List Archives

Mon Mar 10 13:45:09 GMT 2008

Yes you probably could, but at the detriment to all of the other patients 
who now have to wait for you to finish.

You are at an urgent care and probably have a couple dozen more patients 
waiting for you.

Time to move that one along to the hand guy.

Andrew

----- Original Message ----- 
From: "ROBERT ARNOLD" <robsidarn at msn.com>
To: <trauma-list at trauma.org>
Sent: Monday, March 10, 2008 8:34 AM
Subject: Shell Game

I will present a case for discussion:
47 y/o female presents to urgent care clinic
with dogbite, her American Bulldog (rabies-low risk),
to her left index and middle fingers.
x-ray confirms open fracture of distal tuft, index finger.
both digits have partial avulsion injuries to radial aspect,
that is, distal radial half of both dangling by threads and
index finger nailbed disruption, nail angulated 45 degrees ulnarly.
i called the hand guy and he said,
'aah, that sounds like you can take care of that.'
aaack, sid

From: trauma-list-request at trauma.orgSubject: trauma-list Digest, Vol 57, 
Issue 10To: trauma-list at trauma.orgDate: Mon, 10 Mar 2008 12:00:22 +0000Send 
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-listor, 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 specificthan "Re: 
Contents of trauma-list digest..."
--Forwarded Message Attachment--From: rfsmithmd at comcast.netSubject: RE: 
specialists really neededDate: Sun, 9 Mar 2008 09:42:31 -0400To: 
trauma-list at trauma.org     From my cynical side: If the purpose is a return 
to productive societymost of the patients I have seen would benefit more 
form a alcohol or drugrehab specialist than a hand specialist. Reality just 
crushes the life outof my idealism. But i guess it is heavily dependant on 
patient populations.     Mike Mike, As your resident touchy feely Left 
winger I don't think that thought iscynical at all. It's important to 
recognize and try to address the needs ofthe population you serve. It's 
especially important for us to do what wereasonably can to try to lessen the 
likelihood of future injury for ourpatients. Universal screening coupled 
with an immediateevaluation/intervention and seamless transfer to outpatient 
rehab (notwaiting 6-8 weeks) has been advocated. Carl Soderstrom at Maryland 
isprobably foremost in the trauma field re: substance abuse issues. There 
isactually sometimes money to help with programs like this. Rob Smith
--Forwarded Message Attachment--From: aberson at agvscs.comSubject: RE: Hand 
Call Coverage at Busy Urban Trauma CentersDate: Sun, 9 Mar 2008 
11:55:49 -0600To: trauma-list at trauma.orgThat's helpful AJB -----Original 
Message-----From: trauma-list-bounces at trauma.org 
[mailto:trauma-list-bounces at trauma.org]On Behalf Of kmattox at aol.comSent: 
Friday, March 07, 2008 10:44 AMTo: Trauma &amp; Critical Care mailing 
listSubject: Re: Hand Call Coverage at Busy Urban Trauma Centers  The very 
injury you described were for decades managed by general surgeonswith good 
results.  This injury can and are currently managed by interestedgeneral, 
pediatric, orthopedic, plastic, vascular, and even neuro surgeons.It is not 
a turf war it is a value and committment issue to the disciplineof surgery. 
I tend to believe that surgeons that find reasons they mustexcessively limit 
their surgery skills simply should not be surgeons.  Sent via BlackBerry by 
AT&T -----Original Message-----From: "Dr. Andrew Berson" 
<aberson at agvscs.com> Date: Fri, 7 Mar 2008 07:14:15 To:"'Trauma &amp; 
Critical Care mailing list'" <trauma-list at trauma.org>Subject: RE: Hand Call 
Coverage at Busy Urban Trauma Centers  Dr. Mattox, I agree with the care of 
the simple lacerations, etc and that is what isoccuring.  The muddy issue 
centers around injuries that are somewhere inbetween. i.e. a deep laceration 
that severs tendons or neural structures,but is not a near amputation.  I 
feel that this could/should be handled by aqualified orthopedic surgeon, but 
we are getting significant push back inthis area.  Thoughts? 
AJB -----Original Message-----From: trauma-list-bounces at trauma.org 
[mailto:trauma-list-bounces at trauma.org]On Behalf Of KMATTOX at aol.comSent: 
Thursday, March 06, 2008 8:44 PMTo: trauma-list at trauma.orgSubject: Re: Hand 
Call Coverage at Busy Urban Trauma Centers  I have no real idea what a 
"Trauma" orthopedist is that is different from a regular orthopedic surgeon? 
I also have taken a close  look at what has been attempted to be sent to us 
at the BTGH as "hand" trauma  from theimmediate 14 count area.      Every 
day we  repeatedly get calls for a transfer for a higher level of care for a 
"hand  trauma" case, because they do not have ahand surgeon on  call. 
When we ask about the case, it might be a minor  (or even major) hand bone 
fracture.   That is general  orthopedics.    If thecase comes to us, it will 
be treated by an  orthopedist, or a plastic surgeon.Our "HAND SURGEON" is 
called in for basically a "replantation" and a couple of other  diagnoses. 
So....................when we have a  finger tip amputation, that just needs 
a closure, we do not accept a patient intransfer and ask that the emergency 
physician at the sending hospital close the  wound,as will be done when we 
receive the patient.   NOT a higher  liver of care.By FAR the majority of 
cases  that are labeled "hand" can and probably shouldbe managed by the 
ACUTE CARE  SURGEON (the new name for what was the routine garden variety 
"general surgeon  of the past.         k    In a message dated 3/6/2008 
9:35:02 P.M. Central Standard Time,  deanlutrin at gmail.com writes: Andrew 
Barring an amputation which could be immediately  salvaged, almost all 
handscan wait till the morning. That's how it is done  in most teaching 
hospitalsin South Africa. Where I work, we have so much  hand trauma that 
there is adaily 'hand list' done under axillary block or  some other 
localanaesthetic. The occasional abscess needs to be drained at  night and 
somedebridemens should be done - surely a ortho guy can do that?  As long as 
youcan make a plan that there is someone who can reimplant  fingers and 
handswhen that occasionally occurs, I think you can tell the  greedy guys to 
getlost. My two cents Dean LutrinJHB, South  Africa -----Original 
Message-----From: 
trauma-list-bounces at trauma.org[mailto:trauma-list-bounces at trauma.org]On 
Behalf Of Dr. Andrew BersonSent: Thursday, March 06, 2008 11:45 PMTo: 
'Trauma & Critical Care mailing list'Subject: Hand Call Coverage  at Busy 
Urban Trauma Centers  To list members: I'm looking  for input from busy 
level I and II centers on how hand callcoverage issues  are being handled. 
Specifically, is this coverage providedby the  ortho traumatologist or by a 
separate hand call list.  The issuethat we are dealing with is that after 
years of a very successful callroster for this subspecialty, we are running 
into a very untenablesituation.  In the past this coverage was provided by 
theortho-traumatologists that had a robust elective hand surgery 
practice.These surgeons are already part of the paid call roster for 
orthopedics,and were providing hand "coverage" on nights where one of  their 
non-handsurgery colleagues might be on call for general ortho  trauma.  Now, 
thehand surgeons are refusing to provide this coverage  unless they are 
givenan additional stipend.  The general ortho-trauma  physicians do not 
feelcomfortable in caring for significant hand issues,  since this is not 
partof their elective practice. The question is,  should a board certified 
orthopedic surgeon, on a paidtrauma call list at  a busy level II trauma 
center be capable of evaluatingan injured hand and  at least providing 
initial management of the injury,until their "hand  surgery" partner is 
available the next day, or are weforced to give into  the demands of the 
hand specialists and provide anotherstipend position on  the call roster. 
(It should be mentioned that theamount being  requested outpaces the stipend 
paid to the IN HOUSETrauma/Acute Care  surgeon, even thought hand call is a 
home based callwhich does not receive  many true emergencies).   Please give 
any constructive  feedback.  I would also be interested to knowhow many list 
members  are seeing similar issues with their hand callrosters. Thank you in 
advance. Andrew J. Berson, M.D.Assist. Trauma DirectorMemorial  Health 
System,Colorado Springs, CO --trauma-list :  TRAUMA.ORGTo change your 
settings or unsubscribe 
 visit:http://www.trauma.org/index.php?/community/ --trauma-list  : 
TRAUMA.ORGTo change your settings or unsubscribe 
visit:http://www.trauma.org/index.php?/community/     **************It's Tax 
Time! Get tips, forms, and advice on AOL Money & Finance. 
(http://money.aol.com/tax?NCID=aolprf00030000000001)--trauma-list : 
TRAUMA.ORGTo change your settings or unsubscribe 
visit:http://www.trauma.org/index.php?/community/ --trauma-list : 
TRAUMA.ORGTo change your settings or unsubscribe 
visit:http://www.trauma.org/index.php?/community/
--Forwarded Message Attachment--From: aberson at agvscs.comSubject: RE: Hand 
Call Coverage at Busy Urban Trauma CentersDate: Sun, 9 Mar 2008 
12:08:24 -0600To: trauma-list at trauma.orgThank you so much for the helpful 
input. Andy -----Original Message-----From: trauma-list-bounces at trauma.org 
[mailto:trauma-list-bounces at trauma.org]On Behalf Of William BrombergSent: 
Friday, March 07, 2008 7:08 AMTo: 'Trauma &amp; Critical Care mailing 
list'Subject: Re: Hand Call Coverage at Busy Urban Trauma Centers 
Background on the site:Memorial Health University Med. Center, SavannahState 
Level I, ACS unverified (dropped when the neurosurgeons refused topublish a 
backup call schedule) 1300-1400 registry admits, 2200-2300activations Our 
plastics and ortho hand trained/privileged individuals split hand call(about 
1:5) they get paid a stipend (about $750/night I think). Prior tothis we had 
a hand call schedule that all the ortho and plastics people wereon without a 
stipend - it was a HUGE hassle to get someone to come in with alot of pass 
the buck being played. No-one would do replants ("We're not acenter!"). Now 
it's just a moderate hassle to get someone to come in. There's stillsome 
pass the buck (the plastics people don't have wrist privileges havingbeen 
blocked years ago by the ortho guys so if there's a wrist injury theyget 
passive aggressive and say to call ortho, etc. etc. etc.). Nobody willdo 
replants. If you do give in and pay up make sure that there's a contract to 
definewhat "hand call" means. Bill >>> "Dr. Andrew Berson" 
<aberson at agvscs.com> 3/6/2008 4:45 PM >>> To list members: I'm looking for 
input from busy level I and II centers on how hand callcoverage issues are 
being handled.  Specifically, is this coverage providedby the ortho 
traumatologist or by a separate hand call list.  The issue thatwe are 
dealing with is that after years of a very successful call roster forthis 
subspecialty, we are running into a very untenable situation.  In thepast 
this coverage was provided by the ortho-traumatologists that had arobust 
elective hand surgery practice.  These surgeons are already part ofthe paid 
call roster for orthopedics, and were providing hand "coverage" onnights 
where one of their non-hand surgery colleagues might be on call forgeneral 
ortho trauma.  Now, the hand surgeons are refusing to provide thiscoverage 
unless they are given an additional stipend.  The generalortho-trauma 
physicians do not feel comfortable in caring for significanthand issues, 
since this is not part of their elective practice. The question is, should a 
board certified orthopedic surgeon, on a paidtrauma call list at a busy 
level II trauma center be capable of evaluatingan injured hand and at least 
providing initial management of the injury,until their "hand surgery" 
partner is available the next day, or are weforced to give into the demands 
of the hand specialists and provide anotherstipend position on the call 
roster.  (It should be mentioned that theamount being requested outpaces the 
stipend paid to the IN HOUSETrauma/Acute Care surgeon, even thought hand 
call is a home based call whichdoes not receive many true emergencies). 
Please give any constructive feedback.  I would also be interested to 
knowhow many list members are seeing similar issues with their hand 
callrosters. Thank you in advance. Andrew J. Berson, M.D.Assist. Trauma 
DirectorMemorial Health System,Colorado Springs, CO --trauma-list : 
TRAUMA.ORGTo change your settings or unsubscribe 
visit:http://www.trauma.org/index.php?/community/  --trauma-list : 
TRAUMA.ORGTo change your settings or unsubscribe 
visit:http://www.trauma.org/index.php?/community/
--Forwarded Message Attachment--From: nmcswai at tulane.eduSubject: RE: Hand 
Call Coverage at Busy Urban Trauma CentersDate: Sun, 9 Mar 2008 
12:31:42 -0500To: trauma-list at trauma.orgyou seem to be "right on" Norman 
Norman McSwain MDTrauma Director, Charity HospitalProfessor of Surgery, 
Tulane UniversityNew Orleans LA504 988 5111norman.mcswain at tulane.edu 
<mailto:norman.mcswain at tulane.edu>  ________________________________ From: 
trauma-list-bounces at trauma.org on behalf of Michael Stein M.D.Sent: Sat 
3/8/2008 4:18 PMTo: 'Trauma &amp; Critical Care mailing list'Subject: RE: 
Hand Call Coverage at Busy Urban Trauma Centers   Ken, Rick, Jeff and 
others.. I have always wanted to say this but never had the guts, since it 
isprobably politically incorrect. There is no doubt that there is some added 
value to be treated for a complexhand injury by a qualified hand surgeon. 
However, most hand injuries can bedealt with adequately by a "General" 
Trauma Surgeon, or a "General"Orthopedic Surgeon.  Since the FIRST world 
society developed themedico-legal environment that promotes some of the 
behavior mentioned in theprevious posts on this issue, those "altruist" 
"General" docs will not takethe risk anymore. Since that same FIRST world 
society became clients instead of patients, theydemand the best of care and 
nothing less (even theoretically).  The courtsfollowed the trend and 
supported this society.  Thus, our bunch of dedicateddocs, full of altruism 
faded out sometime in the last century (the 20th). But now, this FIRST world 
society of clients (not patients) wants to bargainabout the amount of money 
they are prepared to pay these "super" handsurgeons. Well, if they are not 
prepared to pay they do not deserve the service.  Aswe say here, "This 
society made this cake - now the same society should eatit" - or something 
like that. Sorry about this emotional post. Mickey Stein -----Original 
Message-----From: trauma-list-bounces at trauma.org 
[mailto:trauma-list-bounces at trauma.org]On Behalf Of KMATTOX at aol.comSent: 
Saturday, March 08, 2008 2:23 AMTo: trauma-list at trauma.orgSubject: Re: Hand 
Call Coverage at Busy Urban Trauma Centers I can imagine many, if not the 
MAJORITY of emergencies that are manifest on the HAND, I would RATHER have a 
NON-DECLARED HAND SPECIALIST  to care for myself or my family , than someone 
with the narrow declared focus of the DECLARED HAND SPECIALIST.     I would 
hope that every  emergency roomphysician wouldcomprehend and appreciate 
that. k  In a message dated 3/7/2008 6:18:09 P.M. Central Standard Time, 
Rick.Moore at TriadHospitals.com writes: ED  physician thinks the patient needs 
aspecialist, specialist says "I don't  repair that type of injury" andthen 
the higher level of care center  refuses to take the patient. Atthis point 
the patient is at the mercy of  an ED physician or generalorthopedist who 
may or may not handle the care  appropriately. I am veryconfident in our ED 
Physicians and our General  Orthopedists, but if thehand belongs to my wife, 
my children or myself, I  want the Hand Surgeon!And our patients deserve no 
less.Rick  Moore     **************It's Tax Time! Get tips, forms, and 
advice on AOL Money &Finance. 
(http://money.aol.com/tax?NCID=aolprf00030000000001)--trauma-list : 
TRAUMA.ORGTo change your settings or unsubscribe 
visit:http://www.trauma.org/index.php?/community/ --trauma-list : 
TRAUMA.ORGTo change your settings or unsubscribe 
visit:http://www.trauma.org/index.php?/community/
_________________________________________________________________
Climb to the top of the charts! Play the word scramble challenge with star 
power.
http://club.live.com/star_shuffle.aspx?icid=starshuffle_wlmailtextlink_jan--
trauma-list : TRAUMA.ORG
To change your settings or unsubscribe visit:
http://www.trauma.org/index.php?/community/ 

List Archives

For your convenience, find the Trauma List Archive Below

Shell Game