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Preop IO lines in unstable trauma patients

Kmattox kmattox at aol.com
Sat Aug 20 12:18:34 BST 2011


I have been watching the IO push for about 4 decades.   It is now a given that elevation if the blood pressure pre operative control of hemorrhage is bad.   It is also a given that LR and NS are BAD in the EMS and ER patient.    

I really need some help here.  Just what, then, is the logic or requirement for IO?    What does IO add the has any positive effect on outcome?    What is driving it's continued use?     

I repeat.  It is long overtime for us to redefine " resuscitation."

k

Sent from my iPhone

On 2011-08-20, at 7:14 AM, Pret Bjorn <p.bjorn at tds.net> wrote:

> I arrived late; but if we're talking about access (as opposed to monitoring), there's a good argument here for an IO line.  Or two.
> 
> Either that, or think of the laparotomy as a vena cava cutdown... 
> 
> Seems like you're not going to learn much from a CVP that you don't already suspect -- or that can't wait until the big stuff is packed off.
> 
> Just me.
> 
> Pret Bjorn, RN
> Bangor, ME USA
> 
> Clumsily sent from my cell phone.
> 
> -----Original Message-----
> From: Curt Bergstrom <cyberg66 at aol.com>
> Sent: Saturday, August 20, 2011 2:45
> To: Trauma-List [TRAUMA.ORG] <trauma-list at trauma.org>
> Subject: Re: preop lines in unstable patients
> 
> I suspect the fear from your anesthesia colleagues is that they will be blamed for the patient's untimely death in the event of an unfavorable intraop outcome. A strong defense to the claim that the patient died due to anesthesia's inability to resuscitate the patient is to have optimal access before surgery began. You should ask them what they fear (beyond release of 'auto-tamponade') by proceeding without delay. 
> 
> My impression of a unstable trauma patient requiring laparotomy is that nothing causing their hypotension is going to get better by delaying surgical intervention until a cordis or other large bore central access can be placed. If your anesthesia department has a concern with proceeding, you might want to examine protocols for what access should be obtained in the trauma bay and get good access before you get to the OR.
> 
> Sent from my iPad
> 
> On Aug 19, 2011, at 9:19 PM, caesar ursic <cmursic at gmail.com> wrote:
> 
>> *You are right.  They are wrong.  *
>> *Open up the belly up ASAP, find the bleeding, and stop it.  *
>> *At the very least you can pack and manually compress the aorta while they
>> start their lines.*
>> 
>> On Fri, Aug 19, 2011 at 10:29 AM, Rwolfer <rwolfer at aol.com> wrote:
>> 
>>> Got a question for everyone.  For some reason our anethsia now says the abc
>>> of trauma gor unstable pt with positve fast includes putting in  a line
>>> prior to making abd incision.  Pt w no palp distal pulse no cuff pressur and
>>> grey.  Just want to know if i am missing some new artical. They seem to
>>> think "bleeding is tamponoded" and cutting open will lwt restart.  I try to
>>> tell them that one can put entire blood volume easily into belly and will
>>> not get a line in until i stop bleeding bit they wont listen thanks
>>> Rw
>>> 
>>> 
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