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interesting trauma case

Scott Bricker scottbricker at verizon.net
Sat Dec 29 19:56:30 GMT 2012

Interesting shift in the discussion, and I'd like to hear from the Trauma Surgeons/Emegency Physicians on this; do these photos REALLY matter in your evaluation of the patient?

I don't treat the wrecked car, I treat the patient in front of me. I personally see little value in reviewing images provided by rescue folks. I don't care if the car is destroyed - if the patient has ZERO signs or symptoms of injury, I'm not going to embark on a work up based on the mechanism of injury/severity of damage alone. It is similar to the teaching in my region regarding motorcycle helmets - EMS providers are instructed to bring the helmet, which is ceremoniously presented for my inspection. I oblige, but it really offers no value in my work up of the patient. In fact, much of the collision history (speed, restraint use, impact type, air bag deployment, color of vehicle, etc.) is of limited value, and often inaccurate.

I have yet to see an operative head injury in a patient with no loss of consciousness, and a perfect GCS. And I have yet to see a clinically silent aortic transaction - they all complain of back pain. 

Anyone share these sentiments, I'd love to hear arguments, pro and con.

Scott Bricker, MD
Los Angeles, California

Sent from my iPhone

On Dec 29, 2012, at 11:20, Peter <petercoti at gmail.com> wrote:

>> From what I have heard, photos taken with a cell phone can cause some
> HIPAA problems as it is an "unauthorized device" In the prehospital
> setting it is ideal for ambulances to be stocked with a Polaroid.
> Peter Coti NJEMT
> On 12/29/2012 14:14, Ems wrote:
>> Being a prehospital provider when or if I can I try to snap a couple pics of vehicle damage with my phone for the MD to review. Sometimes people have different ideas of actual levels of damage or fail to communicate the damage effectively. 
>> Sent from my iPhone 
>> Matt Batey AAS EMT-P
>> On Dec 29, 2012, at 13:02, "McSwain, Norman E" <nmcswai at tulane.edu> wrote:
>>>> From that prospective you are correct. A lot of 'crumble' means that much of the energy was absorbed just and the airbags and  seat belts do. But it also gives information to the physicians taking care of the patient, what the 'potential' injuries may be. It does not indicate they those injures *are* present but the *potential* of what might be present.
>>> I was recently involved in a legal case when the physician did not consider the *potential* of an injury that was present and is commonly is associated with the mechanism of injury (kinematics, if you would) and therefore the injury did not get managed for several months.
>>> Norman
>>> Norman McSwain MD, FACS
>>> Professor of Surgery, Tulane University
>>> Trauma Director, Spirit of Charity Trauma Center, ILH
>>> Medical Director PreHosptial Trauma Life Support (PHTLS)
>>> 504 988 5111
>>> -----Original Message-----
>>> From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] On Behalf Of Joe Nemeth, Mr
>>> Sent: Saturday, December 29, 2012 12:45 PM
>>> To: Trauma-List [TRAUMA.ORG]
>>> Subject: RE: interesting trauma case
>>> Dr. McSwain,
>>> I am not sure I understand the point of your questions below considering the definitive DIAGNOSTIC imaging report by Keith.
>>> Furthermore although  "damage to vehicle" has a high negative pred. value (i.e. if EMS reports a fender-bender, unlikely to have catastrophic injury), it has poor PPV considering cars nowadays are MADE to crumple.  
>>> jn

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