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Wed Jan 30 11:52:09 GMT 2008

Yeah - what HE said!  ;-)

Matt, you and I are on the same page here - but you said it far better than I did -   Thanks!

Take care,
Ron

>>> Matthew Reeds <mgreeds at reeds.uk.com> 1/30/2008 5:27 AM >>>

Mike & Ron,
When pontificating over the treatment that I give to any patient, I always try to ask what I would want for myself and apply this to give the best treatment to each patient. I would NOT want to be in an A&E/ED resuscitation room but would "rather" be in either theatre/OR, ITU/HDU, the ward or radiology (depending upon my injury) having the proper treatment that I need. This is what I would strive for with any of my patients.
Therefore I see NO reason for the patient to remain in A&E/ED for resuscitation. As Ron says, if the patient needs surgery, then off to theatre/OR they go. If they need non-operative resuscitation, then off to ITU or HDU they go for the care required. [This frees up theatre/OR resources and time as Mike says if surgery is not required for better utilisation.] Radiology resuscitation is ONLY required for THERAPEUTIC intervention such as angio for pelvic haemorrhage and stabilisation (if the extra-peritoneal pelvic packing approach is NOT used etc.)
>From my experience, there is NO need/role for A&E/ED resuscitation - if the patient is that sick, then they need to be elsewhere (e.g. theatre/OR, ITU/HDU etc.)
Even for major haemorrhage that requires surgery, these UNSTABLE patients SHOULD be rapidly transported to theatre/OR for surgery for emergency treatment. I would NOT NORMALLY advocate A&E/ED operating UNLESS absolutely necessary which has happened to me on a couple of occasions [such as cardiac arrest secondary to IVC transection at the bifurcation from multiple stab wounds from a bayonet in a 19 year old male.] He had been "down" for 3 mins when he arrived in A&E by paramedics/EMT and there was no way we could transfer him to theatre/OR on the top floor (11th floor) and at the other end of the hospital to save him - a fault of the hospital design. Therefore we performed a laparotomy in the A&E/ED resus room and got him back with RAPID abdominal packing and then transferred to theatre just as rapidly. However, this should be a RARE occasion and ONLY be absolutely necessary to imminently save life rather than be the norm. In essence this comes down to clinical acumen, experience and ability of the clinician to use sound judgment and I agree with Mike, that if the patient doesn't need surgery, then theatre/OR is not the best place to resuscitate the patient - they should be in the ITU/HDU instead.

Matthew
Surgery U.K.

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