Login
Site Search
Trauma-List Subscription

Subscribe

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

Modify

Home > List Archives

interesting trauma case

Andrew J Bowman andrewj.bowman at gmail.com
Sun Dec 30 01:00:40 GMT 2012


And this practice continues. 

Andrew J Bowman

On Dec 29, 2012, at 19:56, Ems <mbatey at sumnerems.org> wrote:

> Seen a lot of Pts loaded in to helicopters solely because of MOI. Only to be D/C'ed 2 hrs later with a $15,000 bill. 
> 
> Sent from my iPhone 
> Matt Batey AAS EMT-P
> 
> On Dec 29, 2012, at 18:25, Brandon Oto <brandon at degreesofclarity.com> wrote:
> 
>> It seems to me that mechanism matters insofar as the story behind *any* illness or injury matters. It gives context and tells us where to look. Surely a person who says they tripped and bumped their knee will receive different care than the person kicked in the belly by a mule. That doesn't mean much on its own, but what does?
>> 
>> If there's a point to saying "mechanism doesn't matter," I think it's largely as a backlash to the cult of mechanism that (driven by fear of liability) has empowered MoI to completely eclipse all other aspects of the exam or diagnostic findings. In other words, the "he seems okay, but look at that mechanism!" phenomenon. To some extent this is reasonable -- Dr. McSwain's point about "looking harder" at some patients -- but only if it's understood that mechanism, particularly in cases like those MVAs in modern EZ-fold cars, has fairly poor predictive value and should not carry an unreasonable amount of weight.
>> 
>> Whenever clinicians demand "the works" based on mechanism, I ask what they're worried about. Generally it's not a bad outcome for the patient, but for themselves...
>> 
>> Brandon
>> 
>> ***
>> http://degreesofclarity.com/
>> http://emsbasics.com/
>> 
>> 
>> 
>> 
>> On Dec 29, 2012, at 7:11 PM, Doc Holiday wrote:
>> 
>>> 
>>> From: Scott Bricker>... like to hear from the Trauma Surgeons/Emegency Physicians on this; do these photos REALLY matter in your evaluation of the patient?
>>> 
>>> --> Not in my (EM) experience.
>>> 
>>>> I don't treat the wrecked car, I treat the patient in front of me. I personally see little value in reviewing images
>>> 
>>> --> I DO think mechanism is a useful thing to consider. I make a big point about it a number of times in teaching ATLS. I think that understanding the mechanism may be as relevant to the trauma "disease" as would understanding bacteria is to infectious disease. NOT always, but you generally don't know in advance that knowledge of mechanism will not help.
>>> 
>>> BUT I generally DON'T find the pre-hospital pictures useful in this regard. I prefer the verbal descriptions. Someone said "a photo says a thousand words". That was well-timed in its comic contribution, but it made me think. A PICTURE is worth a 1000 words and it can be drawn or spoken. This probably comes from the fact that the artist is able to convey a message using emphasis of various types. A photo, often taken with a phone and/or in darkness and/or with poor lighting and/or by someone who has no training in photography - that might SAY a thousand words, but it's not WORTH that many!
>>> 
>>> I don't need to see it - just tell me which part of the car was damaged and describe the damage in under one sentence. Good enough. And cars are made differently these days, so there is somewhat less you can extrapolate from what is left after an accident, as a few have hinted at already.
>>> 
>>> From: McSwain, Norman E (nmcswai at tulane.edu) > That is the same approach that the physician had when he missed the injury that is commonly described as a potential. He was sued for the missed injury and the patient had a bad outcome. I strongly believe in assessing for the potential injury and do it every time I see a trauma patient
>>> 
>>> --> I am 100% with you on the need to assess potentials, clues, "what are the bad things I could be missing", what do I need to rule out. I agree. BUT I don't find the photos useful in this context; verbal is better to help me focus on a scene if I cannot see it first hand. I won't stop others using photos and I am glad if they find photos help them. They don't seem to help me. I make a point of looking at every picture presented to me for long enough to make the person who took the trouble feel appreciated and I thank them for their efforts. Whenever the point comes up for discussion with pre-hospital crews and they want to know what sort of photography our ED (a "level one") would like to receive generally, we say "none". Still, I agree 100% that mechanism is important and, even when it turns out not to be, remembering to think about it STILL IS!                         
>>> --
>>> 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/


More information about the trauma-list mailing list