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Fri Oct 12 13:11:42 BST 2007

One additional point, just to fulfill my role as the devil's advocate:  Now that we know the outcome of your patient, are you certain that the patient WOULDN'T have benefited from a stop in the trauma bay?  Maybe he died from a tension pneumothorax that you missed...maybe a ED thoracotomy would've saved him...true, survival is low in the EDT population, but your mortality is 100%.  So, did you make the right call?  I think this case should be reviewed by your peers.

RD

> Date: Fri, 12 Oct 2007 07:28:08 -0400> From: stephen.richey at gmail.com> To: trauma-list at trauma.org> Subject: Re: Ideal ED length of stay?> > >> > I have taken unstable penetrating cases direct to OR, but it's not common> > for us by any means.> > > > I can count on one hand (actually 3 fingers) the times I've done that in> going on 12 years as an EMS provider. What amazes me is that our primary> receiving hospital had direct to cath lab admissions for field diagnosed MIs> but a penetrating trauma to the chest with deteriorating vitals we were> expected to stop in the ED. The last time I did it, the ED physician on> duty (our deputy medical director) told me to stop and my response involve a> four letter word starting with 'f' and "you". It was a hunting accident> with a through and through from one mid axillary line to the other at about> nipple level, and barely obtainable vitals. I was not stopping for anything> and we had already called the trauma alert, the ED charge nurse had notified> the OR and had let us prior to our arrival know the OR was read. So we kept> going.....I walked out of the hallway that leads back towards the ORs to> find the ED doc waiting on me. He ripped into me and my 'defense' was> "Look, you can fire me if you like, but he needed a surgeon. He made it to> the OR alive. If that is worth me losing my job or my cert, so be it."> Then I turned around and walked off.> > BTW, the patient died on the table. And no, I didn't get fired.> > -- > Stephen L. Richey, CRT> > "It is better to know some of the questions than all of the answers."- James> Thurber> --> trauma-list : TRAUMA.ORG> To change your settings or unsubscribe visit:> http://www.trauma.org/index.php?/community/
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Ideal ED length of stay?