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Sat Mar 24 11:25:05 GMT 2007

As I noted previously, the reason the cut down is taught is not that it is
the "recommended" approach but rather because it can be adapted to almost
any circumstances with whatever supplies are available. Although its'
principles are fairly universally accepted and it provides a treatment
framework with which teams can work in cohesion, ATLS is not primarily
intended for folks in major centers but for the fellow who is out there in
impoverished circumstances 

R Wigle MD FACS

If only everyone had your thoughts Richard and applied the ATLS "principles"
as you apparently do..but unfortunately they don't.

Here in the U.K., some centres are still teaching saphenous vein cutdown as
the "recommended approach" and agree that it CAN be fairly easy to do (such
as operator dependence, anatomical knowledge and skill etc.) but there are
better ways to obtain access and QUICKER in an emergency for those
clinicians who fail to obtain IV access.

Its principles are universally accepted and it does indeed provide a
framework as you say. However, in the U.K. ATLS is still strictly adhered to
by too many people in major centres who cannot think outside the box, use
their own clinical judgment and acumen and ignore ATLS guidelines when, by
doing so, they are then acting in their patient's best interests.

Matthew Reeds

Surgery

U.K.

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