Operating Room Resuscitations

[Errington Thompson]

I would add that those patient that don't need to go to the OR but still
need significant resuscitation maybe better in the ICU than the ER or
anywhere else.  For the most part trauma surgeons run their own ICU's.
These are the nurses that have heard your lectures.  They come to your
conferences.  They know what you want.  

The ICU is a great place for patients who need resuscitation but DON'T need
the operating room. 

E

Errington C. Thompson, MD, FACS, FCCM
Trauma/Surgical Critical Care
Author - Letter to America
Asheville, NC

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of Ronald Gross
Sent: Wednesday, January 30, 2008 6:52 AM
To: trauma-list at trauma.org
Subject: Re: Operating Room Resuscitations

Yeah - what HE said!  ;-)

Matt, you and I are on the same page here - but you said it far better than
I did -   Thanks!

Take care,
Ron

>>> Matthew Reeds <mgreeds at reeds.uk.com> 1/30/2008 5:27 AM >>>

Mike & Ron,
When pontificating over the treatment that I give to any patient, I always
try to ask what I would want for myself and apply this to give the best
treatment to each patient. I would NOT want to be in an A&E/ED resuscitation
room but would "rather" be in either theatre/OR, ITU/HDU, the ward or
radiology (depending upon my injury) having the proper treatment that I
need. This is what I would strive for with any of my patients.
Therefore I see NO reason for the patient to remain in A&E/ED for
resuscitation. As Ron says, if the patient needs surgery, then off to
theatre/OR they go. If they need non-operative resuscitation, then off to
ITU or HDU they go for the care required. [This frees up theatre/OR
resources and time as Mike says if surgery is not required for better
utilisation.] Radiology resuscitation is ONLY required for THERAPEUTIC
intervention such as angio for pelvic haemorrhage and stabilisation (if the
extra-peritoneal pelvic packing approach is NOT used etc.)
>From my experience, there is NO need/role for A&E/ED resuscitation - if the
patient is that sick, then they need to be elsewhere (e.g. theatre/OR,
ITU/HDU etc.)
Even for major haemorrhage that requires surgery, these UNSTABLE patients
SHOULD be rapidly transported to theatre/OR for surgery for emergency
treatment. I would NOT NORMALLY advocate A&E/ED operating UNLESS absolutely
necessary which has happened to me on a couple of occasions [such as cardiac
arrest secondary to IVC transection at the bifurcation from multiple stab
wounds from a bayonet in a 19 year old male.] He had been "down" for 3 mins
when he arrived in A&E by paramedics/EMT and there was no way we could
transfer him to theatre/OR on the top floor (11th floor) and at the other
end of the hospital to save him - a fault of the hospital design. Therefore
we performed a laparotomy in the A&E/ED resus room and got him back with
RAPID abdominal packing and then transferred to theatre just as rapidly.
However, this should be a RARE occasion and ONLY be absolutely necessary to
imminently save life rather than be the norm. In essence this comes down to
clinical acumen, experience and ability of the clinician to use sound
judgment and I agree with Mike, that if the patient doesn't need surgery,
then theatre/OR is not the best place to resuscitate the patient - they
should be in the ITU/HDU instead.
 
Matthew
Surgery U.K.

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