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Sat Mar 10 13:37:26 GMT 2007

Well stated Karim!

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of Karim Brohi
Sent: Saturday, March 10, 2007 6:54 AM
To: 'Trauma &amp; Critical Care mailing list'
Subject: RE: Log-roll in the trauma bay

Thank God mutual agreement Fridays are over and we can move on to Sensible
Saturdays.

Trauma care is all about playing the odds.  Of course you can only be
successful at playing the odds if you know the odds.  The odds of a patient
with an admission BP of 65 dying are 1 in 5 (Eastridge, AAST 2006).  BP of
60: 1 in 4.

This patient has blunt trauma, and has a tender abdomen.  You haven't told
us his pulse rate.  You haven't told us what the chest and pelvis X-rays
show.  You need to quickly exclude tension pneumothorax.  A FAST exam may
help you if you have time (but don't forget retroperitoneal haemorrhage).

Chances are, he is bleeding from his abdomen.   Chances are, if you get into
his belly in the next 10 minutes, you can save him.  Chances are, if you
don't get into the OR for another 40+ minutes, he'll die.

"We'll just quickly log-roll him. Let's quickly get an arterial line in.
Let's just quickly get a C-spine X-ray.  ........."

5mins + 5mins + 5mins  = dead.

No log roll no nothing.  This patient goes straight to a place of definitive
care.  Examining the back, monitoring physiology, everything else can be
done in the operating room with before or after laparotomy, depending on
haemodynamics.

It *may* be that this patient is in severe neurogenic shock and is not
bleeding at all.  The odds are against this, by orders of 100:1 or 1000:1.
Worst case, he has a negative laparotomy - it won't kill him.  A log roll
might.

Hooray for Sensible Saturdays, and let it be Sensible Saturday every day of
the week. 

Karim

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of ARS
Sent: 09 March 2007 21:32
To: Trauma &amp, Critical Care mailing list
Subject: RE: Log-roll in the trauma bay

mutual agreement fridays...i like that....I vote to log roll ......no
brainer

DO NOT RESUSITATE!!

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Log-roll in the trauma bay