List Archives

Fri Aug 17 04:20:04 BST 2007

May I ask a "naive" question...

What was the patient doing in the "CT scan 2 hours after arrival "  
with a "systolic BP 0f 40-60" ??

J Levasseur MD
Joliette, QC, Canada

A question to the group.  Does a Level 1 Trauma Center have a   
responsibility
to accept an "unstable" patient from a Level 3 Trauma  Center?  30yr  
male
MVC, GCS 15, systolic BP 40-60. Resuscitation with  crystalloids and  
PRBC.  CT
revealed liver & spleen laceration and  suspected aortic injury. OR  
team in
house but no cardiothoracic  capabilities.  Level 1 Trauma Center is  
about 15
miles  away.

Le 07-08-16 à 23:00, ABMoss at aol.com a écrit :

>
> Unfortunately, the patient died in CT scan 2 hours after arrival at  
> Level  3.
> Autopsy is pending.
>
>
> In a message dated 8/16/2007 10:18:17 PM Eastern Daylight Time,
> KMATTOX at aol.com writes:
>
> As  presented a number of comments can be made:
>
> 1.    It  is contra indicated and probably unethical to  transfer  
> this person
>
> from one trauma center (level 3) to another trauma center  (level  1)
> 2.    There is no quality difference nor should there  be  any outcome
> difference between a Verified or Certified Level 3 trauma  Center   
> and a
> Level I
> Trauma Center,   NON whatsoever.,  except for  neurosurgery and
> cardiopulmonary
> bypass (and then even  MAYBE)
> 3.  A level 3 trauma surgery should be able with  personnel,   
> equipment., and
> protocols to take care of anything in the  abdomen, any vascular   
> trauma not
> requiring CPB,  ALL orthopedic  injuries, ALL neck injuries and  most
> thoracic
> injuries with the same  outcome as a Level I trauma  center.
> 4.    A  patient with a suspected thoracic aortic injury  is NOT  
> unstable
> from
> the aortic injury, unless there is total disruption of the  aorta  
> and  total
> instability manifest as death.
> 5.    As  described, this patient should have the LOCAL  surgeons  
> at the
> Level
> 3 trauma center do an open laparotomy NOW, and take care  of  
> whatever  is
> required to control the bleeding or sepsis.
> 6.   To transfer this patient as described will  DECREASE his  
> chances  of
> survival and increase the  complications.
>
> Kenneth L. Mattox,  MD
> Houston
>
>
>
>
>
>
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