penetrating posterior torax injury continued

[Robert Smith]

Richard,
 
I don't think there was an issue with your docs or your paramedics. From a
systems point of view, I think the primary issues was a lack of medical
control in the pre-hospital area; specifically a lack of standardized triage
protocols to determine which patients should be bypassed to a trauma center.
Secondarily I think your institution needs to put a protocol in place
dealing with how you will respond to seriously injured patients that you're
not prepared to treat who may suddenly show up for some reason. Not that you
don't have the surgical capability to treat them, just that as an
institution you're not set up to routinely handle it.
 
Rob Smith, MD
 
 

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From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of Richard van der Kleyn
Sent: Wednesday, November 01, 2006 10:36 AM
To: trauma-list at trauma.org
Subject: penetrating posterior torax injury continued


Thanks for your responsis so far. 
 
in reply to the ambulance triage: unfortunatly where i work the ambulance
personel are still relativly untrained--not more then a first aid degree and
some theoretical courses: the ambulance personal decided (rightly) not to
wait for the medicalised ambulance (medic and nurse) and transport the 5
miutes to our hospital instead of the 40 minutes to the trauma cente.
 
continue: the pacient sudenly entered into bradycardia without pulse and
reanamacion was started, the surgeon alerted the OR for an emergency
toracotomia ( with some advising on my part)  and advised the head of
surgery (two surgeons have to be present during OR), after 5 minutes the
pacient entered into sinus rithum with pulse. Instead of going to OR (the
head of surgery and the anestesiologist were agaist operating here) it was
again decided to transport the pacient to the trauma center, on reading the
pacient for transport she entered into asistolia and died after 30 minutes
of reanimacion.
 
Comments: a sad case of how a non prepered sistem failed a pacient.
Unfortunatly where i work (spain) ATLS is still in its early days ( I was
the only one in resus who has done the course) and having worked in an level
1 dutch trauma centrum know how the sistem should work. For this i want to
review this casa with my fellow emergency physicians and the surgical
department to improve our own respons to, thankely, rare cases in our part
of the world.

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