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Fri Aug 17 02:03:26 BST 2007

Unlikely to survive transfer. Agree, most likely cause of shock is hemorrhage from spleen and liver.

  Covering general surgeon needs to explore, intervene as indicated (splenectomy, pack abdomen) and attempt to stabilize before consideration of transfer.

Roy Danks <roydanks at hotmail.com> wrote:

This one will stir things up a bit...

My impression: He's not unstable from the "suspected" Ao injury. Unless he has a chest full of blood and obvious leak. He's unstable from the liver/spleen...assuming that's what the CT seemed to show:? contrast extrav?

But I digress. I think the Level III center, with inhouse OR staff and, presumably a general surgeon who can open an abdomen and pack or remove injured organs has the obligation to stabilize the patient. We're not talking neurosurgery to evac a EDH/SDH and we don't even know that the Ao injury exists.

So, no, I don't think you're obligated AT THAT MOMENT. They need to perform up to their abilities. Even ATLS says this.

Others?

RRD
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