List Archives

Sat Dec 29 18:23:24 GMT 2007

Dear All,

Benazir Bhutto's tragedy is a refelction of the insanity that prevails in the world today.  Insanity also drowns the voice of sanity. 
May God give us the wisdom to maintain our sanity.

I am still searrching for any good references for analgesia in trauma. 

With regards,

Zunorain Dodhy

----- Original Message ----
From: "trauma-list-request at trauma.org" <trauma-list-request at trauma.org>
To: trauma-list at trauma.org
Sent: Saturday, 29 December, 2007 3:00:08 PM
Subject: trauma-list Digest, Vol 54, Issue 37

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Today's Topics:

   1. RE: Mass casualty management challenges in Rawalpindi
      (Bjorn, Pret)
   2. Re: trauma-list Digest, Vol 54, Issue 36
      (czuehlke at frontiernet.net)
   3. CMS Deadline for Comments (Milici, Justin J.)

-----Inline Message Follows-----

Ditto.  Preferably peace AND justice -- both are prerequisites for
safety.  Which is one reason why safety is in such short supply.

Pret Bjorn, RN
Bangor ME USA

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of KMATTOX at aol.com
Sent: Thursday, December 27, 2007 10:14 AM
To: trauma-list at trauma.org
Subject: Mass casualty management challenges in Rawalpindi

I extend prayers for peace and safety for Pakistan and all of our
surgical  
friends in Pakistan.   Our commendations for a valiant surgical effort
to the 
surgeons in Rawalpindi General Hospital.   Such a highly  political and

international event causes disruption at a hospital that never  goes
away.     In 
addition to the injuries in former Prime  Minister Bhutto, many other
injuries 
and deaths occurred, giving a mass casualty  situation at that
 location.

Surge and multiple casualty  management now face all of us in our
individual  
hospitals.     

Kenneth Mattox, MD
Houston

**************************************See AOL's top rated recipes 
(http://food.aol.com/top-rated-recipes?NCID=aoltop00030000000004)
--
trauma-list : TRAUMA.ORG
To change your settings or unsubscribe visit:
http://www.trauma.org/index.php?/community/

Ditto.  Preferably peace AND justice -- both are prerequisites for
safety.  Which is one reason why safety is in such short supply.

Pret Bjorn, RN
Bangor ME USA

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of KMATTOX at aol.com
Sent: Thursday, December 27, 2007 10:14 AM
To: trauma-list at trauma.org
Subject: Mass casualty management challenges in Rawalpindi

I extend prayers for peace and safety for Pakistan and all of our
surgical  
friends in Pakistan.   Our commendations for a valiant surgical effort
to the 
surgeons in Rawalpindi General Hospital.   Such a highly  political and

international event causes disruption at a hospital that never  goes
away.     In 
addition to the injuries in former Prime  Minister Bhutto, many other
injuries 
and deaths occurred, giving a mass casualty  situation at that
 location.

Surge and multiple casualty  management now face all of us in our
individual  
hospitals.     

Kenneth Mattox, MD
Houston

**************************************See AOL's top rated recipes 
(http://food.aol.com/top-rated-recipes?NCID=aoltop00030000000004)
--
trauma-list : TRAUMA.ORG
To change your settings or unsubscribe visit:
http://www.trauma.org/index.php?/community/

-----Inline Message Follows-----

The same method is done in our facility during a blunt trauma as long  
as the patient remains stable. The only rsik I can potentially see is  
that if the patient has internal damage and needs to be sent to the OR

immediately. We usually will not have them drink the contrast and just

send him to CT without any contrast.
Carol RN

Quoting trauma-list-request at trauma.org:

> Send trauma-list mailing list submissions to
>     trauma-list at trauma.org
>
> To subscribe or unsubscribe via the World Wide Web, visit
>     http://list.mistral.net/mailman/listinfo/trauma-list
> or, via email, send a message with subject or body 'help' to
>     trauma-list-request at trauma.org
>
> You can reach the person managing the list at
>     trauma-list-owner at trauma.org
>
> When replying, please edit your Subject line so it is more specific
> than "Re: Contents of trauma-list digest..."
>
>
> Today's Topics:
>
>    1. Re: BAT (Dan Burgess)
>    2. Mass casualty management challenges in Rawalpindi
>       (KMATTOX at aol.com)
>
>
>
 ----------------------------------------------------------------------
>
> Message: 1
> Date: Thu, 27 Dec 2007 08:00:46 -0600
> From: "Dan Burgess" <dburgess at mhg.com>
> Subject: Re: BAT
> To: "Critical Care mailing list Trauma &amp" <trauma-list at trauma.org>
> Message-ID: <47735BAE02000001001BD6F7 at email01.mhghpf.com>
> Content-Type: text/plain; charset=us-ascii
>
> IV an PO contrast visualize different pathology.  One form does not  

> substitute for the other.  My understanding is that with PO contrast

>  the delay is so that the water can be absorbed by the bowel  
> allowing  the iodine residue to enhance the intestinal lining.  IV  
> contast  evaluates vascular distribution of the contrast medium.   
> Different  methods of administration for visualizing different  
> pathology.
>
> Dan P Burgess RN MS
> Education/Skills Coordinator
> Emergency/Urgent Care Services
> Memorial Hospital at Gulfport
> 228-575-2079
>
> Confidentiality Notice: This e-mail message, including any
> attachments, is for the sole use of the intended recipient(s)
> and may contain confidential and privileged information.
> Any unauthorized review, use, disclosure, or distribution is
> prohibited.  If you are not the intended recipient, please
> contact the sender by reply e-mail and destroy all copies of
> the original message.
>
>>>> "Ronald Gross" <Rgross at harthosp.org> 12/26/2007 6:39 PM >>>
> IV contrast is fine and we use it on every scan.  Just make sure   
> that the creatinine is normal, or you just might end up with some   
> element of ATN if you are not careful about protecting those beans   
> pre-scan.
>
> Have a safe and healthy New Year,
> Ron
>
>>>> "cathy armstrong" <cathyarmstrong1 at googlemail.com> 12/26/2007 5:24
 PM >>>
> why not iv contrast?
> cathy
>
> On Dec 25, 2007 5:37 AM, <ccrone at charter.net> wrote:
>
>> I work at a small, rural ER (about 18, 000 annual ED volume).  We
 have no
>> FAST/Ultrasound immediately available at all times.  If we have a
 case of
>> blunt abdominal trauma & order a CT scan, our radiologist demands
 that we
>> have the patient drink oral contrast & wait 2 hours for the CT to be
>> performed.  It then takes another 30 minutes for the report to be
 obtained.
>>    What do other institutions currently do regarding the use of oral
>> contrast when obtaining abdominal/pelvic CT's for blunt abdominal
 trauma in
>> a hemodynamically stable patient-- with suspected internal injuries?
>>
>> Thanks
>> --
>> trauma-list : TRAUMA.ORG <http://trauma.org/>
>> To change your settings or unsubscribe visit:
>> http://www.trauma.org/index.php?/community/
>>
> --
> trauma-list : TRAUMA.ORG
> To change your settings or unsubscribe visit:
> http://www.trauma.org/index.php?/community/
>
> --
> trauma-list : TRAUMA.ORG
> To change your settings or unsubscribe visit:
> http://www.trauma.org/index.php?/community/
>
>
>
>
>
> ------------------------------
>
> Message: 2
> Date: Thu, 27 Dec 2007 10:14:06 EST
> From: KMATTOX at aol.com
> Subject: Mass casualty management challenges in Rawalpindi
> To: trauma-list at trauma.org
> Message-ID: <c2f.25e6372f.34a51b3e at aol.com>
> Content-Type: text/plain; charset="US-ASCII"
>
>
> I extend prayers for peace and safety for Pakistan and all of our
 surgical
> friends in Pakistan.   Our commendations for a valiant surgical   
> effort  to the
> surgeons in Rawalpindi General Hospital.   Such a highly  political
 and
> international event causes disruption at a hospital that never  goes

>  away.     In
> addition to the injuries in former Prime  Minister Bhutto, many   
> other injuries
> and deaths occurred, giving a mass casualty  situation at that
 location.
> Surge and multiple casualty  management now face all of us in our
 individual
> hospitals.
>
> Kenneth Mattox, MD
> Houston
>
>
>
>
>
> **************************************See AOL's top rated recipes
> (http://food.aol.com/top-rated-recipes?NCID=aoltop00030000000004)
>
>
> ------------------------------
>
> --
> trauma-list : TRAUMA.ORG
> To change your settings or unsubscribe visit:
> http://www.trauma.org/index.php?/community/
>
> End of trauma-list Digest, Vol 54, Issue 36
> *******************************************
>

The same method is done in our facility during a blunt trauma as long  
as the patient remains stable. The only rsik I can potentially see is  
that if the patient has internal damage and needs to be sent to the OR

immediately. We usually will not have them drink the contrast and just

send him to CT without any contrast.
Carol RN

Quoting trauma-list-request at trauma.org:

> Send trauma-list mailing list submissions to
>     trauma-list at trauma.org
>
> To subscribe or unsubscribe via the World Wide Web, visit
>     http://list.mistral.net/mailman/listinfo/trauma-list
> or, via email, send a message with subject or body 'help' to
>     trauma-list-request at trauma.org
>
> You can reach the person managing the list at
>     trauma-list-owner at trauma.org
>
> When replying, please edit your Subject line so it is more specific
> than "Re: Contents of trauma-list digest..."
>
>
> Today's Topics:
>
>    1. Re: BAT (Dan Burgess)
>    2. Mass casualty management challenges in Rawalpindi
>       (KMATTOX at aol.com)
>
>
>
 ----------------------------------------------------------------------
>
> Message: 1
> Date: Thu, 27 Dec 2007 08:00:46 -0600
> From: "Dan Burgess" <dburgess at mhg.com>
> Subject: Re: BAT
> To: "Critical Care mailing list Trauma &amp" <trauma-list at trauma.org>
> Message-ID: <47735BAE02000001001BD6F7 at email01.mhghpf.com>
> Content-Type: text/plain; charset=us-ascii
>
> IV an PO contrast visualize different pathology.  One form does not  

> substitute for the other.  My understanding is that with PO contrast

>  the delay is so that the water can be absorbed by the bowel  
> allowing  the iodine residue to enhance the intestinal lining.  IV  
> contast  evaluates vascular distribution of the contrast medium.   
> Different  methods of administration for visualizing different  
> pathology.
>
> Dan P Burgess RN MS
> Education/Skills Coordinator
> Emergency/Urgent Care Services
> Memorial Hospital at Gulfport
> 228-575-2079
>
> Confidentiality Notice: This e-mail message, including any
> attachments, is for the sole use of the intended recipient(s)
> and may contain confidential and privileged information.
> Any unauthorized review, use, disclosure, or distribution is
> prohibited.  If you are not the intended recipient, please
> contact the sender by reply e-mail and destroy all copies of
> the original message.
>
>>>> "Ronald Gross" <Rgross at harthosp.org> 12/26/2007 6:39 PM >>>
> IV contrast is fine and we use it on every scan.  Just make sure   
> that the creatinine is normal, or you just might end up with some   
> element of ATN if you are not careful about protecting those beans   
> pre-scan.
>
> Have a safe and healthy New Year,
> Ron
>
>>>> "cathy armstrong" <cathyarmstrong1 at googlemail.com> 12/26/2007 5:24
 PM >>>
> why not iv contrast?
> cathy
>
> On Dec 25, 2007 5:37 AM, <ccrone at charter.net> wrote:
>
>> I work at a small, rural ER (about 18, 000 annual ED volume).  We
 have no
>> FAST/Ultrasound immediately available at all times.  If we have a
 case of
>> blunt abdominal trauma & order a CT scan, our radiologist demands
 that we
>> have the patient drink oral contrast & wait 2 hours for the CT to be
>> performed.  It then takes another 30 minutes for the report to be
 obtained.
>>    What do other institutions currently do regarding the use of oral
>> contrast when obtaining abdominal/pelvic CT's for blunt abdominal
 trauma in
>> a hemodynamically stable patient-- with suspected internal injuries?
>>
>> Thanks
>> --
>> trauma-list : TRAUMA.ORG <http://trauma.org/>
>> To change your settings or unsubscribe visit:
>> http://www.trauma.org/index.php?/community/
>>
> --
> trauma-list : TRAUMA.ORG
> To change your settings or unsubscribe visit:
> http://www.trauma.org/index.php?/community/
>
> --
> trauma-list : TRAUMA.ORG
> To change your settings or unsubscribe visit:
> http://www.trauma.org/index.php?/community/
>
>
>
>
>
> ------------------------------
>
> Message: 2
> Date: Thu, 27 Dec 2007 10:14:06 EST
> From: KMATTOX at aol.com
> Subject: Mass casualty management challenges in Rawalpindi
> To: trauma-list at trauma.org
> Message-ID: <c2f.25e6372f.34a51b3e at aol.com>
> Content-Type: text/plain; charset="US-ASCII"
>
>
> I extend prayers for peace and safety for Pakistan and all of our
 surgical
> friends in Pakistan.   Our commendations for a valiant surgical   
> effort  to the
> surgeons in Rawalpindi General Hospital.   Such a highly  political
 and
> international event causes disruption at a hospital that never  goes

>  away.     In
> addition to the injuries in former Prime  Minister Bhutto, many   
> other injuries
> and deaths occurred, giving a mass casualty  situation at that
 location.
> Surge and multiple casualty  management now face all of us in our
 individual
> hospitals.
>
> Kenneth Mattox, MD
> Houston
>
>
>
>
>
> **************************************See AOL's top rated recipes
> (http://food.aol.com/top-rated-recipes?NCID=aoltop00030000000004)
>
>
> ------------------------------
>
> --
> trauma-list : TRAUMA.ORG
> To change your settings or unsubscribe visit:
> http://www.trauma.org/index.php?/community/
>
> End of trauma-list Digest, Vol 54, Issue 36
> *******************************************
>

-----Inline Message Follows-----

FYI... see below.

Justin Milici, RN, MSN, CCRN, CEN, CFRN, TNS
Trauma Education, Prevention/Outreach
Trauma Services - 11 Roberts
Baylor University Medical Center
3500 Gaston Ave.
Dallas, TX 75246
(214) 820-6818
(214) 820-1086 - Fax
(214) 344-3961 - Pager
E-mail: JustinM at baylorhealth.edu

________________________________
From: Scott Parsley [mailto:sparsley at kellerfd.com]
Sent: Friday, December 28, 2007 11:09 AM
To: Milici, Justin J.
Subject: CMS Deadline for Comments

Hi Justin,

While the rule from CMS is driven towards ambulance services it too has
 an impact on receiving ER staff.

For anyone so inclined to comment back to CMS here is a link and some
 discussion points.

Thanks!
________________________________
From: Scott Parsley
Sent: Friday, December 28, 2007 9:27 AM
To: tcemspo at yahoogroups.com
Subject: CMS Deadline for Comments

The deadline to submit comments on the proposed changes to the
 ambulance provider rule requiring signatures above and beyond what is normally
 accepted is midnight on Monday.

You can copy this link below and paste it into your browser to navigate
 to the CMS website and enter your comments.

http://www.accessdata.fda.gov/scripts/oc/dockets/comments/getDocketInfo.cfm?EC_DOCUMENT_ID=165&SORT=&MAXROWS=15&START=1&CID=&AGENCY=CMS

When submitting your comments you have the opportunity to submit for
 not only yourself but for a professional association.  Being that TCEMSPO
 meets that standard I would request that an officer from our
 organization submit a comment on behalf of the organization in opposition to the
 proposed changes.

The proposed changes would require transport crews to spend additional
 out of service time attempting to obtain documentation above and beyond
 the current rule as well as burdening ill or injured patients,
 distressed family members and taking emergency department staff away from
 their role as care providers to satisfy compliance with this rule.

If this rule change is implemented it will still need CMS oversight and
 auditing for compliance and enforcement, no less than what the current
 rule requires.

Instead of implementing this rule it would be preferred that CMS
 exercise greater enforcement of the current rule on those who are not in
 compliance instead of shifting the burden back onto those who do comply.

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FYI... see below.