-----Original Message-----
From: "Claudia Baptista" 
Date: Fri, 13 Apr 2007 13:50:16 
To:trauma-list at trauma.org
Subject: Damage Control

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From: "Robert F. Smith" <rfsmithmd at comcast.net>
Subject: RE: Trauma legislation update
Date: Fri, 13 Apr 2007 12:06:14 -0400
To: "'Trauma &amp; Critical Care mailing list'" <trauma-list at trauma.org>

$12 million. How pathetic!

R. Smith

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of Bjorn, Pret
Sent: Friday, April 13, 2007 10:16 AM
To: Trauma & Critical Care mailing list
Subject: FW: Trauma legislation update

For U.S. trauma care providers: please contact your legislative
delegates. Contact info below.

Pret Bjorn, RN

Bangor, ME USA

TO: Coalition for American Trauma Care Advisory Council Organizations
and HRSA Stakeholders 

FROM: Marcia Mabee, MPH, PhD; Executive Director, CATC

Please see the message below from Adrienne Roberts at the American
College of Surgeons (ACS). An advocacy letter urging House and Senate
Appropriators to provide $12 million in FY 2008 appropriations for the
Trauma-EMS program is now posted on the ACS legislative action site.
The link to the site is provided below. Please forward to your members
and please use this opportunity to send a letter to your Senators and
Representative!!! ALSO, please review the attached ACS letter urging
for sign on by your organization -- DEADLINE COB APRIL 17TH. 

______________________ 

Just wanted everyone to know that the College has posted a letter of
support for $12 million for the Trauma-EMS Program in the FY 2008
L-HHS-E approps bill on our Legislative Action Center. Please feel free
to direct any of your members to this site as well to send letters to
the Hill. Thanks!! The link is http://www.capitolconnect.com/acspa/ 

From: KMATTOX at aol.com
Subject: Gov Corzine & TRAUMA CENTERS
CC: 
Date: Fri, 13 Apr 2007 12:29:40 EDT
To: trauma-list at trauma.org, ccm-l at ccm-l.org

The following has just been posted to a NATIONAL news network blog site. 
Anyone on this list can use this initiative to communicate with local and 
federal persons. We are all grateful for the dedicated trauma team at Cooper 
Hospital in Camden, New Jersey. Thank you for being there and continue your 
good work. 

k

Cooper Hospital in Camden New Jersey is recognized as one of the best trauma 
centers in the country. It has been repeatedly stated that the very best 
trauma center in the greater Philadelphia area is the one in Camden New 
Jersey. The Governor is fortunate that one of the jewels of the nation's trauma 
and disaster Integrated Collaborative Network was there for him when he needed 
it. Ironically, these trauma centers are struggling for support for their 
infrastructure, surgical critical care recognition within the trauma center 
network and incorporation into the regional EOC networks of our disaster 
preparedness and response. New Jersey has NOT followed its neighbor to the 
north, Connecticut, in structuring its medical disaster response on top of an 
existing integrated trauma system. Governor, here is a chance to build on 
something good that is already in place. 
Kenneth L. Mattox, MD 
Houston 
_kmattox at aol.com_ (mailto:kmattox at aol.com) 

************************************** See what's free at http://www.aol.com.

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