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Sun Dec 9 16:55:24 GMT 2007

> Date: Sun, 9 Dec 2007 12:33:44 +0000
> From: vagenasp at yahoo.fr
> To: trauma-list at trauma.org
> Subject: (no subject)
> 
> Goodmorning from Greece.
> I am about to take the final exams as a specialist general surgeon.
> I have heard about a book called " Top Knife ".
> Please, if anyone knows some details about the edition, i would be grateful 
> 
> Thanks

I'm speaking as a nonsurgeon and nonphysician, but I found the book outstanding -- it was as hard to put down as a good novel, and I'm quite annoyed that I have it somewhere in storage while I move homes.

It is very carefully restricted to what goes on in the OR, not ER nor PACU nor SICU.  When I've observed surgery being performed by a resident or fellow, with a very good senior faculty member guiding the process, sometimes the resident would be unclear where to go next. The teacher would quickly review the anatomy and tell the resident where to feel for the structure he could not find.

There are many elegant but simple techniques, although I simply don't know if these are common among competent trauma surgeons. For example, the problem of sutures cutting through the soft spleen tissue was addressed, and then solved with a technique of wrapping the spleen first with an absorbable hemostatic material. The sutures put tension on that stronger material, not the spleen itself. 
> 
> 
> 
> 
> ----- Message d'origine ----
> De : caesar ursic <cmursic at gmail.com>
> À : "Trauma &, Critical Care mailing list" <trauma-list at trauma.org>
> Envoyé le : Dimanche, 9 Décembre 2007, 7h44mn 52s
> Objet : Re: Trauma Systems & Centres
> 
> >  What is interesting, is what the fate of small trauma centers will be.
> > If, for a mere reason of low volume, they cannot meet the 'gold standard'
> > (assuming that we've adjusted for other confounders) should they be shut
> > down or penalized?
> 
> 
> *A small trauma center that serves a large geographical area (albeit
> probably sparsely populated) will never see enough patients to meet any one
> of several proposed benchmarks, given a stable increase in local population
> growth.  Shut them down and you are now forcing local EMS agencies to travel
> much greater distances to deliver the injured to the 'nearest' trauma
> center.  So ask yourself these questions: Can the local infrastructure
> support this?  More helicopters, perhaps?  Will eliminating the local Level
> II or III facility with 'low' numbers actually improve outcomes in these
> patients who are now spending much more time in a pre-hospital setting due
> to greater travel times to definitive care?  Will the  'gold standard'
> destination trauma center cope well with the sudden increase in the number
> of patients arriving at its door?  *
> 
> 
> > Or should we bite the bullet, send specialists to these centers and try to
> > increase the volume?
> 
> 
> *Who is the 'we' of which you speak?  The American College of Surgeons?   The
> local/state agencies that regulate trauma centers?  The nearest
> University-affiliated teaching hospital?  The military?  And how do you
> propose that trauma volume be increased?  How will any given geographic area
> increase the incidence / prevalence of serious injury, outside of inciting
> riots and dispensing free tequila and Glocks outside bars?*
> 
> 
> > Finally, does meeting the 'gold standard' and becoming a center of
> > excellence equal improved quality?
> 
> 
> *Ahh...well, that depends on whom you read.  Practice does make perfect; the
> question is, how much practice? *
> 
> >
> >  KH
> >
> 
> *CMU*
> 
> -- 
> 'Twas brillig, and the slithy toves
> Did gyre and gimble in the wabe:
> All mimsy were the borogoves,
> And the mome raths outgrabe.
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