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Mon Sep 8 14:42:33 BST 2008

My level 2 hospital did not have a PICU however, accepted pediatric trauma pts that were admitted to our TICU and all nurses had to be cross-trained into caring for them and have pals cert.   We went by age or sometimes weight  
( having cared for 16-17 yr olds well over 100kg) for the "peds" criteria. Always admitted under a pediatric intensivist with a pediatric surgical consult. However, any emergencies ,  upon ER arrival or while in TICU the in house trauma surgeon handles it.   Peds 17 are adults, admitted to my burn/TICU.

Angela
----------------------------------------
> From: trauma-list-request at trauma.org
> Subject: trauma-list Digest, Vol 63, Issue 10
> To: trauma-list at trauma.org
> Date: Mon, 8 Sep 2008 12:00:12 +0100
> 
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> Today's Topics:
> 
>    1. Article requests (Stephen Richey)
>    2. peds consults (rwolfer at aol.com)
>    3. Re: Article requests (=?ISO-2022-JP?B?GyRCOSxJdCEhNUhPOhsoQg==?=)
>    4. RE: Surgical Intensivist Consultations (McSwain, Norman E Jr.)
> 
> 
> ----------------------------------------------------------------------
> 
> Message: 1
> Date: Sun, 7 Sep 2008 10:44:29 -0400
> From: "Stephen Richey" 
> Subject: Article requests
> To: trauma-list at trauma.org,	"Discussion of Critical Care Medicine"
> 	
> Message-ID:
> 	
> Content-Type: text/plain; charset=ISO-8859-1
> 
> Can anyone provide me with copies of the following articles?
> 
> Tien HC et al: An evaluation of tactical combat casualty care interventions
> in a combat environment. J Am Coll Surg 207(2): 174-8
> 
> Mabry R and McManus JG: Prehospital advances in the management of severe
> penetrating trauma. Crit Care Med 2008 Jul 36(Supplement 7): S258-66
> 
> Brodie S et al: Tourniquet use in combat trauma: UK military experience.  J
> R Army Med Corps 2007 Dec 153(4): 310-3
> 
> Doyle GS and Taillac PP: Tourniquets: a review of current use with proposals
> for expanded prehospital use. Prehosp Emerg Care 2008 Apr-Jun 12(2): 241-56
> 
> 
> -- 
> Stephen L. Richey, CRT
> Aviation Injury Research Project Leader
> Saginaw Valley State University
> Work E-mail: slrichey at svsu.edu
> Home Office Phone: 248-366-4452
> 
> "If everyone is thinking alike, then somebody isn't thinking."- George S.
> Patton
> 
> 
> ------------------------------
> 
> Message: 2
> Date: Sun, 07 Sep 2008 20:53:13 -0400
> From: rwolfer at aol.com
> Subject: peds consults
> To: trauma-list at trauma.org
> Message-ID: 
> Content-Type: text/plain; charset="us-ascii"
> 
> I have a question that is in line with sicu consults.? what about pediatric traumas.? At what age do you or your hospital require a peds or picu consult for pedi trauma cases. Our hospital recently instituted a all pts under 14. the problem we have with that is that the picu nurses then refuse to contact our trauma service and instead the picu staff. we also have different philosphies. we belive in early extubation and early mobilization. they believe in extremely heavy sedation and prolonged intubation. In fact most of the picu kids leave picu going into withdrawl from benzos and narcotics
> thanks
> rw
> 
> 
> -----Original Message-----
> From: Sue 
> To: Trauma & Critical Care mailing list 
> Sent: Sat, 6 Sep 2008 6:00 pm
> Subject: Re: Surgical Intensivist Consultations
> 
> 
> Cathy,?
> ?
> I would urge you to also address this question to the Critical?
> Care Medicine list, led by Fearless Leader Dave Crippen:?
> Here is the link to subscribe:?
> ?
> http://www.ccm-l.org/about.html?
> ?
> Sue?
> ?
> ?
> Dudick, Cathy wrote:?
> ?
>>I have a question about the care of non trauma surgical intensive care?
>>patients.?
>>?
>>>?
>>We are a level 2 trauma center with a busy SICU. We the trauma?
>>attendings(all double boarded in surgery/cc), provide 99% of the?
>>critical care-lines, etc (no real resident/PA coverage at night). We?
>>and our surgery department support a formal policy of mandatory surgical?
>>intensivist consultation for all SICU patients. Our goal is to provide?
>>24hour/7day intensivist in house coverage. We feel this is in the best?
>>interest of patient care. Also, it prevents us from "meeting" the?
>>patient for the first time during a crisis, as we often are called for?
>>septic shock, airway emergencies, etc, when no other intensivists are?
>>readily available(mostly after hours and at night). We would prefer to?
>>be acquainted with the patients and perhaps treat small problems before?
>>they escalate. Lastly, it would help us manage our beds in the ICU.?
>>The medical intensivists (private practitioners) do not stay in house,?
>>but balk at the idea of a mandatory surgical Intensivist (hospital?
>>faculty) consult policy for surgical ICU patients.>?
>>>?
>>Who cares for that patient in your unit, the surgical intensivist, the?
>>medical intensivist, etc??
>>?
>>>?
>>Are your intensivists in house 24/7??
>>?
>>>?
>>Do you have a written policy that mandates a surgical intensivist?
>>consult for all admissions to the SICU??
>>?
>>>?
>>Your input is much appreciated.?
>>?
>>>?
>>Cathy>?
>>--?
>>trauma-list : TRAUMA.ORG?
>>To change your settings or unsubscribe visit:?
>>http://www.trauma.org/index.php?/community/?
>>?
>>?
>>>?
> ?
> -- ?
> Sue Roundy, M.Ed., EMT-P (ret.)?
> President, High Sierra Resources?
> email: suefire6 at charter.net Past President, Nevada Emergency Medical Assoc.?
> President & Captain (ret.), Dayton (NV) Volunteer Fire Department ?
> All email checked by Norton Anti-Virus?
> ?
> "I am the master of my house and what my wife says shall be done."?
> Frank Thornton Olmstead?
> ?
> ?
> --?
> trauma-list : TRAUMA.ORG?
> To change your settings or unsubscribe visit:?
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> 
> 
> 
> ------------------------------
> 
> Message: 3
> Date: Mon, 8 Sep 2008 12:18:58 JST
> From: y-kobe at umin.ac.jp (=?ISO-2022-JP?B?GyRCOSxJdCEhNUhPOhsoQg==?=)
> Subject: Re: Article requests
> To: 
> Message-ID: 
> Content-Type: text/plain; charset=iso-2022-jp
> 
>> Can anyone provide me with copies of the following articles?
>> 
>> Tien HC et al: An evaluation of tactical combat casualty care interventions
>> in a combat environment. J Am Coll Surg 207(2): 174-8
>> 
>> Mabry R and McManus JG: Prehospital advances in the management of severe
>  penetrating trauma. Crit Care Med 2008 Jul 36(Supplement 7): S258-66
>> 
>> Brodie S et al: Tourniquet use in combat trauma: UK military experience.  J R 
> Army Med Corps 2007 Dec 153(4): 310-3
>> 
>> Doyle GS and Taillac PP: Tourniquets: a review of current use with proposals f
> or expanded prehospital use. Prehosp Emerg Care 2008 Apr-Jun 12(2): 241-56
>> 
>> -- 
>> Stephen L. Richey, CRT
>> Aviation Injury Research Project Leader
>> Saginaw Valley State University
>> Work E-mail: slrichey at svsu.edu
>> Home Office Phone: 248-366-4452
> 
> Brodie S et al: Tourniquet use in combat trauma: UK military experience.  J R Ar
> my Med Corps 2007 Dec 153(4): 310-3
> 
> You can download this article above with http://www.ramcjournal.com/current.html
> 
> KOBE Yoshiro
> Kimitu Chuo hospital
> Japan
> y-kobe at umin.ac.jp
> 
> 
> ------------------------------
> 
> Message: 4
> Date: Sun, 7 Sep 2008 08:32:43 -0500
> From: "McSwain, Norman E Jr." 
> Subject: RE: Surgical Intensivist Consultations
> To: "Trauma &" ,	"Trauma & Critical
> 	Care mailing list" 
> Cc: "Vernick, Jerome" , "Kountz,	David
> 	MD" , "Miller,	Rick"
> 	, "Hanna,	Niveen"
> 	, "Garcia,	Felix"
> 	, lcbaker1 at mac.com, "Malhotra,	Atul, M.D."
> 	, "Maldonado,	Ivan"
> 	, "Ahmed,	Nasim"
> 	
> Message-ID:
> 	
> Content-Type: text/plain;	charset="iso-8859-1"
> 
> We have 2 ICU's one surgical and one medical. All surgical patients are admitted to the surgical ICU and cared for by the Trauma/Critical Care Surgeon who is covering the ICU that week. Original surgeon has input on the care but orders are written by the T/CC ICU team. All trauma surgeons do general and trauma and are a part of the trauma team. 
>  
> New or difficult patients are discussed daily at the 0700 surgical conference. All patients that need to return to the OR are discussed at this conference and the original surgeon or the one most available will take the patient to the OR. "Who" does not matter since we work as one big team. Any disagreements are discussed and consensus obtained at that conference. Patients the require immediate return to the OR at night are taken back by the in-house trauma surgeon. 
>  
> We have only 6 General/Trauma surgeons who provide all of this care. VERY collegial relationship. Trauma volume about 3000 patients per year. (not as large as Pre-Katrina but population is gradually returning). Penetrating trauma is about 65 - 70 %. This does not count the general surgical patient volume. Same surgeons do the general surgery as well. Vascular and CT surgery is done by those specialist. Trauma surgeon does all the trauma except sheer injuries to the aorta. This is done by CT. We do have hand, ortho, OMFS, N/S, and GU available as needed. These are not in-house but have < 30 minute response times. We have in-house staff radiology and IR within 20-30 minutes
>  
> One last point to make...we also have a VERY collegial relationship with the Emergency Physicians. All major trauma is a joint participation resuscitation by TS & EM with the TS having the final decision as to when the patient goes to surgery, volume resuscitation, etc. We try to keep the major resuscitations to < 20 minutes.
>  
> I hope this detailed review of the Charity (MCL) Hospital service is a help to your deliberations
>  
> Norman
>  
> Norman McSwain MD
> Trauma Director, Charity Hospital
> Professor of Surgery, Tulane University
> New Orleans LA
> 504 988 5111
> norman.mcswain at tulane.edu  
> 
> ________________________________
> 
> From: trauma-list-bounces at trauma.org on behalf of kmattox at aol.com
> Sent: Sat 9/6/2008 6:12 AM
> To: Trauma & Critical Care mailing list
> Cc: Vernick, Jerome; Hanna, Niveen; Miller, Rick; Kountz, David MD; Garcia, Felix; lcbaker1 at mac.com; Malhotra, Atul, M.D.; Maldonado, Ivan; Ahmed, Nasim
> Subject: Re: Surgical Intensivist Consultations
> 
> 
> 
> In tHe BTGH all patients admitted to the SICU are automaticaLly suegery patients.  All others are consultants.   Only the surGeon can wRIte orders.   Others can write a recommendation in progress notes.  
> 
> K
> 
> 
> Sent via BlackBerry by AT&T
> 
> -----Original Message-----
> From: "Dudick, Cathy" 
> 
> Date: Thu, 4 Sep 2008 10:50:46
> To: 
> Cc: Vernick, Jerome; Kountz,  David  MD; Miller,  Rick; Hanna,  Niveen; Garcia,  Felix; ; Malhotra,  Atul, M.D.; Maldonado,  Ivan; Ahmed,  Nasim
> Subject: Surgical Intensivist Consultations
> 
> 
> I have a question about the care of non trauma surgical intensive care
> patients.
> 
> 
> 
> We are a level 2 trauma center with a busy SICU.  We the trauma
> attendings(all double boarded in surgery/cc), provide 99% of the
> critical care-lines, etc (no real resident/PA coverage at night).  We
> and our surgery department support a formal policy of mandatory surgical
> intensivist consultation for all SICU patients.  Our goal is to provide
> 24hour/7day intensivist in house coverage.  We feel this is in the best
> interest of patient care. Also, it prevents us from "meeting" the
> patient for the first time during a crisis, as we often are called for
> septic shock, airway emergencies, etc, when no other intensivists are
> readily available(mostly after hours and at night).  We would prefer to
> be acquainted with the patients and perhaps treat small problems before
> they escalate.  Lastly, it would help us manage our beds in the ICU.
> The medical intensivists (private practitioners) do not stay in house,
> but balk at the idea of a mandatory surgical Intensivist (hospital
> faculty) consult policy for surgical ICU patients.
> 
> 
> 
> Who cares for that patient in your unit, the surgical intensivist, the
> medical intensivist, etc?
> 
> 
> 
> Are your intensivists in house 24/7?
> 
> 
> 
> Do you have a written policy that mandates a surgical intensivist
> consult for all admissions to the SICU?
> 
> 
> 
> Your input is much appreciated.
> 
> 
> 
> Cathy
> 
> --
> trauma-list : TRAUMA.ORG
> To change your settings or unsubscribe visit:
> http://www.trauma.org/index.php?/community/
> --
> trauma-list : TRAUMA.ORG
> To change your settings or unsubscribe visit:
> http://www.trauma.org/index.php?/community/
> 
> 
> 
> 
> ------------------------------
> 
> --
> trauma-list : TRAUMA.ORG
> To change your settings or unsubscribe visit:
> http://www.trauma.org/index.php?/community/
> 
> End of trauma-list Digest, Vol 63, Issue 10
> *******************************************

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