Login
Site Search
Trauma-List Subscription

Subscribe

Would you like to receive list emails batched into one daily digest?
No Yes
Modify Your Subscription

Modify

Home > List Archives

VOMIT - Victim of Modern Imaging Technology

Doc Holiday drydok at hotmail.com
Fri Aug 26 10:57:57 BST 2011


From: nmcswai at tulane.edu
> In your hospital the scans may take only 1-2 minutes but this is not reality. You are not counting the movement of the patient to and from radiography suite, the movement of the patient to the scanner, the set up of the scanner computer to make the images and the reconstruction of the images. Even with efficient personnel this takes upwards of 30 minutes


> In your hospital the scans may take only 1-2 minutes but this is not reality. You are not counting the movement of the patient to and from radiography suite, the movement of the patient to the scanner, the set up of the scanner computer to make the images and the reconstruction of the images. Even with efficient personnel this takes upwards of 30 minutes

--> Times will vary with patients and hospitals and one may include this item and ignore another when calculating times... Of course, we must consider that not all hospitals will have the same level of experience at clnical examination as a part of the ED trauma team. In some places there may well be a surgeon or EP with skills and confidence such as already mentioned on this thread. At other places and other times the surgeon may mot be one who is as confident of excluding all which must be excluded with hands and stethoscpoe only. And, having worked alongside some really dedicated surgeon clinicians, who I doubt have many betters, even they were quite often already stuck inside a patient's abdomen in theatre (being the only one really likely to save the life) by the time the 2nd-5th victims from the same RTA arrived in the ED... So what is reality, eh?
 
As for "upwards of 30mins", this for us is not always reality either. I am sure that, with the promotion by experienced surgeons as well as their involvement in planning for new EDs and procedures, it can stop being a reality where you are as well. Some of the ways by which we accomplish FAR less than 30mins (times HAVE been measured) are:
- ED and its enviorns were designed with input from and under the guide of experienced EPs (and remember that many such in the UK have extensive surgical backgrounds and some insight into how things work with surgeons)
- Systems were designed and are continuing to be audited and improved by EPs & other specialists with both civilian AND recent military experience and sound knowledge of the latest concepts
- We thus do not use a "radiography suite", but have our CT scanner table LESS THAN 3m away from the foot of the ED trolley, with slides and scoops right there and MORE than sufficient pairs of hands in our teams to RAPIDLY move the patient
- Other places have done better than us and built a moving CT machine which parks just at the head/foot of the trauma trolley. Everyone simply has to step away for the patient to have "moved to CT"!
- Our radiology colleagues are "in" on the act, so we have the machines pre-programmed and the radiographers well-practised at setting up the protocols to begin VERY SOON after the patient lands on the scanner
- Our patients often arrive on the helo with an experienced pre-hospital doc (from EM, surgery, ortho, anaesth, or other) on board and the patient is thus "prepped" for the encounter with the trauma team to such an extent that we literally CAN SAFELY go from helo VIA CT to ED trolley. We often simply do a primary survey on the stretcher, as it enters from the helo, then push onto the CT table
- With the trauma radiologist right there in the ED scanner room, by the computers, we do not have to wait for the final computer reconstruction for ALL the details - som are shouted to us as the images are taken
 
Of course, we may well also have a good surgeon right there with experienced hands, but it appears that having a CT does not trouble them, nor does it prevent them from getting a chance to lay hands...
 
It CAN be done!
It can be done BETTER than we do it.
A couple of years ago, when we were only starting with this, I WOULD HAVE SAID THE SAME AS YOU about the 30mins...
Our statistical data for trauma outcomes shows we ARE doing well, not merely thinking we are doing well! 		 	   		  


More information about the trauma-list mailing list