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Fri Aug 17 16:02:52 BST 2007

I don't know how to say this correctly or without sounding callous, so I am gonna just say it........If a patient is profoundly hypotensive as a result of bleeding, does not respond immediately to fluid resuscitationin the ED, and the patient looks like he/she is going to die, the only right place for that patient to die is in the OR.  

"Nuff said.

Ron

>>> <ABMoss at aol.com> 8/16/2007 11:00 PM >>>

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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