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Mon May 5 17:04:46 BST 2008

Doug,

I completely agree that the patient needs to be in theatre ASAP with the
right people treating him. However I interpreted the comment "found him
lying on floor in a pool of blood" to mean that he was not actually in the
hospital but rather pre-hospital (this may or may not be true) but this is
what precipitated my comments. [Rightly or wrongly I presume that NO
hospital anywhere in the world would leave someone in their waiting room
having to wait to be seen in a pool of blood and who was haemodynamically
unstable?!] In this case, urgent haemostasis is required by whatever means
necessary.

No one would advocate getting this patient to theatre straight away more
than me and getting the right speciality (MaxFax here) involved from the
outset. However, for the above reasons (i.e. assuming that he is
pre-hospital), he is not going to have an operation straight away, no matter
one's hopes or intentions. Another problem, from my own experience at least
(which has already been mentioned by others and highlights this) is the fact
of the long delays that we have in getting some specialities such as MaxFax
(although this is not by any means the only speciality) to come and see the
patient urgently. As you rightly say, there is no doubt that they must be
called straight away and need to take the patient to theatre for proper
surgical control of the bleeding immediately. The adjuncts which I described
are merely temporising measures which may be required to be employed in the
interim (for the period which usually ensues before specialist help actually
arrives.)

Regards,

Matthew

-----Original Message-----
From: DWGKENNEDY at aol.com [mailto:DWGKENNEDY at aol.com] 
Sent: 04 May 2008 13:56
To: trauma-list at trauma.org
Subject: Re: Stab Mouth

Hmmmmm.

If this person had a fracture, even dentoalveolar, what was to be gained by

you delaying and ''really struggling'' - why not just refer the patient and 

get  specialist help? You can even see what they do!

First poster - This reads as thought you feel referring a patient means you

have failed.

Second poster - If the wound is bleeding that much he needs specialist help

and an operation not having stuff packed into his wounds. He is in a
hospital 

after all.

If you don't want specialist help with this, when do you call?

Best wishes,

Doug Kennedy 

Cons Maxillofacial Surgeon, UK

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