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Sat Aug 20 19:31:27 BST 2011

How do you put a pulseless, moribund patient 'to sleep'?

Sent from my iPad

On Aug 20, 2011, at 9:19 AM, Krin135 at aol.com wrote:

> Insisting on balanced anesthesia, are you, Nick?
> 
> ck
> 
> 
> In a message dated 08/20/11 09:39:14 Central Daylight Time,  
> nick at macartney.org writes:
> 
> Dear  Ken,
> While I agree entirely with you about resuscitation before the  appropriate
> clamp is applied, generally it is regarded as good practice to  put the
> patient to sleep first. For that you need some venous access - or  if you
> cannot find a vein, then an intraosseous.
> Also it is easier to  place the intarosseous before your access is blocked
> by surgeon, scrub  nurse, trays etc etc.
> 
> Nick
> Dr NJD Macartney FRCA FFICM
> ICU  Director
> Chase Farm Hospital
> The Ridgeway
> Enfield
> EN2 8JL
> +4420  8375 1074
> 
> 
> 
> 
> 
> 
> 
> 
> On 20/08/2011 12:18, "Kmattox"  <kmattox at aol.com> wrote:
> 
>> 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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> 
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Preop IO lines in unstable trauma patients