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Fri Aug 17 16:14:42 BST 2007

NO!!

The level I Trauma Center has the responsibility to accept an unstable patient only after the sending hospital has stabilized the patient to the best of their abilities and cannot offer the patient anything further. 

This patient's hypovolemic hemorrhagic shock is not due to the suspected aortic tear, but rather due to the hepatic and splenic injuries which require an emergent laparotomy with, at the very least splenorrhaphy/splenectomy and damage control packing and then the patient can be sent to the Level I Center.  All they need is an OR 9already ready) and a general surgeon who has (we hope) completed an ACGME or other equivalent general surgical training program and who still remembers how to operate WITHOUT a laparascope<

Just my 2 cents..........

Ron

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

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.

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