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Home > List Archives

trauma-list Digest, Vol 95, Issue 3

McSwain, Norman E nmcswai at tulane.edu
Wed May 4 20:03:13 BST 2011


How do you know this is present if you do not do any studies pre
insertion. A US is not near accurate enough and it takes  too long to do
a CT. We see multiply abdominal GWS each week and very few IVC injuries.
Putting such a stent in each of them would take a lot of time  while the
patient continues to bleed
Norman
Norman McSwain MD, FACS
Professor, Tulane School of Medicine
Trauma Director, Spirit of Charity Trauma Center, ILH/MCLNO 
norman.mcswain at tulane.edu
504 988 5111


-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of jrhmdtraum at aol.com
Sent: Wednesday, May 04, 2011 1:08 PM
To: trauma-list at trauma.org
Subject: Re: trauma-list Digest, Vol 95, Issue 3

Karim,


We have found that if we suspect an injury to the cava (by location or
the ER docs CT) we insert a shunt via the groin prior to going to the
OR.  Probably 7 of 10 DONT need it - but if we wait and do it in the OR
after we have opened the abd, they don't seem to work.


John


And to add to response to Norm:


Totally agree with Rob Smith!!!


One of the level 1s in our area has Norm's model and they are always
having deaths due to failure of communication by the two teams (the
last, a splenic injury became hypotensive and was given drugs).  The
problem is that the critical care people have equal data that shows that
patients NOT taken care of by critical care trained folks also have
problems (wearing my FCCM hat).  The only solution is that the trauma
docs must either be boarded in critical care themselves or hire such.
That is one of my major problems with the new acute care fellowship in
that I think it will water down the critical care training such that the
kids will not be board eligible.  Time will tell.


But bottom line (with adding to Rob's):  The patient must be under the
sole care of the trauma/CRITICAL CARE doc until which time she/he feels
that the patient can be transferred to another service (eg ortho)!   But
a surgical residency or most trauma fellowships is NOT enough to be
qualified to be a critical care doc.



> Message: 2
> Date: Tue, 3 May 2011 13:58:28 +0100
> From: Karim Brohi <karim at trauma.org>
> Subject: Tips & tricks for managing caval and retrohepatic injuries
> To: Trauma and Critical Care mailing list <trauma-list at trauma.org>
> Message-ID: <BANLkTinY8PGNOdUFOsVt6MrCv6nuv3-Lgg at mail.gmail.com>
> Content-Type: text/plain; charset=ISO-8859-1
> 
> The list has been a bit quiet recently so here's a quickie - I'm
> giving a talk tomorrow at the Australasian Surgical Congress on the
> management of inferior vena cava and retrohepatic venous injuries and
> it seems to me that this is one area in particular where surgeons have
> developed their own tips, tricks or techniques to manage thiese
> injuries.  So does anyone have any golden nuggets of tools or
> manoevres or anyting that gets them out of trouble, makes venous
> control/repair easier, etc?
> 
> I have a couple - here's one of mine: I was always taught to use
> spongesticks to control bleeding from a caval injury by pressing down
> on the cava proximally and distally.  I find langenbeck retractors are
> much more effective (the flat bit pressing down against the spine) for
> this purpose.
> 
> I have more - but you'll need to show me yours first!
> 
> Karim







-----Original Message-----
From: trauma-list-request at trauma.org
To: trauma-list at trauma.org
Sent: Wed, May 4, 2011 10:14 am
Subject: trauma-list Digest, Vol 95, Issue 3


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Today's Topics:

   1. RE: Transfer from ICU (Phyllis.Uribe at HealthONEcares.com)
   2. Re: Tips & tricks for managing caval and retrohepatic
      injuries (Tom Konig)
   3. Tips & tricks for managing caval and retrohepatic injuries
      (Dudick, Catherine)
   4. Hernia  repair (rm khattar)
   5. Re: Tips & tricks for managing caval and retrohepatic
      injuries (Kmattox)
   6. Transfer from ICU (rm khattar)
   7. Fw: Transfer from ICU (rm khattar)
   8. RE: Transfer from ICU (McSwain, Norman E)
   9. Re: Tips & tricks for managing caval and retrohepatic
      injuries (Dr Timothy Hardcastle)
  10. RE: Transfer from ICU (McSwain, Norman E)
  11. Re: trauma-list Digest, Vol 95, Issue 2 (John Hall)


----------------------------------------------------------------------

Message: 1
Date: Tue, 3 May 2011 16:11:47 -0500
From: <Phyllis.Uribe at HealthONEcares.com>
Subject: RE: Transfer from ICU
To: <trauma-list at trauma.org>
Message-ID:
 
<8854EFD20061C549B7A44E3E280BB7D2D12E3FA067 at FWDCWPMSGCMS05.hca.corpad.ne
t>
    
Content-Type: text/plain; charset="us-ascii"

We only let the ICU team take care of medical patients...the Trauma
Surgeons are 
intensivists and maintain control of the trauma patient in ICU.

Phyllis Uribe  
ph:  303-788-5082
phyllis.uribe at healthonecares.com
www.swedishhospital.com
 
 
-----Original Message-----
From: McSwain, Norman E [mailto:nmcswai at tulane.edu] 
Sent: Tuesday, May 03, 2011 7:14 AM
To: Trauma-List [TRAUMA.ORG]
Subject: Transfer from ICU

Of late, it seems that many of our patients get transferred out of the
ICU, to the floor to the general surgery service, to ortho, to
neurosurgery and others, without adequate communication from the ICU
service to the receiving service. We have tried several methods,
transfer forms, voice communication, transfer notes in the chart, etc.
None of the systems work (ICU staff forgets, receiving service is not
available, phone calls are not returned, etc). This did not happen when
the patient was cared for by the primary surgeon both in the ICU and on
the floor after ICU care as there was no transfer of provider only
location of care was different. Now that the ICU team and not the
primary surgeon takes care of the patient, the transfer of care not
ideal. I would like to know what system that you have found in major
trauma centers that works. What mechanism have you found that works
consistently

 

Thanks for your input

 

Norman

Norman McSwain MD, FACS

Professor, Tulane School of Medicine

Trauma Director, Spirit of Charity Trauma Center, ILH/MCLNO 

norman.mcswain at tulane.edu <mailto:norman.mcswain at tulane.edu> 

504 988 5111

 




------------------------------

Message: 2
Date: Tue, 3 May 2011 22:51:27 +0100
From: Tom Konig <tomkonig at hotmail.com>
Subject: Re: Tips & tricks for managing caval and retrohepatic
    injuries
To: "Trauma-List [TRAUMA.ORG]" <trauma-list at trauma.org>
Cc: Trauma and Critical Care mailing list <trauma-list at trauma.org>
Message-ID: <BLU0-SMTP1260B3E957E3C9CD0866CF5DD9E0 at phx.gbl>
Content-Type: text/plain; charset="utf-8"

All be it in an animal model.
In a simulated supra hepatic IVC injury  below the diaphragm we placed a
foley 
into the caval wound and inflated the balloon. Retraction reduced blood
loss and 
the wound edges could then be sutured (carefully to avoid deflating the
balloon) 
with either interrupted or a running suture. The balloon allowed blood
to pass 
and maintain sub diaphragmatic venous return. 
Tom

Mr Thomas K?nig BSc (Hons) MB BS MRCS RAMC
Specialist Registrar in General, Vascular and Trauma Surgery


On 3 May 2011, at 13:58, Karim Brohi <karim at trauma.org> wrote:

> The list has been a bit quiet recently so here's a quickie - I'm
> giving a talk tomorrow at the Australasian Surgical Congress on the
> management of inferior vena cava and retrohepatic venous injuries and
> it seems to me that this is one area in particular where surgeons have
> developed their own tips, tricks or techniques to manage thiese
> injuries.  So does anyone have any golden nuggets of tools or
> manoevres or anyting that gets them out of trouble, makes venous
> control/repair easier, etc?
> 
> I have a couple - here's one of mine: I was always taught to use
> spongesticks to control bleeding from a caval injury by pressing down
> on the cava proximally and distally.  I find langenbeck retractors are
> much more effective (the flat bit pressing down against the spine) for
> this purpose.
> 
> I have more - but you'll need to show me yours first!
> 
> Karim
> --
> trauma-list : TRAUMA.ORG
> To change your settings or unsubscribe visit:
> http://www.trauma.org/index.php?/community/
> 


------------------------------

Message: 3
Date: Tue, 3 May 2011 19:23:37 -0400
From: "Dudick, Catherine" <Catherine.Dudick at atlanticare.org>
Subject: Tips & tricks for managing caval and retrohepatic injuries
To: <trauma-list at trauma.org>
Message-ID:
 
<86828899AA262546A4564A95D7A9B9940116FF86 at msexchbe04.atlanticare.org>
Content-Type: text/plain;   charset="us-ascii"

After a quick packing of a penetrating retrohepatic caval injury, I
called IR to help and they successfully deployed an endovascular aortic
extension graft that bridged the leaking area. We did not use any
subsequent systemic anticoagulation. 

 

After Dr. Gilani's intriguing lectures at the Trauma, Critical Care and
Acute Care Surgery 2011 conference in Las Vegas, I can easily conceive
of doing this in the OR, not the IR suite, essentially combining an open
and endovascular procedure in the hands of the trauma surgeon. Dr.
Gilani stressed how important endovascular skills are to the trauma
surgeon and how useful they can be, as this patient demonstrates.

 

I probably can find the pics and email them to you if you like.

 

Cathy Dudick

 

------------------------------

 

Message: 2

Date: Tue, 3 May 2011 13:58:28 +0100

From: Karim Brohi <karim at trauma.org>

Subject: Tips & tricks for managing caval and retrohepatic injuries

To: Trauma and Critical Care mailing list <trauma-list at trauma.org>

Message-ID: <BANLkTinY8PGNOdUFOsVt6MrCv6nuv3-Lgg at mail.gmail.com>

Content-Type: text/plain; charset=ISO-8859-1

 

The list has been a bit quiet recently so here's a quickie - I'm

giving a talk tomorrow at the Australasian Surgical Congress on the

management of inferior vena cava and retrohepatic venous injuries and

it seems to me that this is one area in particular where surgeons have

developed their own tips, tricks or techniques to manage thiese

injuries.  So does anyone have any golden nuggets of tools or

manoevres or anyting that gets them out of trouble, makes venous

control/repair easier, etc?

 

I have a couple - here's one of mine: I was always taught to use

spongesticks to control bleeding from a caval injury by pressing down

on the cava proximally and distally.  I find langenbeck retractors are

much more effective (the flat bit pressing down against the spine) for

this purpose.

 

I have more - but you'll need to show me yours first!

 

Karim

 



------------------------------

Message: 4
Date: Wed, 4 May 2011 05:57:07 +0530 (IST)
From: rm khattar <dr_rm_khattar at yahoo.co.in>
Subject: Hernia  repair
To: trauma-list at trauma.org
Message-ID: <933668.93265.qm at web95204.mail.in2.yahoo.com>
Content-Type: text/plain; charset=utf-8

Please read European Hernia Society guidelines for repair of hernias.
All symptomatic hernias need to be repaired irrespective of size.I do
not 
understand the concept of cosmetic repair,even  small hernias can
strangulate 
both umbilical and inguinal.Repairing small hernias in older individual
does 
improve the mobility of the individual.
R.M.Khattar
Delhi
India. 


------------------------------

Message: 5
Date: Tue, 3 May 2011 19:42:11 -0500
From: Kmattox <kmattox at aol.com>
Subject: Re: Tips & tricks for managing caval and retrohepatic
    injuries
To: "Trauma-List [TRAUMA.ORG]" <trauma-list at trauma.org>
Message-ID: <8C3BB4D0-97B3-4DD8-81E2-4C2B9E01D849 at aol.com>
Content-Type: text/plain;   charset=us-ascii

Congrats.    Thanks.    I would like.  

k




Sent from my iPhone

On 2011-05-03, at 6:23 PM, "Dudick, Catherine"
<Catherine.Dudick at atlanticare.org> 
wrote:

> After a quick packing of a penetrating retrohepatic caval injury, I
> called IR to help and they successfully deployed an endovascular
aortic
> extension graft that bridged the leaking area. We did not use any
> subsequent systemic anticoagulation. 
> 
> 
> 
> After Dr. Gilani's intriguing lectures at the Trauma, Critical Care
and
> Acute Care Surgery 2011 conference in Las Vegas, I can easily conceive
> of doing this in the OR, not the IR suite, essentially combining an
open
> and endovascular procedure in the hands of the trauma surgeon. Dr.
> Gilani stressed how important endovascular skills are to the trauma
> surgeon and how useful they can be, as this patient demonstrates.
> 
> 
> 
> I probably can find the pics and email them to you if you like.
> 
> 
> 
> Cathy Dudick
> 
> 
> 
> ------------------------------
> 
> 
> 
> Message: 2
> 
> Date: Tue, 3 May 2011 13:58:28 +0100
> 
> From: Karim Brohi <karim at trauma.org>
> 
> Subject: Tips & tricks for managing caval and retrohepatic injuries
> 
> To: Trauma and Critical Care mailing list <trauma-list at trauma.org>
> 
> Message-ID: <BANLkTinY8PGNOdUFOsVt6MrCv6nuv3-Lgg at mail.gmail.com>
> 
> Content-Type: text/plain; charset=ISO-8859-1
> 
> 
> 
> The list has been a bit quiet recently so here's a quickie - I'm
> 
> giving a talk tomorrow at the Australasian Surgical Congress on the
> 
> management of inferior vena cava and retrohepatic venous injuries and
> 
> it seems to me that this is one area in particular where surgeons have
> 
> developed their own tips, tricks or techniques to manage thiese
> 
> injuries.  So does anyone have any golden nuggets of tools or
> 
> manoevres or anyting that gets them out of trouble, makes venous
> 
> control/repair easier, etc?
> 
> 
> 
> I have a couple - here's one of mine: I was always taught to use
> 
> spongesticks to control bleeding from a caval injury by pressing down
> 
> on the cava proximally and distally.  I find langenbeck retractors are
> 
> much more effective (the flat bit pressing down against the spine) for
> 
> this purpose.
> 
> 
> 
> I have more - but you'll need to show me yours first!
> 
> 
> 
> Karim
> 
> 
> 
> --
> trauma-list : TRAUMA.ORG
> To change your settings or unsubscribe visit:
> http://www.trauma.org/index.php?/community/


------------------------------

Message: 6
Date: Wed, 4 May 2011 06:21:43 +0530 (IST)
From: rm khattar <dr_rm_khattar at yahoo.co.in>
Subject: Transfer from ICU
To: trauma-list at trauma.org
Message-ID: <19535.66268.qm at web95210.mail.in2.yahoo.com>
Content-Type: text/plain; charset=utf-8

As Dr Mattox writes trauma patient's sole responsibility is on the
surgeon be it 
a trauma/General/orthopedic/neuro/vascular surgeon right from admission
to 
discharge irrsepctive of the floor the patient is being managed.In ICU
the 
intensivist does contribute to the management regarding respiratory 
care,nutrition,DVT prophylaxis and host of other issues.
R.M.Khattar
Delhi India. 


------------------------------

Message: 7
Date: Wed, 4 May 2011 06:26:53 +0530 (IST)
From: rm khattar <dr_rm_khattar at yahoo.co.in>
Subject: Fw: Transfer from ICU
To: trauma-list at trauma.org
Message-ID: <692244.2614.qm at web95212.mail.in2.yahoo.com>
Content-Type: text/plain; charset=utf-8


--- On Wed, 4/5/11, rm khattar <dr_rm_khattar at yahoo.co.in> wrote:

> From: rm khattar <dr_rm_khattar at yahoo.co.in>
> Subject: Transfer from ICU
> To: trauma-list at trauma.org
> Date: Wednesday, 4 May, 2011, 6:21 AM
> As Dr Mattox writes trauma patient's
> sole responsibility is on the surgeon be it a
> trauma/General/orthopedic/neuro/vascular surgeon right from
> admission to discharge irrsepctive of the floor the patient
> is being managed.In ICU the intensivist does contribute to
> the management regarding respiratory care,nutrition,DVT
> prophylaxis and host of other issues.
> R.M.Khattar
> Delhi India.
> 


------------------------------

Message: 8
Date: Tue, 3 May 2011 20:21:56 -0500
From: "McSwain, Norman E" <nmcswai at tulane.edu>
Subject: RE: Transfer from ICU
To: "Trauma-List [TRAUMA.ORG]" <trauma-list at trauma.org>
Message-ID:
    <B79C02DCC4FA074DB02381DF1C5D60BA038AAEBC at EX07.ad.tulane.edu>
Content-Type: text/plain; charset="iso-8859-1"

Thanks for all your words of wisdom. I do not disagree but I did need
support 
for my discussions
 
Norman
 
Norman McSwain, MD, FACS
Trauma Director, Spirit of Charity Trauma Center, ILH/MCLNO
Professor of Surgery, Tulane University
New Orleans LA
504 988 5111
norman.mcswain at tulane.edu <mailto:norman.mcswain at tulane.edu> 

________________________________

From: trauma-list-bounces at trauma.org on behalf of Karim Brohi
Sent: Tue 5/3/2011 2:24 PM
To: Trauma-List [TRAUMA.ORG]
Subject: Re: Transfer from ICU



Norman

Isn't this a governance / quality issue for ICU and something to be
audited & then raised at a hospital governance committee level?
Doesn't matter who is running the show if the receiving teams after
ICU are not getting appropriate and vital information.  It's a
fundamental patient safety issue.

Probably doesn't matter what system you use if there's no culture
within the ICU to do a discharge summary and this has to be addressed
at a supra-departmental level if you get no joy from simple
communication.

Karim

On Tue, May 3, 2011 at 14:14, McSwain, Norman E <nmcswai at tulane.edu>
wrote:
> Of late, it seems that many of our patients get transferred out of the
> ICU, to the floor to the general surgery service, to ortho, to
> neurosurgery and others, without adequate communication from the ICU
> service to the receiving service. We have tried several methods,
> transfer forms, voice communication, transfer notes in the chart, etc.
> None of the systems work (ICU staff forgets, receiving service is not
> available, phone calls are not returned, etc). This did not happen
when
> the patient was cared for by the primary surgeon both in the ICU and
on
> the floor after ICU care as there was no transfer of provider only
> location of care was different. Now that the ICU team and not the
> primary surgeon takes care of the patient, the transfer of care not
> ideal. I would like to know what system that you have found in major
> trauma centers that works. What mechanism have you found that works
> consistently
>
>
>
> Thanks for your input
>
>
>
> Norman
>
> Norman McSwain MD, FACS
>
> Professor, Tulane School of Medicine
>
> Trauma Director, Spirit of Charity Trauma Center, ILH/MCLNO
>
> norman.mcswain at tulane.edu <mailto:norman.mcswain at tulane.edu>
>
> 504 988 5111
>
>
>
> --
> 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/


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------------------------------

Message: 9
Date: Wed, 4 May 2011 08:19:17 +0200 (SAST)
From: "Dr Timothy Hardcastle" <dr.tchardcastle at absamail.co.za>
Subject: Re: Tips & tricks for managing caval and retrohepatic
    injuries
To: "Trauma-List \[TRAUMA.ORG\]" <trauma-list at trauma.org>
Message-ID:
    <65146.196.35.102.165.1304489957.squirrel at aiamail.lantic.net>
Content-Type: text/plain;charset=iso-8859-1

Karim

I try to keep it simple:
If the cava is ruptured below the liver and the renals, with a simple
repair after simple compression possible (I also use the Langenbeck or
Morris to compress - I find the swab-sticks clumsy!) and the patient is
stable - repair with running suture, otherwise I ligate the cava - done
this 5 times in the last few years with only one of the patients
demising
from other injuries.

For the retro-hepatic cava: Once you know it is the cava and not the
liver, PACK and get out - especially in blunt injury. Thereafter speak
to
your endovascular colleagues for intervention post-stabilisation. They
can
occlude the arterial branches and then go back with experienced HPB
surgeons to do the repair under controlled circumstances, on some form
of
bypass / liver exclusion. The Belasegaram clamp may also be useful if
the
liver surface is bleeding badly! Access is important - don't be scared
to
use a T-incision and have thoracic control of the intra-pericardial IVC.

As far as the Shrock shunt is concerned - no success and I feel it is a
overused but unsuccessful option.

Regards
Tim
Dr T C Hardcastle
M.B., Ch.B. (Stell); M. Med. (Chir) (Stell); FCS (SA)
Principal Specialist Trauma Surgeon /
Honorary Senior Lecturer UKZN Dept Surgery
Deputy Director - IALCH Trauma Service
Durban, South Africa


> The list has been a bit quiet recently so here's a quickie - I'm
> giving a talk tomorrow at the Australasian Surgical Congress on the
> management of inferior vena cava and retrohepatic venous injuries and
> it seems to me that this is one area in particular where surgeons have
> developed their own tips, tricks or techniques to manage thiese
> injuries.  So does anyone have any golden nuggets of tools or
> manoevres or anyting that gets them out of trouble, makes venous
> control/repair easier, etc?
>
> I have a couple - here's one of mine: I was always taught to use
> spongesticks to control bleeding from a caval injury by pressing down
> on the cava proximally and distally.  I find langenbeck retractors are
> much more effective (the flat bit pressing down against the spine) for
> this purpose.
>
> I have more - but you'll need to show me yours first!
>
> Karim
> --
> trauma-list : TRAUMA.ORG
> To change your settings or unsubscribe visit:
> http://www.trauma.org/index.php?/community/
>





------------------------------

Message: 10
Date: Wed, 4 May 2011 08:16:08 -0500
From: "McSwain, Norman E" <nmcswai at tulane.edu>
Subject: RE: Transfer from ICU
To: "Trauma-List [TRAUMA.ORG]" <trauma-list at trauma.org>
Message-ID:
    <B79C02DCC4FA074DB02381DF1C5D60BA04B28B9C at EX07.ad.tulane.edu>
Content-Type: text/plain;   charset="us-ascii"

Thanks but the question was not about the ICU care. It was about the
handoff from the ICU to the floor general surgeons or the specialist
surgeon such as plastic, ortho, or neuro. How do you hand this to assure
that all the information is transmitted and that they accept the care of
the patient and agree with the transfer
Norman
Norman McSwain MD, FACS
Professor, Tulane School of Medicine
Trauma Director, Spirit of Charity Trauma Center, ILH/MCLNO 
norman.mcswain at tulane.edu
504 988 5111


-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of
Phyllis.Uribe at HealthONEcares.com
Sent: Tuesday, May 03, 2011 4:12 PM
To: trauma-list at trauma.org
Subject: RE: Transfer from ICU

We only let the ICU team take care of medical patients...the Trauma
Surgeons are intensivists and maintain control of the trauma patient in
ICU.

Phyllis Uribe  
ph:  303-788-5082
phyllis.uribe at healthonecares.com
www.swedishhospital.com
 
 
-----Original Message-----
From: McSwain, Norman E [mailto:nmcswai at tulane.edu] 
Sent: Tuesday, May 03, 2011 7:14 AM
To: Trauma-List [TRAUMA.ORG]
Subject: Transfer from ICU

Of late, it seems that many of our patients get transferred out of the
ICU, to the floor to the general surgery service, to ortho, to
neurosurgery and others, without adequate communication from the ICU
service to the receiving service. We have tried several methods,
transfer forms, voice communication, transfer notes in the chart, etc.
None of the systems work (ICU staff forgets, receiving service is not
available, phone calls are not returned, etc). This did not happen when
the patient was cared for by the primary surgeon both in the ICU and on
the floor after ICU care as there was no transfer of provider only
location of care was different. Now that the ICU team and not the
primary surgeon takes care of the patient, the transfer of care not
ideal. I would like to know what system that you have found in major
trauma centers that works. What mechanism have you found that works
consistently

 

Thanks for your input

 

Norman

Norman McSwain MD, FACS

Professor, Tulane School of Medicine

Trauma Director, Spirit of Charity Trauma Center, ILH/MCLNO 

norman.mcswain at tulane.edu <mailto:norman.mcswain at tulane.edu> 

504 988 5111

 


--
trauma-list : TRAUMA.ORG
To change your settings or unsubscribe visit:
http://www.trauma.org/index.php?/community/


------------------------------

Message: 11
Date: Wed, 4 May 2011 08:23:39 -0400
From: John Hall <jrhmdtraum at aol.com>
Subject: Re: trauma-list Digest, Vol 95, Issue 2
To: "trauma-list at trauma.org" <trauma-list at trauma.org>
Message-ID: <78B94009-CC61-4C44-82D2-B5E6EF7EA391 at aol.com>
Content-Type: text/plain; charset=us-ascii

The only method is for the trauma doc to be cert in critical care and
manage 
total.  Any other method is, i believe, gross malpractice

Sent from my iPhone
John R. Hall, M.D., FACS, FCCM
Professor of Surgery


On May 3, 2011, at 5:06 PM, trauma-list-request at trauma.org wrote:

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> Today's Topics:
> 
>   1. radiocontrast media allergy (Joe Nemeth, Mr)
>   2. Tips & tricks for managing caval and retrohepatic injuries
>      (Karim Brohi)
>   3. Transfer from ICU (McSwain, Norman E)
>   4. RE: Transfer from ICU (Doc Holiday)
>   5. Re: Transfer from ICU (John Francis)
>   6. Re: Transfer from ICU (Robert Smith)
>   7. Re: Transfer from ICU - Surgeons continuing responsibility 
>      (KMATTOX at aol.com)
>   8. Re: Transfer from ICU (KMATTOX at aol.com)
>   9. Re: Open access publishing (Nicholas Macartney)
>  10. Re: Open access publishing (Mathias Kalkum)
>  11. Re: Transfer from ICU (Karim Brohi)
>  12. Re: Tips & tricks for managing caval and retrohepatic
>      injuries (Jan Duijff)
>  13. Re: trauma-list Digest, Vol 94, Issue 5 (B.D.D. van Loo)
> 
> 
> ----------------------------------------------------------------------
> 
> Message: 1
> Date: Tue, 3 May 2011 08:36:44 -0400
> From: "Joe Nemeth, Mr" <joe.nemeth at mcgill.ca>
> Subject: radiocontrast media allergy
> To: "trauma-list at trauma.org" <trauma-list at trauma.org>
> Message-ID:
>
<C2DD10EE955351439354C2D8E6755A97089269ED5A at EXMBXVS1.campus.mcgill.ca>
> Content-Type: text/plain; charset="us-ascii"
> 
> I realize that in the context of trauma, we don't often have all of
the info 
re: "allergies".
> 
> However, when facing the problem of a pt with a legit contrast
"allergy" is 
anyone using a short prep (8 hour) instead of the 13 hour protocol (see
ref 
below)?
> 
> jn
> 
> 
> 
> ---------------------------------------------
> Joe Nemeth MD CCFP EM
> Director
> Department of Emergency Medicine
> Montreal General Hospital
> Assistant Professor
> Montreal Children's Hospital
> McGill University Health Centre
> 
> 
> -Greenberger PA, Patterson R:  The prevention of immediate generalized

reactions to radiocontrast media in high-risk patients.  J Allergy Clin
Immunol 
87. 867-872.1991;
> -American College of Radiology :  Manual on contrast media,  6th ed.
The 
College Reston (VA)2008. (accessed 2009 June 8). Available:
www.acr.org/SecondaryMainMenuCategories/quality_safety/contrast_manual.a
spx
> 
> 
> 
> 
> 
> 
> ------------------------------
> 
> Message: 2
> Date: Tue, 3 May 2011 13:58:28 +0100
> From: Karim Brohi <karim at trauma.org>
> Subject: Tips & tricks for managing caval and retrohepatic injuries
> To: Trauma and Critical Care mailing list <trauma-list at trauma.org>
> Message-ID: <BANLkTinY8PGNOdUFOsVt6MrCv6nuv3-Lgg at mail.gmail.com>
> Content-Type: text/plain; charset=ISO-8859-1
> 
> The list has been a bit quiet recently so here's a quickie - I'm
> giving a talk tomorrow at the Australasian Surgical Congress on the
> management of inferior vena cava and retrohepatic venous injuries and
> it seems to me that this is one area in particular where surgeons have
> developed their own tips, tricks or techniques to manage thiese
> injuries.  So does anyone have any golden nuggets of tools or
> manoevres or anyting that gets them out of trouble, makes venous
> control/repair easier, etc?
> 
> I have a couple - here's one of mine: I was always taught to use
> spongesticks to control bleeding from a caval injury by pressing down
> on the cava proximally and distally.  I find langenbeck retractors are
> much more effective (the flat bit pressing down against the spine) for
> this purpose.
> 
> I have more - but you'll need to show me yours first!
> 
> Karim
> 
> 
> ------------------------------
> 
> Message: 3
> Date: Tue, 3 May 2011 08:14:04 -0500
> From: "McSwain, Norman E" <nmcswai at tulane.edu>
> Subject: Transfer from ICU
> To: "Trauma-List [TRAUMA.ORG]" <trauma-list at trauma.org>
> Message-ID:
>    <B79C02DCC4FA074DB02381DF1C5D60BA04A7E3DE at EX07.ad.tulane.edu>
> Content-Type: text/plain;   charset="us-ascii"
> 
> Of late, it seems that many of our patients get transferred out of the
> ICU, to the floor to the general surgery service, to ortho, to
> neurosurgery and others, without adequate communication from the ICU
> service to the receiving service. We have tried several methods,
> transfer forms, voice communication, transfer notes in the chart, etc.
> None of the systems work (ICU staff forgets, receiving service is not
> available, phone calls are not returned, etc). This did not happen
when
> the patient was cared for by the primary surgeon both in the ICU and
on
> the floor after ICU care as there was no transfer of provider only
> location of care was different. Now that the ICU team and not the
> primary surgeon takes care of the patient, the transfer of care not
> ideal. I would like to know what system that you have found in major
> trauma centers that works. What mechanism have you found that works
> consistently
> 
> 
> 
> Thanks for your input
> 
> 
> 
> Norman
> 
> Norman McSwain MD, FACS
> 
> Professor, Tulane School of Medicine
> 
> Trauma Director, Spirit of Charity Trauma Center, ILH/MCLNO 
> 
> norman.mcswain at tulane.edu <mailto:norman.mcswain at tulane.edu> 
> 
> 504 988 5111
> 
> 
> 
> 
> 
> ------------------------------
> 
> Message: 4
> Date: Tue, 3 May 2011 13:47:19 +0000
> From: Doc Holiday <drydok at hotmail.com>
> Subject: RE: Transfer from ICU
> To: ".Trauma List" <trauma-list at trauma.org>
> Message-ID: <SNT104-W492B9B0EBE18717058DCB6C09E0 at phx.gbl>
> Content-Type: text/plain; charset="iso-8859-1"
> 
> 
>> ...What mechanism have you found that works consistently...
> 
> --> How about setting a protocol KEEPING the surgeon who was initially

involved (before ICU), co-rounding on the patient with the ICU staff,
or, if 
schedules do not permit, surgeon does a daily round alone on his/her ICU

patients and thus there are no surprises. ICU patients unlikely to
object to 
this. Surgeon maintains "ownership" before-during-post-ICU. If there is
more 
than one surgical specialty involved initially or at any stage, then
they can 
round together, OR separately, OR decide to leave future care for only
one of 
htem to continue.
> 
> The rule will be that no patient can be in ITU without a NAMED 
non-ITU-specialist also in in co-charge of care and responsibility, i.e.
the 
patient already belongs to the "floor" doc WHILE the patient is in ITU
and it's 
the "floor" doc's responsibility to keep AT LEAST up to date on that
patient, if 
not actively co-managing with the intensivist.
> 
> At the same time this is brought in, institute an audit of when things
go 
wrong and initiate mandatory re-training or disciplinary action for any
staff 
who fail to follow transfer protocols (only the first few will need to
happen 
before the message gets through).
> 
> Both actions together cannot be seen as merely punitive, as the first
idea is 
quite clearly of benefit to the patient.                    
> 
> ------------------------------
> 
> Message: 5
> Date: Tue, 3 May 2011 10:06:23 -0400
> From: John Francis <surjohn at gmail.com>
> Subject: Re: Transfer from ICU
> To: "Trauma-List [TRAUMA.ORG]" <trauma-list at trauma.org>
> Message-ID: <BANLkTimDT7Mwmv+iWo1GU9MrBpmJzrp8rQ at mail.gmail.com>
> Content-Type: text/plain; charset=ISO-8859-1
> 
> This is exactly the reason we do not allow "closed" ICU's. Our
> Credentialing and privileges do not allow for the primary surgeon to
> "walk away" from the patient until all surgical issues have been
> addressed. The last time I checked, surgical ICU care is still within
> the scope and practice of Trauma Surgeons. I strongly decry "handing
> off" care to Intensivist no matter how skilled. At what point does the
> doctor/patient relationship become merely a figment of our historical
> memory?
> 
> John E. Francis MD FACS
> Trauma Director
> SERH, Lafayette, Indiana
> 
> On Tuesday, May 3, 2011, Doc Holiday <drydok at hotmail.com> wrote:
>> 
>>> ...What mechanism have you found that works consistently...
>> 
>> --> How about setting a protocol KEEPING the surgeon who was
initially 
involved (before ICU), co-rounding on the patient with the ICU staff,
or, if 
schedules do not permit, surgeon does a daily round alone on his/her ICU

patients and thus there are no surprises. ICU patients unlikely to
object to 
this. Surgeon maintains "ownership" before-during-post-ICU. If there is
more 
than one surgical specialty involved initially or at any stage, then
they can 
round together, OR separately, OR decide to leave future care for only
one of 
htem to continue.
>> 
>> The rule will be that no patient can be in ITU without a NAMED 
non-ITU-specialist also in in co-charge of care and responsibility, i.e.
the 
patient already belongs to the "floor" doc WHILE the patient is in ITU
and it's 
the "floor" doc's responsibility to keep AT LEAST up to date on that
patient, if 
not actively co-managing with the intensivist.
>> 
>> At the same time this is brought in, institute an audit of when
things go 
wrong and initiate mandatory re-training or disciplinary action for any
staff 
who fail to follow transfer protocols (only the first few will need to
happen 
before the message gets through).
>> 
>> Both actions together cannot be seen as merely punitive, as the first
idea is 
quite clearly of benefit to the patient.
>> --
>> trauma-list : TRAUMA.ORG
>> To change your settings or unsubscribe visit:
>> http://www.trauma.org/index.php?/community/
>> 
> 
> 
> ------------------------------
> 
> Message: 6
> Date: Tue, 3 May 2011 07:13:42 -0700
> From: Robert Smith <rfsmithmd at comcast.net>
> Subject: Re: Transfer from ICU
> To: "Trauma-List \[TRAUMA.ORG\]" <trauma-list at trauma.org>
> Message-ID: <FA51539F-B30C-4E1D-872C-E0848489B6BD at comcast.net>
> Content-Type: text/plain; charset=us-ascii
> 
> Dr. McSwain,
> 
> Funny, you sort of assume everyone is doing things more or less the
same.
> 
> At County all significant trauma is triaged to Trauma. We would have
taken all 
trauma but as it is, only minor lacerations or simple ortho goes to the
ED. 
There is a physically separate Trauma resuscitation area, separate
dedicated 
staff, separate Trauma ICU, Obs unit etc. Whoever is on call in house
"gets" all 
the trauma patients for a 24hr period starting at 8:00 AM. The patients
stay on 
the Trauma service until Trauma feels they are stable to have a single
system 
issue dealt with by another service like Ortho. So even if they're
discharged to 
the floor, they're still on the Trauma service and are rounded on by the
Trauma 
service. No other service is allowed to write orders on Trauma patients,
and/or  
the nurses are not allowed to act on them.
> 
> Rob Smith
> 
> 
> On May 3, 2011, at 6:14 AM, McSwain, Norman E wrote:
> 
>> Of late, it seems that many of our patients get transferred out of
the
>> ICU, to the floor to the general surgery service, to ortho, to
>> neurosurgery and others, without adequate communication from the ICU
>> service to the receiving service. We have tried several methods,
>> transfer forms, voice communication, transfer notes in the chart,
etc.
>> None of the systems work (ICU staff forgets, receiving service is not
>> available, phone calls are not returned, etc). This did not happen
when
>> the patient was cared for by the primary surgeon both in the ICU and
on
>> the floor after ICU care as there was no transfer of provider only
>> location of care was different. Now that the ICU team and not the
>> primary surgeon takes care of the patient, the transfer of care not
>> ideal. I would like to know what system that you have found in major
>> trauma centers that works. What mechanism have you found that works
>> consistently
>> 
>> 
>> 
>> Thanks for your input
>> 
>> 
>> 
>> Norman
>> 
>> Norman McSwain MD, FACS
>> 
>> Professor, Tulane School of Medicine
>> 
>> Trauma Director, Spirit of Charity Trauma Center, ILH/MCLNO 
>> 
>> norman.mcswain at tulane.edu <mailto:norman.mcswain at tulane.edu> 
>> 
>> 504 988 5111
>> 
>> 
>> 
>> --
>> trauma-list : TRAUMA.ORG
>> To change your settings or unsubscribe visit:
>> http://www.trauma.org/index.php?/community/
> 
> 
> 
> ------------------------------
> 
> Message: 7
> Date: Tue, 3 May 2011 10:20:18 EDT
> From: KMATTOX at aol.com
> Subject: Re: Transfer from ICU - Surgeons continuing responsibility 
> To: trauma-list at trauma.org
> Message-ID: <54aa6.1dc0315a.3af16922 at aol.com>
> Content-Type: text/plain; charset="US-ASCII"
> 
> Patients have ONE doctor when admitted to a hospital and  consultants.

> The patient's doctor might have another physician  provide authorized
coverage 

> when they are off (etc.), but that one doctor does  not relinquish 
> responsibility, authority, and  accountability.     Consultants render

opinions in 
> the  progress notes and are just that, consultants, who render an
opinion, 
> and are  NOT the patient's doctor.   One doctor (or the
representatives of 
> that  one doctor for that one patient) write the orders, not co - sign
or 
> authorize  orders of others, including consultants.   For trauma, that
one  
> doctor, responsible for the patient from the arrival at the ambulance
dock 
until  
> clinic care is the surgeon, not the EC doctor, not the
anesthesiologist, 
> and not  a consultant, even if that consultant is an intensivist.     
> 
> Any concept of co-management is poor management and poor care, with  
> expected poorer outcomes.     
> 
> I do hope that your hospital has policies which prohibit anyone from  
> writing orders or managing a patient other than the patient's
physician.    
> 
> k
> 
> 
> In a message dated 5/3/2011 9:07:00 A.M. Central Daylight Time,  
> surjohn at gmail.com writes:
> 
> This is  exactly the reason we do not allow "closed" ICU's. Our
> Credentialing and  privileges do not allow for the primary surgeon to
> "walk away" from the  patient until all surgical issues have been
> addressed. The last time I  checked, surgical ICU care is still within
> the scope and practice of Trauma  Surgeons. I strongly decry "handing
> off" care to Intensivist no matter how  skilled. At what point does
the
> doctor/patient relationship become merely a  figment of our historical
> memory?
> 
> John E. Francis MD FACS
> Trauma  Director
> SERH, Lafayette, Indiana
> 
> On Tuesday, May 3, 2011, Doc  Holiday <drydok at hotmail.com> wrote:
>> 
>>> ...What mechanism  have you found that works consistently...
>> 
>> --> How about  setting a protocol KEEPING the surgeon who was
initially 
> involved (before  ICU), co-rounding on the patient with the ICU staff,
or, if 
> schedules do not  permit, surgeon does a daily round alone on his/her
ICU 
> patients and thus  there are no surprises. ICU patients unlikely to
object to 
> this. Surgeon  maintains "ownership" before-during-post-ICU. If there
is 
> more than one  surgical specialty involved initially or at any stage,
then 
> they can round  together, OR separately, OR decide to leave future
care for 
> only one of htem  to continue.
>> 
>> The rule will be that no patient can be in ITU  without a NAMED 
> non-ITU-specialist also in in co-charge of care and  responsibility,
i.e. the 
patient 
> already belongs to the "floor" doc WHILE the  patient is in ITU and
it's 
> the "floor" doc's responsibility to keep AT LEAST  up to date on that
patient, 

> if not actively co-managing with the  intensivist.
>> 
>> At the same time this is brought in, institute an  audit of when
things 
> go wrong and initiate mandatory re-training or  disciplinary action
for any 
> staff who fail to follow transfer protocols (only  the first few will
need to 
> happen before the message gets  through).
>> 
>> Both actions together cannot be seen as merely  punitive, as the
first 
> idea is quite clearly of benefit to the  patient.
>> --
>> 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/
> 
> 
> 
> ------------------------------
> 
> Message: 8
> Date: Tue, 3 May 2011 10:21:23 EDT
> From: KMATTOX at aol.com
> Subject: Re: Transfer from ICU
> To: trauma-list at trauma.org
> Message-ID: <54b85.7acf42e2.3af16963 at aol.com>
> Content-Type: text/plain; charset="US-ASCII"
> 
> Bravo !!
> 
> 
> In a message dated 5/3/2011 9:14:55 A.M. Central Daylight Time,  
> rfsmithmd at comcast.net writes:
> 
> The  patients stay on the Trauma service until Trauma feels they are
stable 
> to have  a single system issue dealt with by another service like
Ortho. So 
> even if  they're discharged to the floor, they're still on the Trauma 
> service and are  rounded on by the Trauma service. No other service is
allowed 
to 
> write orders  on Trauma patients, and/or  the nurses are not allowed
to act 
> on  them.
> 
> Rob  Smith
> 
> 
> 
> 
> 
> ------------------------------
> 
> Message: 9
> Date: Tue, 03 May 2011 19:52:43 +0100
> From: Nicholas Macartney <nick at macartney.org>
> Subject: Re: Open access publishing
> To: "Trauma & Critical Care mailing list" <trauma-list at trauma.org>
> Message-ID: <C9E60D6B.50C6%nick at macartney.org>
> Content-Type: text/plain;   charset="UTF-8"
> 
> My wife had the same scam.
> Fortunately I get missed out as unimportant.
> 
> Nick
> Dr NJD Macartney FRCA FFICM
> ICU Director
> Chase Farm Hospital
> The Ridgeway
> Enfield
> EN2 8JL
> +4420 8375 1074
> 
> 
> 
> 
> 
> 
> 
> 
> On 03/05/2011 13:19, "Miranda Voss" <mvossak at yahoo.co.uk> wrote:
> 
>> Dear All,
>> 
>> Not trauma but still worth sharing:
>> 
>> About 10 years ago, one of my mentors told me always to accept
>> invitations to publish, so when I received an invitation to
contribute a
>> chapter to an on-line endoscopy book a few months ago, I accepted
>> although I had never heard of "Intech" before.  It was slightly
suprising
>> because the invitation came on the strength of a single endoscopy
related
>> article in a local journal and we were allowed to choose our chapter
>> topic. I had never heard of the editor, any of the other authors, or
>> their institutions, and the limited list of chapters covered an even
more
>> limited list of topics.
>> 
>> However, we pressed on and, in the interests of information sharing,
put
>> quite a lot of work into a review article which outlined the burden
of
>> digestive disease in poorer countries and strategies to deal with
cost
>> constraints when providing an endoscopy service.
>> 
>> We submitted the article but oddly, a week after the deadline, we
were
>> not allowed to make an important addition which was prompted by new
>> information. Shortly afterwards, I was sent an invoice for 590?
>> "processing charges". I have withdrawn the article.
>> 
>> I have since Googled "Intech" and the blogs suggest that it is a poor
>> quality product which ?preys? on authors desperate to publish. Being
>> invited to contribute is actually quite an insult!
>> 
>> The moral of this story is that, in the electronic age, there are
>> exceptions to the "always accept invitations to publish" rule. Google
>> before and not after to avoid a waste of time and effort, not to
mention
>> an uncomfortable feeling that you have been the victim of your own
vanity.
>> 
>> Miranda
>> Worcester RSA. 
>> 
>> --
>> trauma-list : TRAUMA.ORG
>> To change your settings or unsubscribe visit:
>> http://www.trauma.org/index.php?/community/
> 
> 
> 
> 
> ------------------------------
> 
> Message: 10
> Date: Tue, 03 May 2011 21:24:20 +0200
> From: Mathias Kalkum <listen at doc-kalkum.de>
> Subject: Re: Open access publishing
> To: "Trauma-List [TRAUMA.ORG]" <trauma-list at trauma.org>
> Message-ID: <4DC05664.6060009 at doc-kalkum.de>
> Content-Type: text/plain; charset=UTF-8
> 
> Dear Miranda,
> 
> we have had this discussion on surginet just a few day ago. Your
> suggestion to just ask aunt google in advance seems quite helpful.
> However, here is what I wrote to Riaan:
> 
> 'Like Danny and many others I get a lot of these 'invitations'. Most
of
> them seem to be very doubtful. However, the idea has a very honourable
> history. PLoS, the Public Library of Science, and BioMedCentral are
the
> ancestors of all open access journals. They are very well acknowledged
> and respected. The idea is having costs covered not by pharmaceutical
> companies or any other lobby groups to stay as independent and
unbiased
> as possible, so the authors have to contribute their share.
> Unfortunately more publishers jumped that train and not all of them
> share the same ethos.'
> 
> Hope this helps.
> 
> 
> Mathias
> 
>
https://secure.wikimedia.org/wikipedia/en/wiki/Public_Library_of_Science
> 
> 
> 
> ------------------------------
> 
> Message: 11
> Date: Tue, 3 May 2011 20:24:56 +0100
> From: Karim Brohi <karimbrohi at gmail.com>
> Subject: Re: Transfer from ICU
> To: "Trauma-List [TRAUMA.ORG]" <trauma-list at trauma.org>
> Message-ID: <BANLkTikGb1M6fZ=t+PXhJsKOp9c1e-Uykg at mail.gmail.com>
> Content-Type: text/plain; charset=ISO-8859-1
> 
> Norman
> 
> Isn't this a governance / quality issue for ICU and something to be
> audited & then raised at a hospital governance committee level?
> Doesn't matter who is running the show if the receiving teams after
> ICU are not getting appropriate and vital information.  It's a
> fundamental patient safety issue.
> 
> Probably doesn't matter what system you use if there's no culture
> within the ICU to do a discharge summary and this has to be addressed
> at a supra-departmental level if you get no joy from simple
> communication.
> 
> Karim
> 
> On Tue, May 3, 2011 at 14:14, McSwain, Norman E <nmcswai at tulane.edu>
wrote:
>> Of late, it seems that many of our patients get transferred out of
the
>> ICU, to the floor to the general surgery service, to ortho, to
>> neurosurgery and others, without adequate communication from the ICU
>> service to the receiving service. We have tried several methods,
>> transfer forms, voice communication, transfer notes in the chart,
etc.
>> None of the systems work (ICU staff forgets, receiving service is not
>> available, phone calls are not returned, etc). This did not happen
when
>> the patient was cared for by the primary surgeon both in the ICU and
on
>> the floor after ICU care as there was no transfer of provider only
>> location of care was different. Now that the ICU team and not the
>> primary surgeon takes care of the patient, the transfer of care not
>> ideal. I would like to know what system that you have found in major
>> trauma centers that works. What mechanism have you found that works
>> consistently
>> 
>> 
>> 
>> Thanks for your input
>> 
>> 
>> 
>> Norman
>> 
>> Norman McSwain MD, FACS
>> 
>> Professor, Tulane School of Medicine
>> 
>> Trauma Director, Spirit of Charity Trauma Center, ILH/MCLNO
>> 
>> norman.mcswain at tulane.edu <mailto:norman.mcswain at tulane.edu>
>> 
>> 504 988 5111
>> 
>> 
>> 
>> --
>> trauma-list : TRAUMA.ORG
>> To change your settings or unsubscribe visit:
>> http://www.trauma.org/index.php?/community/
>> 
> 
> 
> ------------------------------
> 
> Message: 12
> Date: Wed, 4 May 2011 08:19:00 +1200
> From: Jan Duijff <jwduijff at gmail.com>
> Subject: Re: Tips & tricks for managing caval and retrohepatic
>    injuries
> To: "Trauma-List [TRAUMA.ORG]" <trauma-list at trauma.org>
> Message-ID: <BANLkTi=zO-_R+hukdWEUPL5XofgFQefX4Q at mail.gmail.com>
> Content-Type: text/plain; charset=ISO-8859-1
> 
> Hello Mr Brohi,
> 
> we have a patient over here right now with an intrathoracic IVC
rupture
> after MVC. This was repaired after starting cardiopulmonary
> bypass/hypothermia which worked very nice indeed!
> 
> Grant Christey is there, he can tell you all about it!
> 
> Kind regards,
> 
> Jan W Duijff, trauma fellow Waikato hospital
> Hamilton
> New Zealand
> 0064 2102581241
> 
> 
> On Wed, May 4, 2011 at 12:58 AM, Karim Brohi <karim at trauma.org> wrote:
> 
>> The list has been a bit quiet recently so here's a quickie - I'm
>> giving a talk tomorrow at the Australasian Surgical Congress on the
>> management of inferior vena cava and retrohepatic venous injuries and
>> it seems to me that this is one area in particular where surgeons
have
>> developed their own tips, tricks or techniques to manage thiese
>> injuries.  So does anyone have any golden nuggets of tools or
>> manoevres or anyting that gets them out of trouble, makes venous
>> control/repair easier, etc?
>> 
>> I have a couple - here's one of mine: I was always taught to use
>> spongesticks to control bleeding from a caval injury by pressing down
>> on the cava proximally and distally.  I find langenbeck retractors
are
>> much more effective (the flat bit pressing down against the spine)
for
>> this purpose.
>> 
>> I have more - but you'll need to show me yours first!
>> 
>> Karim
>> --
>> trauma-list : TRAUMA.ORG <http://trauma.org/>
>> To change your settings or unsubscribe visit:
>> http://www.trauma.org/index.php?/community/
>> 
> 
> 
> 
> -- 
> Gr,
> 
> 
> ------------------------------
> 
> Message: 13
> Date: Tue, 03 May 2011 23:06:09 +0200
> From: "B.D.D. van Loo" <B.D.vanLoo at amc.uva.nl>
> Subject: Re: trauma-list Digest, Vol 94, Issue 5
> To: trauma-list at trauma.org
> Message-ID: <82bdeb0a2d4635b0.4dc08a61 at amc.uva.nl>
> Content-Type: text/plain; charset="us-ascii"
> 
> Radiology/X-rays of Sherpa's ?
> Not exactly trauma related but... I was recently travelling through
the Nepal 
Himalaya and was fascinated by the Sherpa's and the amount of
luggage/equipment 
they often carry on their backs. It would be interesting to see some
X-rays of 
their back/spine. Does anybody know where to find this on the www. ?
> Thx.
> Benedikt Van Loo
> nurse anesthetist
> Academic Medical Center Amsterdam 
> 
> ----- Original Message -----
> From: trauma-list-request at trauma.org
> Date: Monday, April 25, 2011 7:56 pm
> Subject: trauma-list Digest, Vol 94, Issue 5
> To: trauma-list at trauma.org
> 
> 
>> Send trauma-list mailing list submissions to
>>  trauma-list at trauma.org
>> 
>> To subscribe or unsubscribe via the World Wide Web, visit
>>  http://list.mistral.net/mailman/listinfo/trauma-list
>> or, via email, send a message with subject or body 'help' to
>>  trauma-list-request at trauma.org
>> 
>> You can reach the person managing the list at
>>  trauma-list-owner at trauma.org
>> 
>> When replying, please edit your Subject line so it is more specific
>> than "Re: Contents of trauma-list digest..."
>> 
>> 
>> Today's Topics:
>> 
>>    1. RE: New definition of severe trauma; ISS issue
>>       (Phyllis.Uribe at HealthONEcares.com)
>>    2. from Gen Surg News Feb 2011 (Robert Smith)
>>    3. RE: from Gen Surg News Feb 2011 (Gross, Ronald)
>>    4. Re: New definition of severe trauma? (Karim Brohi)
>>    5. Trauma CT (Dave Napoliello)
>>    6. level I activation (Shawn Ballard)
>>    7. Skype android problems (Krin135 at aol.com)
>>    8. Check out Skype for Android Flaw Puts User Information at
>>       Risk | Blogs | ITBu (Krin135 at aol.com)
>>    9. Appendecitis (rm khattar)
>>   10. (Off topic) Civil War soldiers photographs of wounds (S
Schecter)
>>   11. Using MLP's for PM ICU coverage (Todd Kelly, M.D.)
>>   12. Re: Using MLP's for PM ICU coverage (Ante ?ori?)
>>   13. Re: Using MLP's for PM ICU coverage (JORGE RAMIREZ ARCE)
>>   14. trauma List (rm khattar)
>>   15. RE: trauma List (Doc Holiday)
>>   16. RE: trauma List (Kate Warren)
>>   17. Re: trauma List (Krin135 at aol.com)
>>   18. Re: trauma List (karan botsford)
>>   19. RE: Using MLP's for PM ICU coverage (Seastrom, David, W)
>> 
>> 
>>
----------------------------------------------------------------------
>> 
>> Message: 1
>> Date: Wed, 13 Apr 2011 18:04:18 -0500
>> From: <Phyllis.Uribe at HealthONEcares.com>
>> Subject: RE: New definition of severe trauma; ISS issue
>> To: <trauma-list at trauma.org>
>> Message-ID:
>>
<8854EFD20061C549B7A44E3E280BB7D2D12C61F3DA at FWDCWPMSGCMS05.hca.corpad.ne
t>
>> 
>> Content-Type: text/plain; charset="iso-8859-1"
>> 
>> Another confounding factor with using ISS is that different 
>> facilities and systems use different iterations of the AIS scoring 
>> tool; many injuries are scored lower in the current version than in 
>> past version, making head-to-head comparison difficult.
>> 
>> Phyllis Uribe MS RN 
>> Trauma Program Supervisor 
>> Swedish Medical Center Trauma Service 
>> Level I Trauma Center 
>> office: 499 E. Hampden #380 
>> Englewood, CO 80113 
>> ? 
>> ph:? 303-788-5082
>> cell: 303-594-8808
>> fax: 303-788-6928 
>> phyllis.uribe at healthonecares.com 
>> www.swedishhospital.com 
>> ? 
>> ? 
>> 
>> -----Original Message-----
>> From: Heim Schoettker Katharina [mailto:Catherine.Heim at chuv.ch] 
>> Sent: Wednesday, April 13, 2011 2:52 PM
>> To: trauma-list at trauma.org
>> Subject: New definition of severe trauma?
>> 
>> Is anybody using ISS > 20 as definition of severe trauma? Health-care

>> politicians want Swiss-hospitals  to use ISS > 20 rather than > 15
for 
>> definition of severe trauma. Is anybody aware of scientific arguments

>> for that?
>> Thanks
>> Cat
>> 
>> 
>> 
>> ------------------------------
>> 
>> Message: 2
>> Date: Thu, 14 Apr 2011 13:30:41 -0400
>> From: Robert Smith <rfsmithmd at comcast.net>
>> Subject: from Gen Surg News Feb 2011
>> To: "Trauma-List \[TRAUMA.ORG\]" <trauma-list at trauma.org>
>> Message-ID: <DC66FBF9-DD37-4800-AA2C-CA10C683C13D at comcast.net>
>> Content-Type: text/plain;    charset=windows-1252
>> 
>> Written by Dr. Lazar Greenfield, President Elect of the American 
>> College of Surgeons.
>> 
>> One of the legends of St. Valentine says that he was a priest 
>> arrested by Roman Emperor Claudius II for secretly performing 
>> marriages. Claudius wanted to enlarge his army and believed that 
>> married men did not make good soldiers, rather like Halsted?s
feelings 
>> about surgical residents. But Valentine?s Day is about love, and if 
>> you remember a romantic gut feeling when you met your significant 
>> other, it might have a physiological basis.
>> 
>> It has long been known that Drosophila raised on starch media are 
>> more likely to mate with other starch-raised flies, whereas those fed

>> maltose have similar preferences. In a study published online in the 
>> November issue of the Proceedings of the National Academy of
Sciences, 
>> investigators explored the mechanism for this preference by treating 
>> flies with antibiotics to sterilize the gut and saw the preferences 
>> disappear (Proc. Nad. Acad. Sci. U.S.A. 2010 Nov. 1).
>> 
>> In cultures of untreated flies, the bacterium  L. plantarum was more 
>> common in those on starch, and sure enough, when L. plantarum was 
>> returned to the sterile groups, the mating preference returned. The 
>> best explanation for this is revealed in the significant differences 
>> in their sex pheromones. These experiments also support the
hologenome 
>> theory of evolution wherein the unit of natural selection is the 
>> ?holobiont,? or combination of organism and its microorganisms, that 
>> determines mating preferences.
>> 
>> Mating gets more interesting when you have an organism that can 
>> choose between sexual and asexual reproduction, like the rotifer. 
>> Biologists say that it?s more advantageous for a rotifer to remain 
>> asexual and pass 100% of its genetic information to the next 
>> generation. But if the environment changes, rotifers must adapt 
>> quickly in order to survive and reproduce with new gene combinations 
>> that have an advantage over existing genotypes. So in this new 
>> situation, the stressed rotifers, all of which are female, begin 
>> sending messages to each other to produce males for the switch to 
>> sexual reproduction (Nature 2010 Oct. 13). You can draw your own 
>> inference about males not being needed until there?s trouble in the 
environment.
>> 
>> As far as humans are concerned, you may think you know all about 
>> sexual signals, but you?d be surprised by new findings. It?s been 
>> known since the 1990s that heterosexual women living together 
>> synchronize their menstrual cycles because of pheromones, but when a 
>> study of lesbians showed that they do not synchronize, the
researchers 
>> suspected that semen played a role. In fact, they found ingredients
in 
>> semen that include mood enhancers like estrone, cortisol, prolactin, 
>> oxytocin, and serotonin; a sleep enhancer, melatonin; and of course, 
>> sperm, which makes up only 1%-5%. Delivering these compounds into the

>> richly vascularized vagina also turns out to have major salutary 
>> effects for the recipient. Female college students having unprotected

>> sex were significantly less depressed than were those whose partners 
>> used condoms (Arch. Sex. Behav. 2002;31:289-93). Their better moods 
>> were not just a feature of promiscuity, because women using condoms 
>> were just as depressed as those practi
>>  cing total abstinence. The benefits of semen contact also were seen 
>> in fewer suicide attempts and better performance on cognition tests.
>> 
>> So there?s a deeper bond between men and women than St. Valentine 
>> would have suspected, and now we know there?s a better gift for that 
>> day than chocolates.
>> 
>> One of the legends of St. Valentine says that he was a priest 
>> arrested by Roman Emperor Claudius II for secretly performing 
>> marriages. Claudius wanted to enlarge his army and believed that 
>> married men did not make good soldiers, rather like Halsted?s
feelings 
>> about surgical residents. But Valentine?s Day is about love, and if 
>> you remember a romantic gut feeling when you met your significant 
>> other, it might have a physiological basis.
>> 
>> It has long been known that Drosophila raised on starch media are 
>> more likely to mate with other starch-raised flies, whereas those fed

>> maltose have similar preferences. In a study published online in the 
>> November issue of the Proceedings of the National Academy of
Sciences, 
>> investigators explored the mechanism for this preference by treating 
>> flies with antibiotics to sterilize the gut and saw the preferences 
>> disappear (Proc. Nad. Acad. Sci. U.S.A. 2010 Nov. 1).
>> 
>> In cultures of untreated flies, the bacterium  L. plantarum was more 
>> common in those on starch, and sure enough, when L. plantarum was 
>> returned to the sterile groups, the mating preference returned. The 
>> best explanation for this is revealed in the significant differences 
>> in their sex pheromones. These experiments also support the
hologenome 
>> theory of evolution wherein the unit of natural selection is the 
>> ?holobiont,? or combination of organism and its microorganisms, that 
>> determines mating preferences.
>> 
>> Mating gets more interesting when you have an organism that can 
>> choose between sexual and asexual reproduction, like the rotifer. 
>> Biologists say that it?s more advantageous for a rotifer to remain 
>> asexual and pass 100% of its genetic information to the next 
>> generation. But if the environment changes, rotifers must adapt 
>> quickly in order to survive and reproduce with new gene combinations 
>> that have an advantage over existing genotypes. So in this new 
>> situation, the stressed rotifers, all of which are female, begin 
>> sending messages to each other to produce males for the switch to 
>> sexual reproduction (Nature 2010 Oct. 13). You can draw your own 
>> inference about males not being needed until there?s trouble in the 
environment.
>> 
>> As far as humans are concerned, you may think you know all about 
>> sexual signals, but you?d be surprised by new findings. It?s been 
>> known since the 1990s that heterosexual women living together 
>> synchronize their menstrual cycles because of pheromones, but when a 
>> study of lesbians showed that they do not synchronize, the
researchers 
>> suspected that semen played a role. In fact, they found ingredients
in 
>> semen that include mood enhancers like estrone, cortisol, prolactin, 
>> oxytocin, and serotonin; a sleep enhancer, melatonin; and of course, 
>> sperm, which makes up only 1%-5%. Delivering these compounds into the

>> richly vascularized vagina also turns out to have major salutary 
>> effects for the recipient. Female college students having unprotected

>> sex were significantly less depressed than were those whose partners 
>> used condoms (Arch. Sex. Behav. 2002;31:289-93). Their better moods 
>> were not just a feature of promiscuity, because women using condoms 
>> were just as depressed as those practi
>>  cing total abstinence. The benefits of semen contact also were seen 
>> in fewer suicide attempts and better performance on cognition tests.
>> 
>> So there?s a deeper bond between men and women than St. Valentine 
>> would have suspected, and now we know there?s a better gift for that 
>> day than chocolates.
>> 
>> Reposted in Retraction Watch with many comments worth looking at  :  
>>
http://retractionwatch.wordpress.com/2011/04/06/forget-chocolate-on-vale
ntines-day-try-semen-says-surgery-news-editor-retraction-resignation-fol
low/
>> 
>> 
>> Dr. Shanda Blackmon asks about the ACS response at Southwestern 
>> Surgical:  http://youtu.be/CqD48vqCRUU
>> 
>> 
>> ------------------------------
>> 
>> Message: 3
>> Date: Fri, 15 Apr 2011 00:46:06 -0400
>> From: "Gross, Ronald" <Ronald.Gross at baystatehealth.org>
>> Subject: RE: from Gen Surg News Feb 2011
>> To: "'Trauma-List [TRAUMA.ORG]'" <trauma-list at trauma.org>
>> Message-ID:
>>  <FD2BE6867A90F543AAD02E429F878633014F2A8A605C at bhsexc11.bhs.org>
>> Content-Type: text/plain; charset="us-ascii"
>> 
>> NO COMMENT!
>> 
>> 
>> -----Original Message-----
>> From: trauma-list-bounces at trauma.org 
>> [mailto:trauma-list-bounces at trauma.org] On Behalf Of Robert Smith
>> Sent: Thursday, April 14, 2011 1:31 PM
>> To: Trauma-List [TRAUMA.ORG]
>> Subject: from Gen Surg News Feb 2011
>> 
>> Written by Dr. Lazar Greenfield, President Elect of the American 
>> College of Surgeons.
>> 
>> One of the legends of St. Valentine says that he was a priest 
>> arrested by Roman Emperor Claudius II for secretly performing 
>> marriages. Claudius wanted to enlarge his army and believed that 
>> married men did not make good soldiers, rather like Halsted's
feelings 
>> about surgical residents. But Valentine's Day is about love, and if 
>> you remember a romantic gut feeling when you met your significant 
>> other, it might have a physiological basis.
>> 
>> It has long been known that Drosophila raised on starch media are 
>> more likely to mate with other starch-raised flies, whereas those fed

>> maltose have similar preferences. In a study published online in the 
>> November issue of the Proceedings of the National Academy of
Sciences, 
>> investigators explored the mechanism for this preference by treating 
>> flies with antibiotics to sterilize the gut and saw the preferences 
>> disappear (Proc. Nad. Acad. Sci. U.S.A. 2010 Nov. 1).
>> 
>> In cultures of untreated flies, the bacterium  L. plantarum was more 
>> common in those on starch, and sure enough, when L. plantarum was 
>> returned to the sterile groups, the mating preference returned. The 
>> best explanation for this is revealed in the significant differences 
>> in their sex pheromones. These experiments also support the
hologenome 
>> theory of evolution wherein the unit of natural selection is the 
>> "holobiont," or combination of organism and its microorganisms, that 
>> determines mating preferences.
>> 
>> Mating gets more interesting when you have an organism that can 
>> choose between sexual and asexual reproduction, like the rotifer. 
>> Biologists say that it's more advantageous for a rotifer to remain 
>> asexual and pass 100% of its genetic information to the next 
>> generation. But if the environment changes, rotifers must adapt 
>> quickly in order to survive and reproduce with new gene combinations 
>> that have an advantage over existing genotypes. So in this new 
>> situation, the stressed rotifers, all of which are female, begin 
>> sending messages to each other to produce males for the switch to 
>> sexual reproduction (Nature 2010 Oct. 13). You can draw your own 
>> inference about males not being needed until there's trouble in the 
environment.
>> 
>> As far as humans are concerned, you may think you know all about 
>> sexual signals, but you'd be surprised by new findings. It's been 
>> known since the 1990s that heterosexual women living together 
>> synchronize their menstrual cycles because of pheromones, but when a 
>> study of lesbians showed that they do not synchronize, the
researchers 
>> suspected that semen played a role. In fact, they found ingredients
in 
>> semen that include mood enhancers like estrone, cortisol, prolactin, 
>> oxytocin, and serotonin; a sleep enhancer, melatonin; and of course, 
>> sperm, which makes up only 1%-5%. Delivering these compounds into the

>> richly vascularized vagina also turns out to have major salutary 
>> effects for the recipient. Female college students having unprotected

>> sex were significantly less depressed than were those whose partners 
>> used condoms (Arch. Sex. Behav. 2002;31:289-93). Their better moods 
>> were not just a feature of promiscuity, because women using condoms 
>> were just as depressed as those practi
>>  cing total abstinence. The benefits of semen contact also were seen 
>> in fewer suicide attempts and better performance on cognition tests.
>> 
>> So there's a deeper bond between men and women than St. Valentine 
>> would have suspected, and now we know there's a better gift for that 
>> day than chocolates.
>> 
>> One of the legends of St. Valentine says that he was a priest 
>> arrested by Roman Emperor Claudius II for secretly performing 
>> marriages. Claudius wanted to enlarge his army and believed that 
>> married men did not make good soldiers, rather like Halsted's
feelings 
>> about surgical residents. But Valentine's Day is about love, and if 
>> you remember a romantic gut feeling when you met your significant 
>> other, it might have a physiological basis.
>> 
>> It has long been known that Drosophila raised on starch media are 
>> more likely to mate with other starch-raised flies, whereas those fed

>> maltose have similar preferences. In a study published online in the 
>> November issue of the Proceedings of the National Academy of
Sciences, 
>> investigators explored the mechanism for this preference by treating 
>> flies with antibiotics to sterilize the gut and saw the preferences 
>> disappear (Proc. Nad. Acad. Sci. U.S.A. 2010 Nov. 1).
>> 
>> In cultures of untreated flies, the bacterium  L. plantarum was more 
>> common in those on starch, and sure enough, when L. plantarum was 
>> returned to the sterile groups, the mating preference returned. The 
>> best explanation for this is revealed in the significant differences 
>> in their sex pheromones. These experiments also support the
hologenome 
>> theory of evolution wherein the unit of natural selection is the 
>> "holobiont," or combination of organism and its microorganisms, that 
>> determines mating preferences.
>> 
>> Mating gets more interesting when you have an organism that can 
>> choose between sexual and asexual reproduction, like the rotifer. 
>> Biologists say that it's more advantageous for a rotifer to remain 
>> asexual and pass 100% of its genetic information to the next 
>> generation. But if the environment changes, rotifers must adapt 
>> quickly in order to survive and reproduce with new gene combinations 
>> that have an advantage over existing genotypes. So in this new 
>> situation, the stressed rotifers, all of which are female, begin 
>> sending messages to each other to produce males for the switch to 
>> sexual reproduction (Nature 2010 Oct. 13). You can draw your own 
>> inference about males not being needed until there's trouble in the 
environment.
>> 
>> As far as humans are concerned, you may think you know all about 
>> sexual signals, but you'd be surprised by new findings. It's been 
>> known since the 1990s that heterosexual women living together 
>> synchronize their menstrual cycles because of pheromones, but when a 
>> study of lesbians showed that they do not synchronize, the
researchers 
>> suspected that semen played a role. In fact, they found ingredients
in 
>> semen that include mood enhancers like estrone, cortisol, prolactin, 
>> oxytocin, and serotonin; a sleep enhancer, melatonin; and of course, 
>> sperm, which makes up only 1%-5%. Delivering these compounds into the

>> richly vascularized vagina also turns out to have major salutary 
>> effects for the recipient. Female college students having unprotected

>> sex were significantly less depressed than were those whose partners 
>> used condoms (Arch. Sex. Behav. 2002;31:289-93). Their better moods 
>> were not just a feature of promiscuity, because women using condoms 
>> were just as depressed as those practi
>>  cing total abstinence. The benefits of semen contact also were seen 
>> in fewer suicide attempts and better performance on cognition tests.
>> 
>> So there's a deeper bond between men and women than St. Valentine 
>> would have suspected, and now we know there's a better gift for that 
>> day than chocolates.
>> 
>> Reposted in Retraction Watch with many comments worth looking at  :  
>>
http://retractionwatch.wordpress.com/2011/04/06/forget-chocolate-on-vale
ntines-day-try-semen-says-surgery-news-editor-retraction-resignation-fol
low/
>> 
>> 
>> Dr. Shanda Blackmon asks about the ACS response at Southwestern 
>> Surgical:  http://youtu.be/CqD48vqCRUU
>> --
>> trauma-list : TRAUMA.ORG
>> To change your settings or unsubscribe visit:
>> http://www.trauma.org/index.php?/community/
>> 
>>
----------------------------------------------------------------------
>> Please view our annual report at
http://baystatehealth.org/annualreport
>> 
>> 
>> CONFIDENTIALITY NOTICE: This e-mail communication and any attachments

>> may contain confidential and privileged information for the use of
the 
>> designated recipients named above. If you are not the intended 
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>> site at http://baystatehealth.org.
>> 
>> 
>> ------------------------------
>> 
>> Message: 4
>> Date: Fri, 15 Apr 2011 23:47:20 +0100
>> From: Karim Brohi <karimbrohi at gmail.com>
>> Subject: Re: New definition of severe trauma?
>> To: "Trauma-List [TRAUMA.ORG]" <trauma-list at trauma.org>
>> Message-ID: <BANLkTima+sDdjyNpS7e6cKYA5eafA3QTSA at mail.gmail.com>
>> Content-Type: text/plain; charset=ISO-8859-1
>> 
>> I don't know of any studies that have ever used ISS>20 as a threshold
>> so I'm not sure where this specific value came from, but I do
>> understand the motivation.  As ISS>15 mortality has fallen over the
>> years, it is becoming increasingly difficult to use this group to
>> identify where improvements in process of care or novel therapeutics
>> can improve a mortality endpoint.  However this still represents a
>> large an important group of patients and we probably need to look at
>> non-mortality outcomes in this group to really evaluate how we
deliver
>> care.  So I would not jettison the ISS>15 definition of severe
trauma.
>>  (In fact the ISS 9-15 group are also important but often overlooked)
>> 
>> However there is logic in analysing a more severely injured cohort,
>> and the logical step up for ISS is 25 and above (ISS>24), which we
>> have defined as 'Critically Injured' in a previous paper
>> (http://www.ncbi.nlm.nih.gov/pubmed/20013932) as have others.  (25
>> being AIS 5 squared as a step up from 16 being AIS 4 squared).  These
>> are the group where you can more readily see a mortality impact of
>> improvements in care delivery etc.
>> 
>> Karim
>> 
>> On Wed, Apr 13, 2011 at 23:53, Zsolt J. Balogh
>> <Zsolt.Balogh at hnehealth.nsw.gov.au> wrote:
>>> 
>>> 
>>> Professor Zsolt J. Balogh, MD, PhD, FRACS
>>> Director of Trauma, John Hunter Hospital and Hunter New England 
>> Area Health Service
>>> Discipline Head of Traumatology, University of Newcastle
>>> Newcastle, NSW
>>> AUSTRALIA
>>> Tel: +61 2 49214259
>>> Fax: +61 2 49214274
>>> E-mail: zsolt.balogh at hnehealth.nsw.gov.au
>>> 
>>> 
>>> 
>>> 
>>> -----Original Message-----
>>> From: trauma-list-bounces at trauma.org 
>> [mailto:trauma-list-bounces at trauma.org] On Behalf Of Charlene M
Morris
>>> Sent: Thursday, 14 April 2011 8:55 AM
>>> To: Trauma-List [TRAUMA.ORG]
>>> Subject: Re: New definition of severe trauma?
>>> 
>>> can link to the article be posted, please?
>>> 
>>> cmm
>>> 
>>> On Wed, Apr 13, 2011 at 6:41 PM, Zsolt J. Balogh <
>>> Zsolt.Balogh at hnehealth.nsw.gov.au> wrote:
>>> 
>>>> Dear Cat,
>>>> 
>>>> Please look at our article on the "definition of Polytrauma". Best 
>> Regards,
>>>> Zsolt Balogh
>>>> 
>>>> 
>>>> 
>>>> Professor Zsolt J. Balogh, MD, PhD, FRACS
>>>> Director of Trauma, John Hunter Hospital and Hunter New England 
>> Area Health
>>>> Service
>>>> Discipline Head of Traumatology, University of Newcastle
>>>> Newcastle, NSW
>>>> AUSTRALIA
>>>> Tel: +61 2 49214259
>>>> Fax: +61 2 49214274
>>>> E-mail: zsolt.balogh at hnehealth.nsw.gov.au
>>>> 
>>>> 
>>>> 
>>>> 
>>>> -----Original Message-----
>>>> From: trauma-list-bounces at trauma.org [mailto:
>>>> trauma-list-bounces at trauma.org] On Behalf Of Heim Schoettker
Katharina
>>>> Sent: Thursday, 14 April 2011 6:52 AM
>>>> To: trauma-list at trauma.org
>>>> Subject: New definition of severe trauma?
>>>> 
>>>> Is anybody using ISS > 20 as definition of severe trauma?
Health-care
>>>> politicians want Swiss-hospitals ?to use ISS > 20 rather than > 15 
>> for
>>>> definition of severe trauma. Is anybody aware of scientific 
>> arguments for
>>>> that?
>>>> Thanks
>>>> Cat
>>>> --
>>>> 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/
>>>> 
>>> 
>>> 
>>> 
>>> --
>>> THE best person for the job is the one who knows what to do at that 
>> given
>>> moment and is THERE, regardless of position, age or gender.
>>> --cmm
>>> --
>>> 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/
>>> 
>> 
>> 
>> ------------------------------
>> 
>> Message: 5
>> Date: Fri, 15 Apr 2011 19:31:40 -0400
>> From: Dave Napoliello <nappio at aol.com>
>> Subject: Trauma CT
>> To: "Trauma-List [TRAUMA.ORG]" <trauma-list at trauma.org>
>> Message-ID:
<2jnryt5k16jbxy206avtj2ih.1302910129713 at email.android.com>
>> Content-Type: text/plain; charset=utf-8
>> 
>> I was just informed my community hospital obtains non~contrasted 
>> trauma CT's.  Am I missing something?  Shouldn't a trauma ct have iv 
>> contrast to look for vascular injury or organ extravisation?dn
>> 
>> Sent from my Verizon Wireless Phone
>> 
>> Karim Brohi <karimbrohi at gmail.com> wrote:
>> 
>>> I don't know of any studies that have ever used ISS>20 as a
threshold
>>> so I'm not sure where this specific value came from, but I do
>>> understand the motivation.  As ISS>15 mortality has fallen over the
>>> years, it is becoming increasingly difficult to use this group to
>>> identify where improvements in process of care or novel therapeutics
>>> can improve a mortality endpoint.  However this still represents a
>>> large an important group of patients and we probably need to look at
>>> non-mortality outcomes in this group to really evaluate how we
deliver
>>> care.  So I would not jettison the ISS>15 definition of severe
trauma.
>>> (In fact the ISS 9-15 group are also important but often overlooked)
>>> 
>>> However there is logic in analysing a more severely injured cohort,
>>> and the logical step up for ISS is 25 and above (ISS>24), which we
>>> have defined as 'Critically Injured' in a previous paper
>>> (http://www.ncbi.nlm.nih.gov/pubmed/20013932) as have others.  (25
>>> being AIS 5 squared as a step up from 16 being AIS 4 squared).
These
>>> are the group where you can more readily see a mortality impact of
>>> improvements in care delivery etc.
>>> 
>>> Karim
>>> 
>>> On Wed, Apr 13, 2011 at 23:53, Zsolt J. Balogh
>>> <Zsolt.Balogh at hnehealth.nsw.gov.au> wrote:
>>>> 
>>>> 
>>>> Professor Zsolt J. Balogh, MD, PhD, FRACS
>>>> Director of Trauma, John Hunter Hospital and Hunter New England 
>> Area Health Service
>>>> Discipline Head of Traumatology, University of Newcastle
>>>> Newcastle, NSW
>>>> AUSTRALIA
>>>> Tel: +61 2 49214259
>>>> Fax: +61 2 49214274
>>>> E-mail: zsolt.balogh at hnehealth.nsw.gov.au
>>>> 
>>>> 
>>>> 
>>>> 
>>>> -----Original Message-----
>>>> From: trauma-list-bounces at trauma.org 
>> [mailto:trauma-list-bounces at trauma.org] On Behalf Of Charlene M
Morris
>>>> Sent: Thursday, 14 April 2011 8:55 AM
>>>> To: Trauma-List [TRAUMA.ORG]
>>>> Subject: Re: New definition of severe trauma?
>>>> 
>>>> can link to the article be posted, please?
>>>> 
>>>> cmm
>>>> 
>>>> On Wed, Apr 13, 2011 at 6:41 PM, Zsolt J. Balogh <
>>>> Zsolt.Balogh at hnehealth.nsw.gov.au> wrote:
>>>> 
>>>>> Dear Cat,
>>>>> 
>>>>> Please look at our article on the "definition of Polytrauma". 
>> Best Regards,
>>>>> Zsolt Balogh
>>>>> 
>>>>> 
>>>>> 
>>>>> Professor Zsolt J. Balogh, MD, PhD, FRACS
>>>>> Director of Trauma, John Hunter Hospital and Hunter New England 
>> Area Health
>>>>> Service
>>>>> Discipline Head of Traumatology, University of Newcastle
>>>>> Newcastle, NSW
>>>>> AUSTRALIA
>>>>> Tel: +61 2 49214259
>>>>> Fax: +61 2 49214274
>>>>> E-mail: zsolt.balogh at hnehealth.nsw.gov.au
>>>>> 
>>>>> 
>>>>> 
>>>>> 
>>>>> -----Original Message-----
>>>>> From: trauma-list-bounces at trauma.org [mailto:
>>>>> trauma-list-bounces at trauma.org] On Behalf Of Heim Schoettker
Katharina
>>>>> Sent: Thursday, 14 April 2011 6:52 AM
>>>>> To: trauma-list at trauma.org
>>>>> Subject: New definition of severe trauma?
>>>>> 
>>>>> Is anybody using ISS > 20 as definition of severe trauma?
Health-care
>>>>> politicians want Swiss-hospitals ?to use ISS > 20 rather than > 
>> 15 for
>>>>> definition of severe trauma. Is anybody aware of scientific 
>> arguments for
>>>>> that?
>>>>> Thanks
>>>>> Cat
>>>>> --
>>>>> 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/
>>>>> 
>>>> 
>>>> 
>>>> 
>>>> --
>>>> THE best person for the job is the one who knows what to do at 
>> that given
>>>> moment and is THERE, regardless of position, age or gender.
>>>> --cmm
>>>> --
>>>> 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/
>> 
>> ------------------------------
>> 
>> Message: 6
>> Date: Tue, 19 Apr 2011 10:27:45 -0500
>> From: "Shawn Ballard" <sballard at WNJ.ORG>
>> Subject: level I activation
>> To: <trauma-list at trauma.org>
>> Message-ID:
>>
<864481E5A1EFC947B19A0A4AA35E095204BC42BF at EXCHANGESVR.Internal.wnj.bz>
>> Content-Type: text/plain;    charset="us-ascii"
>> 
>> I know the ACS is specific on arrival time for trauma surgeons for a
>> level I (high-level response). Are their guidelines or requirements
for
>> the response of other team members. For example ED staff respond
>> immediately and support services respond within 10 minutes.
>> 
>> 
>> 
>> Also are the response times for level II and level III activation
>> hospital specific?
>> 
>> 
>> 
>> 
>> 
>> 
>> 
>> 
>> 
>> ------------------------------
>> 
>> Message: 7
>> Date: Tue, 19 Apr 2011 13:09:58 EDT
>> From: Krin135 at aol.com
>> Subject: Skype android problems
>> To: ccm-l at list.pitt.edu, trauma-list at trauma.org
>> Message-ID: <26adb.253237b3.3adf1be6 at aol.com>
>> Content-Type: text/plain; charset="US-ASCII"
>> 
>> considering the number of folks on these lists that use Skype, and 
>> probably 
>>  have Android type phones, I thought that this was pertinent:
>> 
>>
http://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2011-May/_http://www.itbusinessedge.com/cm/blogs/bentley/skype-for-android-flaw-p
uts-
>>
user-information-at-risk/?cs=46554&utm_source=itbe&utm_medium=email&utm_
camp
>> aign=dye&nr=dye_ 
>>
(http://www.itbusinessedge.com/cm/blogs/bentley/skype-for-android-flaw-p
uts-user-information-at-risk/?cs=46554&utm_source=itbe&utm_medi
>> um=email&utm_campaign=dye&nr=dye) 
>> 
>> ck
>> 
>> 
>> ------------------------------
>> 
>> Message: 8
>> Date: Tue, 19 Apr 2011 13:55:28 EDT
>> From: Krin135 at aol.com
>> Subject: Check out Skype for Android Flaw Puts User Information at
>>  Risk |  Blogs | ITBu
>> To: trauma-list at trauma.org, ccm-l at list.pitt.edu
>> Message-ID: <293c1.3da504b8.3adf2690 at aol.com>
>> Content-Type: text/plain; charset="US-ASCII"
>> 
>> _Click  here: Skype for Android Flaw Puts User Information at Risk | 
>> Blogs 
>> |  ITBusinessEdge.com_ 
>>
(http://www.itbusinessedge.com/cm/blogs/bentley/skype-for-android-flaw-p
uts-user-information-at-risk/?cs=46554&utm_source=itbe&utm
>> _medium=email&utm_campaign=dye&nr=dye)  
>> 
>> at the request of one of the list members, a shorter link to the blog

>> in  
>> question.
>> 
>> ck
>> 
>> 
>> ------------------------------
>> 
>> Message: 9
>> Date: Wed, 20 Apr 2011 13:58:08 +0530 (IST)
>> From: rm khattar <dr_rm_khattar at yahoo.co.in>
>> Subject: Appendecitis
>> To: trauma-list at trauma.org
>> Cc: ccm-l at list.pitt.edu
>> Message-ID: <81517.20264.qm at web95207.mail.in2.yahoo.com>
>> Content-Type: text/plain; charset=utf-8
>> 
>> Recently I read an article suggesting incidence of appendicitis is 
>> falling in Finland. Another article said, has appendicitis become a 
>> medical illness? 
>> I have following observations to make regarding appendicitis in my 
>> surgical practice of 25 years.
>> 1.Incidence of appendicitis is falling in India too,due to improved 
>> public health measures,subsequently less viral infections of the 
>> gut,and probably less chances of inflammation of lymphoid follicles
at 
>> entry of appendicular lummen and subsequently less apendicitis.
>> 2.Rate of appendicectomy is falling due to early initiation of 
>> antibiotics of high generation in all abdominal pain ,subsequently 
>> many milder forms of appendicitis is nipped in the bud.
>> 3.Incidence of perforated and gangrenous appendicitis is also falling

>> due to same logic.Hardly any patient goes into septic shock due to 
appendicitis.
>> 4.Many more cases of mild catarrhal inflammation of appendix  leading

>> to reccurrent RIF pain are seen getting treated with antibiotics each

>> time.
>> 5.Studies have shown appendicectomy no more remains a middle of the 
>> night operation,it can safely wait till next morning.
>> 6.Hardly any appendicectomy is done without CT corroboration.
>> 7.Lap appendicectomy has still not become gold standard for appendix 
>> removal.
>> 8.There is increasing questioning regarding Interval appendicectomy 
>> ,since as much as 50 percent of appendecitis treated with antibiotics

>> may not have pain again.
>> R.M.Khattar Delhi India   
>> 
>> 
>> ------------------------------
>> 
>> Message: 10
>> Date: Wed, 20 Apr 2011 15:48:52 -0400
>> From: S Schecter <schecters at gmail.com>
>> Subject: (Off topic) Civil War soldiers photographs of wounds
>> To: "Trauma &amp, Critical Care mailing list"
<trauma-list at trauma.org>
>> Message-ID: <BANLkTimwd1w66Rxp_gK6JFawViBpRG3cCw at mail.gmail.com>
>> Content-Type: text/plain; charset=ISO-8859-1
>> 
>> Some of the photos of the soldiers are not wearing clothes in case
filters
>> are in place.
>> 
>> http://www.flickr.com/photos/medicalmuseum/with/5610191881/
>> 
>> 
>> ------------------------------
>> 
>> Message: 11
>> Date: Thu, 21 Apr 2011 09:51:49 -0500
>> From: "Todd Kelly, M.D." <tkellymd at msn.com>
>> Subject: Using MLP's for PM ICU coverage
>> To: trauma-list at trauma.org
>> Message-ID: <BLU0-SMTP188447D8158BB01531AAC40CF920 at phx.gbl>
>> Content-Type: text/plain; charset="utf-8"
>> 
>> Are any of you using Mid-level providers without an intensivist (NP 
>> or ACNP) to provide in-house night coverage for your ICU's?  If so, 
>> how many beds are they covering?
>> 
>> ------------------------------
>> 
>> Message: 12
>> Date: Fri, 22 Apr 2011 12:46:28 -0500
>> From: Ante ?ori? <ante.coric85 at gmail.com>
>> Subject: Re: Using MLP's for PM ICU coverage
>> To: "Trauma-List [TRAUMA.ORG]" <trauma-list at trauma.org>
>> Message-ID: <BANLkTingJXRwrcd-d0dAHpd2PJeugmxohg at mail.gmail.com>
>> Content-Type: text/plain; charset=ISO-8859-1
>> 
>> We don't use non physician staff for coverage, on most instances
>> intensivist in house or anasthetist (those with 5yrs residency
>> programme)
>> 
>> 2011/4/21, Todd Kelly, M.D. <tkellymd at msn.com>:
>>> Are any of you using Mid-level providers without an intensivist (NP 
>> or ACNP)
>>> to provide in-house night coverage for your ICU's?  If so, how many 
>> beds are
>>> they covering?
>>> --
>>> trauma-list : TRAUMA.ORG
>>> To change your settings or unsubscribe visit:
>>> http://www.trauma.org/index.php?/community/
>>> 
>> 
>> 
>> ------------------------------
>> 
>> Message: 13
>> Date: Sat, 23 Apr 2011 10:03:10 -0600
>> From: JORGE RAMIREZ ARCE <ramfons at racsa.co.cr>
>> Subject: Re: Using MLP's for PM ICU coverage
>> To: "Trauma-List [TRAUMA.ORG]" <trauma-list at trauma.org>
>> Message-ID: <7540c01a39bd0.4db2a3de at racsa.co.cr>
>> Content-Type: text/plain; charset="us-ascii"
>> 
>> An HTML attachment was scrubbed...
>> URL: <
>> 
>> ------------------------------
>> 
>> Message: 14
>> Date: Sun, 24 Apr 2011 14:24:10 +0530 (IST)
>> From: rm khattar <dr_rm_khattar at yahoo.co.in>
>> Subject: trauma List
>> To: trauma-list at trauma.org
>> Message-ID: <27214.69926.qm at web95203.mail.in2.yahoo.com>
>> Content-Type: text/plain; charset=utf-8
>> 
>> What has happenened to trauma list? Are there no contributions or I 
>> am 
>> unsubscribed?
>> R.M.Khattar
>> Delhi India
>> 
>> 
>> ------------------------------
>> 
>> Message: 15
>> Date: Sun, 24 Apr 2011 08:59:42 +0000
>> From: Doc Holiday <drydok at hotmail.com>
>> Subject: RE: trauma List
>> To: ".Trauma List" <trauma-list at trauma.org>
>> Message-ID: <SNT104-W60543B700EE706873105FDC0970 at phx.gbl>
>> Content-Type: text/plain; charset="utf-8"
>> 
>> 
>> From: dr_rm_khattar at yahoo.co.in
>>> What has happenened to trauma list? Are there no contributions or I 
>> am unsubscribed?
>> 
>> --> Not sure what you mean?
>> 
>> The item below came just yesterday:
>> 
>> 
>> 
>> 
>> Re: Using MLP's for PM ICU coverage?
>> 
>>  JORGE RAMIREZ ARCE 
>> 
>> 
>> 
>> 
>> 
>> 
>> 
>> 
>> 
>> 
>> 
>> 
>> ramfons at racsa.co.cr
>> 
>> 
>> 
>> To Trauma-List [TRAUMA.ORG]
>> 
>> 
>> 
>> 
>> 
>> 
>> 
>> 
>> 
>> 
>> From:
>> trauma-list-bounces at trauma.org on behalf of JORGE RAMIREZ ARCE 
>> (ramfons at racsa.co.cr) 
>> 
>> Sent:
>> 23 April 2011 16:05:47
>> 
>> To: 
>> Trauma-List [TRAUMA.ORG] (trauma-list at trauma.org)
>> 
>> 
>> 
>> 
>> 
>> 
>> 
>> 
>> 
>> 
>> We use senior residents in anesthesiology for coverae and an 
>> intensivist is on-call. Tiny unit 6 bed, but covering also recovery 
>> room. (hope to grow in the near future???)
>> 
>> 
>> Jorge Ramirez-Arce, MD
>> Chief SICU.
>> Hospital "Dr. Rafael Angel Calderon Guardia"
>> San Jos?, Costa Rica
>> 
>> El 22/04/11, Ante ?ori? <ante.coric85 at gmail.com> escribi?:

>> 
>> 
>> ------------------------------
>> 
>> Message: 16
>> Date: Sun, 24 Apr 2011 02:40:03 -0700
>> From: "Kate Warren" <traumadocs at cox.net>
>> Subject: RE: trauma List
>> To: "'Trauma-List [TRAUMA.ORG]'" <trauma-list at trauma.org>
>> Message-ID: <001b01cc0263$96a86d20$c3f94760$@net>
>> Content-Type: text/plain;    charset="UTF-8"
>> 
>>  The list is up, maybe it is quiet due to the holiday weekend.
>> 
>> -----Original Message-----
>> From: trauma-list-bounces at trauma.org 
>> [mailto:trauma-list-bounces at trauma.org] On Behalf Of Doc Holiday
>> Sent: Sunday, April 24, 2011 2:00 AM
>> To: .Trauma List
>> Subject: RE: trauma List
>> 
>> 
>> From: dr_rm_khattar at yahoo.co.in
>>> What has happenened to trauma list? Are there no contributions or I 
>> am unsubscribed?
>> 
>> --> Not sure what you mean?
>> 
>> The item below came just yesterday:
>> 
>> 
>> 
>> 
>> Re: Using MLP's for PM ICU coverage?
>> 
>>  JORGE RAMIREZ ARCE 
>> 
>> 
>> 
>> 
>> 
>> 
>> 
>> 
>> 
>> 
>> 
>> 
>> ramfons at racsa.co.cr
>> 
>> 
>> 
>> To Trauma-List [TRAUMA.ORG]
>> 
>> 
>> 
>> 
>> 
>> 
>> 
>> 
>> 
>> 
>> From:
>> trauma-list-bounces at trauma.org on behalf of JORGE RAMIREZ ARCE 
>> (ramfons at racsa.co.cr) 
>> 
>> Sent:
>> 23 April 2011 16:05:47
>> 
>> To: 
>> Trauma-List [TRAUMA.ORG] (trauma-list at trauma.org)
>> 
>> 
>> 
>> 
>> 
>> 
>> 
>> 
>> 
>> 
>> We use senior residents in anesthesiology for coverae and an 
>> intensivist is on-call. Tiny unit 6 bed, but covering also recovery 
>> room. (hope to grow in the near future???)
>> 
>> 
>> Jorge Ramirez-Arce, MD
>> Chief SICU.
>> Hospital "Dr. Rafael Angel Calderon Guardia"
>> San Jos?, Costa Rica
>> 
>> El 22/04/11, Ante ?ori? <ante.coric85 at gmail.com> escribi?:

>> 
>> --
>> trauma-list : TRAUMA.ORG
>> To change your settings or unsubscribe visit:
>> http://www.trauma.org/index.php?/community/
>> 
>> 
>> __________ Information from ESET Smart Security, version of virus 
>> signature database 6066 (20110423) __________
>> 
>> The message was checked by ESET Smart Security.
>> 
>> http://www.eset.com
>> 
>> 
>> 
>> 
>> ------------------------------
>> 
>> Message: 17
>> Date: Sun, 24 Apr 2011 07:30:37 EDT
>> From: Krin135 at aol.com
>> Subject: Re: trauma List
>> To: trauma-list at trauma.org
>> Message-ID: <81ca4.3fdc21c3.3ae563dd at aol.com>
>> Content-Type: text/plain; charset="US-ASCII"
>> 
>> your message came through here.
>> 
>> I figured folks were still recovering from the trip to Las Vegas.
>> 
>> ck
>> 
>> 
>> In a message dated 04/24/11 03:54:28 Central Daylight Time,  
>> dr_rm_khattar at yahoo.co.in writes:
>> 
>> What has  happenened to trauma list? Are there no contributions or I 
>> am  
>> unsubscribed?
>> R.M.Khattar
>> Delhi India
>> --
>> trauma-list :  TRAUMA.ORG
>> To change your settings or unsubscribe  visit:
>> http://www.trauma.org/index.php?/community/
>> 
>> 
>> 
>> ------------------------------
>> 
>> Message: 18
>> Date: Mon, 25 Apr 2011 16:10:40 +0100 (BST)
>> From: karan botsford <karanbotsford at btinternet.com>
>> Subject: Re: trauma List
>> To: "Trauma-List \[TRAUMA.ORG\]" <trauma-list at trauma.org>
>> Message-ID: <454818.34176.qm at web87012.mail.ird.yahoo.com>
>> Content-Type: text/plain; charset=utf-8
>> 
>> 
>> 
>> 
>> 
>> 
>> ________________________________
>> From: Kate Warren <traumadocs at cox.net>
>> To: Trauma-List [TRAUMA.ORG] <trauma-list at trauma.org>
>> Sent: Sunday, 24 April, 2011 10:40:03
>> Subject: RE: trauma List
>> 
>> The list is up, maybe it is quiet due to the holiday weekend.
>> 
>> -----Original Message-----
>> From: trauma-list-bounces at trauma.org 
>> [mailto:trauma-list-bounces at trauma.org] On 
>> Behalf Of Doc Holiday
>> Sent: Sunday, April 24, 2011 2:00 AM
>> To: .Trauma List
>> Subject: RE: trauma List
>> 
>> 
>> From: dr_rm_khattar at yahoo.co.in
>>> What has happenened to trauma list? Are there no contributions or I 
>> am 
>>> unsubscribed?
>> 
>> --> Not sure what you mean?
>> 
>> The item below came just yesterday:
>> 
>> 
>> 
>> 
>> Re: Using MLP's for PM ICU coverage?
>> 
>> JORGE RAMIREZ ARCE 
>> 
>> 
>> 
>> 
>> 
>> 
>> 
>> 
>> 
>> 
>> 
>> 
>> ramfons at racsa.co.cr
>> 
>> 
>> 
>> To Trauma-List [TRAUMA.ORG]
>> 
>> 
>> 
>> 
>> 
>> 
>> 
>> 
>> 
>> 
>> From:
>> trauma-list-bounces at trauma.org on behalf of JORGE RAMIREZ ARCE 
>> (ramfons at racsa.co.cr) 
>> 
>> 
>> Sent:
>> 23 April 2011 16:05:47
>> 
>> To: 
>> Trauma-List [TRAUMA.ORG] (trauma-list at trauma.org)
>> 
>> 
>> 
>> 
>> 
>> 
>> 
>> 
>> 
>> 
>> We use senior residents in anesthesiology for coverae and an 
>> intensivist is 
>> on-call. Tiny unit 6 bed, but covering also recovery room. (hope to 
>> grow in the 
>> near future???)
>> 
>> 
>> Jorge Ramirez-Arce, MD
>> Chief SICU.
>> Hospital "Dr. Rafael Angel Calderon Guardia"
>> San Jos?, Costa Rica
>> 
>> El 22/04/11, Ante ?ori? <ante.coric85 at gmail.com> escribi?: ??? ??? 
>> ??? ? ??? ??? 
>> ? 
>> 
>> --
>> trauma-list : TRAUMA.ORG
>> To change your settings or unsubscribe visit:
>> http://www.trauma.org/index.php?/community/
>> 
>> 
>> __________ Information from ESET Smart Security, version of virus 
>> signature 
>> database 6066 (20110423) __________
>> 
>> The message was checked by ESET Smart Security.
>> 
>> http://www.eset.com
>> 
>> 
>> --
>> trauma-list : TRAUMA.ORG
>> To change your settings or unsubscribe visit:
>> http://www.trauma.org/index.php?/community/
>> 
>> ------------------------------
>> 
>> Message: 19
>> Date: Mon, 25 Apr 2011 12:52:59 -0500
>> From: "Seastrom, David, W" <dwseastrom at cmh.edu>
>> Subject: RE: Using MLP's for PM ICU coverage
>> To: "'Trauma-List [TRAUMA.ORG]'" <trauma-list at trauma.org>
>> Message-ID:
>>  <69A64F7AFB8EA64482FF3FE076B278540FC3EE97 at CMHMAIL0.CMH.Internal>
>> Content-Type: text/plain; charset="utf-8"
>> 
>> We have T/SCC fellows that are in-house 24/7, but we also have staff 
>> intensivist that are in-house 24/7.  We use NP?s that round through 
>> the ICU, but they are always see by the fellow or staff.
>> 
>> David Seastrom RN, BSN, EMT-I
>> Trauma Injury Prevention / Outreach
>> Education Coordinator
>> The Children's Mercy Hospitals & Clinics
>> Kansas City, MO.  64108
>> Office:  816-983-6917
>> Fax:  816-234-3821
>> Pager:  816-458-4995
>> E-Mail:  dwseastrom at cmh.edu<
>> 
>> [cid:image001.jpg at 01CC0347.B4709460]
>> 
>> From: trauma-list-bounces at trauma.org 
>> [mailto:trauma-list-bounces at trauma.org] On Behalf Of JORGE RAMIREZ
ARCE
>> Sent: Saturday, April 23, 2011 11:03 AM
>> To: Trauma-List [TRAUMA.ORG]
>> Subject: Re: Using MLP's for PM ICU coverage
>> 
>> We use senior residents in anesthesiology for coverae and an 
>> intensivist is on-call. Tiny unit 6 bed, but covering also recovery 
>> room. (hope to grow in the near future???)
>> 
>> Jorge Ramirez-Arce, MD
>> Chief SICU.
>> Hospital "Dr. Rafael Angel Calderon Guardia"
>> San Jos?, Costa Rica
>> El 22/04/11, Ante ?ori? <ante.coric85 at gmail.com> escribi?:
>> We don't use non physician staff for coverage, on most instances
>> intensivist in house or anasthetist (those with 5yrs residency
>> programme)
>> 
>> 2011/4/21, Todd Kelly, M.D. <tkellymd at msn.com>:
>>> Are any of you using Mid-level providers without an intensivist (NP 
>> or ACNP)
>>> to provide in-house night coverage for your ICU's?  If so, how many 
>> beds are
>>> they covering?
>>> --
>>> 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/
>> -------------- next part --------------
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>> 
>> ------------------------------
>> 
>> --
>> trauma-list : TRAUMA.ORG
>> To change your settings or unsubscribe visit:
>> http://www.trauma.org/index.php?/community/
>> 
>> End of trauma-list Digest, Vol 94, Issue 5
>> ******************************************
>> 
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> 
> ------------------------------
> 
> --
> trauma-list : TRAUMA.ORG
> To change your settings or unsubscribe visit:
> http://www.trauma.org/index.php?/community/
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> ******************************************


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