do we really need new toys?

[mayagoitia]

I completely agree that the industry tries to make you feel like you´re not 
doing things the proper way unless you use their gadget.
There might be very scarce situations in which you feel in dire need of 
these new toys, but the feeling is that if you didn´t use them you deprived 
the patient of an opportunity, eventhough there might not be any evidence 
that it would have made any major difference.

José Mayagoitia, MD, FACS
josemaya01 at prodigy.net.mx
----- Original Message ----- 
From: "Mike Smertka" <medic0947969 at yahoo.com>
To: <trauma-list at trauma.org>
Sent: Monday, September 24, 2007 9:39 AM
Subject: do we really need new toys?


> Hello all,
>
>  This weekend I attended a trauma care conference.
>
>  As with any convention that doesn't cost a fortune to attend, there were 
> vendors, who probably payed a fair sum to peddle their wares.
>
>  But here is my conundrum:
>
>  There were a bunch of chemical bandages, quick clot etc.
>  Do we really need chemical bandages? If we do, why doesn't a bandage 
> soaked in Epinepherine work just fine? It has worked in surgury for ages. 
> Furthermore, how many injuries are actually severe enough that a chemical 
> bandage will help, but direct pressure or pressure bandages will not?
>
>  Touniquets: There were at least 3 easy to use touniquets for sale. 
> Salesmen were of course trying to show demonstate how superior a specific 
> brand was over another. But how many people really need one? Has the use 
> of them gone up since there is now a few commercial ones?
>
>  Is any of this really needed outside the military? I concede that 
> battlefield medicine is another world compared to civilian medicine. 
> (though I have worked in some neighborhoods that should be considered a 
> battlefield) Is the new mantra of bleeding control: chemical bandage, 
> followed by tourniquet? How does all this play out in the civilian world? 
> What effects does it have on limb saving surgury? Life saving surgury for 
> that matter? So you use a chemical to stop external bleeding, does it stop 
> the liver from bleeding? The spleen? If you have such a massive bleed 
> anywhere but a limb, what is the chance you will survive anyway?
>
>  As for the mechanical assist tourniquet: In the military I am sure there 
> is not exactly an abundance of battlefield plastic or vascular surgeons, 
> but I am not in the military, I was under the impression that a tourniquet 
> was a measure of last resort and desperation. I spent a few years in a 
> level I civilian trauma center, with a patient load of ~90k ED patients 
> and 4500 trauma activations, I saw a tourniquet used only 1 time. Even 
> then, it was modified, to slow bleeding but not stop it, for the purpose 
> of trying to save the limb.
>
>  I would like to hear opinions on whether or not they think these gadgets 
> will have an overall positive or negative effect. does anyone forsee EMS 
> persons starting to use these like backboards? ie: where they are used on 
> everyone. "just in case."
>
>  Thanks for your time, hope to hear from as many as possible on this.
>
>  Mike
>
>
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