<html><div style='background-color:'><P>pleaseeeeeeeee i dont want to recieve any more mails from you.... i hate this shit of medicine.. i dont know howcome i'm in your data base// please erase me.... i repeat i DO NOT WANT TO RECIEVE MORE MAILS... I ' VE BEEN SENDING SEVERAL TIMES A REQUEST TO THE TRAUMA LIST TO UNSUSCRIBE.. BUT I DONT HAVE ANY Answer.. HELP ME PLEASEEEEEEEEEEEEEEEEE</P>
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<P>LUISA FERNANDA AUCAR</P>
<P>GUAYAQUIL - ECUADOR<BR><BR></P><BR><BR><BR>
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<P align=left><FONT face="Verdana, Geneva, Arial, Sans-serif" color=#0033cc><STRONG>LUISA FERNANDA AUCAR, ARQ. </STRONG></FONT></P>
<P align=left><FONT face="Verdana, Geneva, Arial, Sans-serif" color=#0033cc><STRONG>COLEGIO DE ARQUITECTOS DEL GUAYAS</STRONG></FONT></P>
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From: <I>C M <cmarg28@yahoo.com></I><BR>Reply-To: <I>"Trauma &amp; Critical Care mailing list" <trauma-list@trauma.org></I><BR>To: <I>trauma-list@trauma.org</I><BR>Subject: <I>Re: trauma-list Digest, Vol 38, Issue 2</I><BR>Date: <I>Tue, 1 Aug 2006 17:11:13 -0700 (PDT)</I><BR>Remove me from this list, you people need to grow up.<BR><BR>trauma-list-request@trauma.org wrote: Send trauma-list mailing list submissions to<BR>trauma-list@trauma.org<BR><BR>To subscribe or unsubscribe via the World Wide Web, visit<BR>http://list.mistral.net/mailman/listinfo/trauma-list<BR>or, via email, send a message with subject or body 'help' to<BR>trauma-list-request@trauma.org<BR><BR>You can reach the person managing the list at<BR>trauma-list-owner@trauma.org<BR><BR>When replying, please edit your Subject line so it is more specific<BR>than "Re: Contents of trauma-list digest..."<BR>Today's
Topics:<BR><BR>1. PLEASE STOP - AMPUTATION (KMATTOX@aol.com)<BR>2. Re: A Series of Unfortunate Events... (KMATTOX@aol.com)<BR>3. RE: Cease fire NOW or prehospital needle thoracotomy (Roy Danks)<BR>4. Help, Network, Florence Italy (KMATTOX@aol.com)<BR>5. RE: Help, Network, Florence Italy (Bob Waddell II)<BR>6. Fwd: ccml Re: Appendicitis/ CT (KMATTOX@aol.com)<BR>7. Re: Help, Network, Florence Italy (KMATTOX@aol.com)<BR>8. RE: PLEASE STOP - AMPUTATION (Hardcastle, Tim, Dr )<BR>9. Apology (bensonblues@comcast.net)<BR>10. Splenic function after embolization (Joe Nold)<BR>11. MAST/prehospital interventions - for prehospital providers<BR>(Bill Griggs)<BR>12. Re: MAST/prehospital interventions - for prehospital<BR>providers (Ian Seppelt)<BR>13. Re: PLEASE STOP - AMPUTATION (james9daly@eircom.net)<BR>14. RE: Cease fire NOW or pre hospital needle thoracotomy<BR>(STEWART, Paul)<BR>15. Re: Cease
fire NOT (Ronald Gross)<BR>16. Re: PLEASE STOP - AMPUTATION (Ronald Gross)<BR>17. Fwd: ccml Re: Appendicitis/ CT (Ronald Gross)<BR>18. Re: PLEASE STOP - AMPUTATION (Karim Brohi)<BR>19. Re: PLEASE STOP - AMPUTATION (Tony Joseph)<BR>From: KMATTOX@aol.com<BR>Subject: PLEASE STOP - AMPUTATION<BR>Date: Mon, 31 Jul 2006 22:28:52 EDT<BR>To: trauma-list@trauma.org<BR><BR>Dr. Karim, the web master of this site has asked us nicely to STOP the<BR>political dialogue. Many very good clinicians have dropped out. We the<BR>majority are allowing a few terrorist to destroy a very good, yes a wonderful web<BR>site.<BR><BR>I vote that effective immediately, the webmaster AMPUTATE the name and<BR>address of any offender from this list, IMMEDIATELY and without notice,<BR>permission, informed consent or anesthesia, JUST DO IT.<BR><BR>Karim needs a second to this motion, and then he can count the votes any
way<BR>he wishes.<BR><BR>DO NOT BE A PARTY TO THE DEATH AND DESTRUCTION of Trauma.org and<BR>Trauma-list.<BR><BR>k<BR><BR>From: KMATTOX@aol.com<BR>Subject: Re: A Series of Unfortunate Events...<BR>Date: Mon, 31 Jul 2006 22:41:40 EDT<BR>To: trauma-list@trauma.org<BR><BR>Ceasr: I applaud what you did. I am not critical. As you described the<BR>findings, you procedure was a good judgment and option. You have a<BR>protective ileostomy. I like your moving slow. Keep up the good work and<BR>the positive progress notes.<BR><BR>k<BR><BR>From: "Roy Danks" <roydanks@hotmail.com><BR>Subject: RE: Cease fire NOW or prehospital needle thoracotomy<BR>Date: Mon, 31 Jul 2006 21:45:39 -0500<BR>To: "Forrest Robleto" <trauma-list@trauma.org><BR><BR>> Subject: Re: Cease fire NOW or prehospital needle thoracotomy<BR>><BR>> I guess I stand corrected. I got that information from a source I
normally<BR>> consider reliable. It sounded reasonable so I believed it.<BR>><BR>> Is elevation of the lower extremities useful in hypoperfusion for those of<BR>> us without the ability to introduce fluids?<BR><BR>It ain't about BP, it's all about cellular perfusion and reversing/preventing metabolic acidosis, ie: DO2<BR><BR><BR>Ann Emerg Med. 1994 Mar;23(3):564-7. Links<BR>Trendelenburg position and oxygen transport in hypovolemic adults.Sing RF, O'Hara D, Sawyer MA, Marino PL.<BR>Department of Surgery, Graduate Hospital, Philadelphia.<BR><BR>STUDY OBJECTIVE: To evaluate the effect of the Trendelenburg position on oxygen transport in hypovolemic patients. DESIGN: A prospective, self-controlled sequential design. INTERVENTIONS: All patients had indwelling pulmonary artery catheters, and hypovolemia was confirmed by a pulmonary artery wedge pressure of 6 mm Hg or less.
Hemodynamic and oxygen transport variables were measured with the patient supine and again ten minutes after placing the patient in the Trendelenburg position. SETTING: University-affiliated tertiary care surgical ICU. TYPE OF PARTICIPANTS: Eight postoperative adults. RESULTS: Mean arterial blood pressure increased from 64.9 +/- 4.9 to 75.6 +/- 3.5 mm Hg (P < .05), pulmonary artery wedge pressure increased from 4.6 +/- 1.1 to 7.9 +/- 0.8 mm Hg (P < .05), and the systemic vascular resistance rose to 2,965 +/- 210 from 2,302 +/- 199 dyne.sec/cm5 (P < .05). There was no significant change in cardiac index, oxygen delivery, oxygen consumption, or oxygen<BR>extraction ratio. CONCLUSION: The increase in blood pressure from Trendelenburg position is not associated with an improvement in blood flow or tissue oxygenation.<BR><BR><BR><BR>Why can you not introduce fluids? Level of
training? Situation? Please explain.<BR><BR>RRD<BR><BR>_________________________________________________________________<BR>Try Live.com - your fast, personalized homepage with all the things you care about in one place.<BR>http://www.live.com/getstarted<BR>From: KMATTOX@aol.com<BR>Subject: Help, Network, Florence Italy<BR>Date: Mon, 31 Jul 2006 22:56:13 EDT<BR>To: trauma-list@trauma.org<BR><BR>I do hope that this is not out of bounds for this list server. One of the<BR>real beauties of this list is to have the ability to network world wide.<BR><BR>The college age son of our Trauma EC Nurse Manager is going to Florence<BR>Italy for several months soon and would like to just have the name of a physician<BR>contact, particularly a trauma surgeon. Any advice.<BR><BR>k<BR><BR>From: "Bob Waddell II" <bobwaddell@bresnan.net><BR>Subject: RE: Help, Network, Florence Italy<BR>CC:
"'giuliana.bruno@l'" <giuliana.bruno@libero.it><BR>Date: Mon, 31 Jul 2006 21:00:20 -0600<BR>To: "'Trauma &amp; Critical Care mailing list'" <trauma-list@trauma.org><BR><BR>Contact Giuliana Bruno - she is a trauma surgeon in Turin, but has<BR>significant contacts throughout the entire country. Her contact<BR>information is: giuliana.bruno@libero.it Hope this helps.<BR><BR><BR>Take care,<BR><BR>Bob<BR><BR>Robert K. Waddell II<BR><BR>Vice President - Emergency Preparedness and Response<BR><BR>"The Sacco Triage Methodology"<BR><BR>307 920 2020 (c)<BR><BR>bobwaddell@bresnan.net<BR><BR>www.sharpthinkers.com<BR><BR><BR>-----Original Message-----<BR>From: trauma-list-bounces@trauma.org<BR>[mailto:trauma-list-bounces@trauma.org] On Behalf Of KMATTOX@aol.com<BR>Sent: Monday, July 31, 2006 8:56 PM<BR>To: trauma-list@trauma.org<BR>Subject: Help, Network, Florence Italy<BR><BR>I do
hope that this is not out of bounds for this list server. One<BR>of the<BR>real beauties of this list is to have the ability to network world<BR>wide.<BR><BR>The college age son of our Trauma EC Nurse Manager is going to Florence<BR><BR>Italy for several months soon and would like to just have the name of a<BR>physician<BR>contact, particularly a trauma surgeon. Any advice.<BR><BR>k<BR>--<BR>trauma-list : TRAUMA.ORG<BR>To change your settings or unsubscribe visit:<BR>http://www.trauma.org/traumalist.html<BR><BR><BR><BR>From: KMATTOX@aol.com<BR>Subject: Fwd: ccml Re: Appendicitis/ CT<BR>Date: Mon, 31 Jul 2006 23:12:58 EDT<BR>To: trauma-list@trauma.org<BR><BR><BR>From: "Brian Shapiro" <siddsidd@comcast.net><BR>To: <KMATTOX@aol.com><BR>Subject: Re: ccml Re: Appendicitis/ CT<BR>Date: Mon, 31 Jul 2006 23:11:14 -0400<BR><BR>I think there is little reason to perform an appendectomy
in the middle of the night. I perform most appendectomies laprascopically as an outpatient the next morning (if I get the consult after about 9pm), 6am is a great time to do an appendix.I start antibiotics once diagnosis is made. For the last several months I have been using the 36 hour rule (see last reference) declaring an emergency when that time is approached (day or night). Now I am on call at least every other night (for the last 13 years without residents). I think the literature supports this approach. CT scanning has decreased negative appendectomy rate (at my hospital from almost 20% to 5%).<BR><BR><BR>1. J Pediatr Surg. 2005 Dec;40(12):1912-5.<BR>Emergent vs urgent appendectomy in children: a study of outcomes.<BR><BR><BR>2.: World J Surg. 2006 Jun;30(6):1033-7. Appendectomy versus antibiotic treatment in acute appendicitis. a prospective multicenter randomized controlled
trial.<BR><BR><BR>J Am Coll Surg. 2006 Mar;202(3):401-6. Epub 2006 Jan 18.<BR>How time affects the risk of rupture in appendicitis<BR><BR><BR><BR><BR>Brian Shapiro MD FACS<BR>Trauma Director<BR>Chief of Surgery<BR>Genesys Health System<BR>Grand Blanc Michigan<BR>----- Original Message -----<BR>From: KMATTOX@aol.com<BR>To: kirkmahon@hotmail.com ; ccm-l@ccm-l.org<BR>Sent: Monday, July 31, 2006 10:22 PM<BR>Subject: ccml Re: Appendicitis/ CT<BR><BR><BR>In a message dated 7/31/2006 5:11:40 P.M. Central Standard Time, kirkmahon@hotmail.com writes:<BR>Otherwise, they ALL get CT. It is an innordinate<BR>drain on ER resources. Frankly, I feel it is often a maneuver to avoid<BR>coming in to examine the patient until the last possible moment. I would<BR>love Dr. Mattox to train more of the guys/gals from the Tub to actually<BR>practice that way in real life (sans CT dependency.)<BR><BR>Ex Baylor
Med Student and Grad from the Tub.....practicing in Dallas, TX,<BR><BR><BR>I fear, I really do fear that the request for the CT scan by surgeons in patients with suspected appendicitis is a temporizing move to get more tests during the night, so they dont have to come into the hospital to operate until daylight hours giving the appendix a greater chance to rupture, due to physician (surgeon) delay. Even in the current days of some physicians at the Ben Taub General Hospital (county hospital in Houston), some persons, and yes even at times some of our junior surgical residents who have recently rotated in the private hospital order CT scans. The attitude adjustment capabilities of our educational offerings in the M&M conference are not the same reinforcement and discipline producing as former years.<BR><BR>k<BR>From: KMATTOX@aol.com<BR>Subject: Re: Help, Network, Florence Italy<BR>CC:
giuliana.bruno@libero.it<BR>Date: Mon, 31 Jul 2006 23:13:47 EDT<BR>To: trauma-list@trauma.org<BR><BR>Bob, thank you so very very much<BR><BR>This is a wonderful list with even better members<BR><BR>k<BR><BR>From: "Hardcastle, Tim, Dr <tch@sun.ac.za>" <tch@sun.ac.za><BR>Subject: RE: PLEASE STOP - AMPUTATION<BR>Date: Tue, 1 Aug 2006 06:43:27 +0200<BR>To: "Trauma &amp; Critical Care mailing list" <trauma-list@trauma.org><BR><BR>Ken<BR><BR>As per the suggestion: SECONDED! (I'm sure Tony Joseph from Down Under would agree - he suggested this last week already!)<BR><BR>Tim<BR>Dr T C Hardcastle<BR>M.B.,Ch.B.(Stell); M.Med(Chir); FCS(SA)<BR>Senior Surgeon / Senior Lecturer: Surgery (Trauma and ICU)<BR>ATLS instructor and DSTC Cape Town Course Director<BR>Intern program Coordinator: Surgery<BR>Program Manager: Emergency Medicine (SU)<BR>Clinical Head (Director): Diana
Princess of Wales Trauma Unit<BR>Department of Surgery Room 4064<BR>Tygerberg Hospital / University of Stellenbosch<BR>PO Box 19063<BR>Tygerberg 7505<BR>Western Cape<BR>South Africa<BR>e-mail: tch@sun.ac.za<BR>Cell: +27824681615<BR>Office: +27219389281 or 4911 pager 0302<BR><BR><BR><BR>-----Original Message-----<BR>From: trauma-list-bounces@trauma.org<BR>[mailto:trauma-list-bounces@trauma.org]On Behalf Of KMATTOX@aol.com<BR>Sent: Tuesday, August 01, 2006 4:29 AM<BR>To: trauma-list@trauma.org<BR>Subject: PLEASE STOP - AMPUTATION<BR><BR><BR>Dr. Karim, the web master of this site has asked us nicely to STOP the<BR>political dialogue. Many very good clinicians have dropped out. We the<BR>majority are allowing a few terrorist to destroy a very good, yes a wonderful web<BR>site.<BR><BR>I vote that effective immediately, the webmaster AMPUTATE the name and<BR>address of any offender from this
list, IMMEDIATELY and without notice,<BR>permission, informed consent or anesthesia, JUST DO IT.<BR><BR>Karim needs a second to this motion, and then he can count the votes any way<BR>he wishes.<BR><BR>DO NOT BE A PARTY TO THE DEATH AND DESTRUCTION of Trauma.org and<BR>Trauma-list.<BR><BR>k<BR>--<BR>trauma-list : TRAUMA.ORG<BR>To change your settings or unsubscribe visit:<BR>http://www.trauma.org/traumalist.html<BR><BR>From: bensonblues@comcast.net<BR>Subject: Apology<BR>Date: Tue, 01 Aug 2006 04:46:11 +0000<BR>To: trauma-list@trauma.org<BR><BR>Karim,<BR><BR>You are right, and I am sorry. I will forever remained focused like alaser beam.<BR><BR>DB<BR>From: Joe Nold <jnoldscarmaker@yahoo.com><BR>Subject: Splenic function after embolization<BR>Date: Mon, 31 Jul 2006 21:56:44 -0700 (PDT)<BR>To: "Trauma &amp, Critical Care mailing list" <trauma-list@trauma.org><BR><BR>Can
anyone give some guidance on any recent studies of splenic function after embolization.<BR>I've found some from the 80's looking at auto-transplantation, but can't find much dealing with post-embo spleens.<BR><BR>Any help would be appreciated.<BR><BR>jnoldscarmaker@yahoo.com<BR><BR><BR>---------------------------------<BR>Do you Yahoo!?<BR>Next-gen email? Have it all with the all-new Yahoo! Mail Beta.<BR>From: "Bill Griggs" <wgriggs@bigpond.net.au><BR>Subject: MAST/prehospital interventions - for prehospital providers<BR>CC: "Trauma &amp; Critical Care mailing list" <trauma-list@trauma.org><BR>Date: Tue, 1 Aug 2006 15:19:37 +0930<BR>To: <farcpr@gmail.com><BR><BR>Hi Forrest,<BR><BR>My name is Bill Griggs. I am a medical specialist and the Director of<BR>Trauma at an Australian Major Trauma Centre. I also spent 15 years working<BR>as a road paramedic and a total of
over 30 years working for, and with,<BR>Ambulance Services. I assume from your post and from your website that you<BR>are involved in prehospital care? I am pleased to see prehospital care<BR>providers and other non-medical specialists having the "courage" (a careful<BR>and deliberate choice of word given some of the responses that one may be<BR>subjected to!) to post questions here.<BR><BR>One of the problems we have as Ambulance Officer/Paramedic/EMTs is that<BR>during our training we tend to be given "facts" which for the most part we<BR>have to accept. The same can be true for medical students. Unfortunately<BR>medicine is as much art as it is science. So, as new data are uncovered<BR>sometimes these "facts" change.<BR><BR>So, as a couple of prehospital examples....<BR>- in the past I have used MAST but based on the current data I would not do<BR>so again.<BR>- in the past I have
given bicarbonate and calcium routinely for cardiac<BR>arrest but based on the current data I would not do so again.<BR><BR>I note that, for both of these interventions, I can remember individual<BR>cases where there seemed to be an apparent improvement in a patient's<BR>condition which was related in time to these interventions. However the<BR>data are very clear, for any identifiable group of patients they are bad and<BR>worsen outcome. It is really important to avoid the "in my experience"<BR>fallacy when there are clear data to guide practice.<BR><BR>Did I hurt people with these (and other) interventions? Probably. Do I<BR>worry about that? A little. How do I deal with that? I try to accept that<BR>I was doing what I understood was the best treatment at the time, and that<BR>what the best treatment might be, is constantly subject to change.<BR><BR>Am I doing something in my practice
now which, in 5 or 10 years time (or<BR>sooner), will be shown to be hurting people? Undoubtedly. Do I know which<BR>bit(s) of my practice that is? No. So, I am hurting some people. What are<BR>my options?<BR>(1) quit medicine and take up basket weaving or something else. (No offence<BR>intended to any avid basket weavers out there :-))<BR>(2) keep going and try to adapt my practice in the face of new evidence -<BR>this means I have to admit to myself that I may be doing things which are<BR>bad for my patients. This is an extremely important admission because it<BR>allows me to discard bad practices when they are identified as such, and not<BR>cling to them for the sake of "tradition" or because to change would mean I<BR>have to admit I was wrong. I have already admitted I am wrong in advance!<BR><BR>With regard to you question about hypoperfused patients, one of the issues<BR>is that
they are many causes of hypoperfusion. Perhaps not surprisingly,<BR>what might be good for one cause may be bad for another. To look at your<BR>example of leg raising, a person who is about to faint but who has normal<BR>blood volume may benefit from being laid flat and even from having their<BR>legs raised. This should improve perfusion to the brain and possibly<BR>prevent them fainting. However, while a person who may be about to pass out<BR>from internal blood loss could be laid flat, raising the legs is not clearly<BR>of benefit and may actually cause harm.<BR><BR>One theory is when you are bleeding internally, the resulting lowering of<BR>your blood pressure and vasoconstriction may both act to slow the rate of<BR>ongoing bleeding - presumably a good thing! If you raise the legs and<BR>"autotransfuse" the patient you may raise the blood pressure and the venous<BR>filling pressures
"tricking" the body's pressure and volume receptors into<BR>decreasing the amount of vasoconstriction. In turn these two factors<BR>(raised BP and decreased vasoconstriction) turn may lead to an increase in<BR>the rate of bleeding and a hastening of the patient's death.<BR><BR>Clearly there can be many variables and what actually happens will be<BR>different from patient to patient.<BR><BR>However there are pretty good data showing that transfusing/ infusing<BR>patients who have ongoing bleeding without controlling the bleeding is a bad<BR>thing. I can provide references if you like, but a search of Medline will<BR>enable you to find articles yourself without having me filter them to<BR>provide the ones that support my own viewpoint! You do need to learn how to<BR>assess articles and their raw data, to enable you to make your own make<BR>judgements. This is because, unfortunately,
abstracts and conclusions seem<BR>too often to be at significant variance from what the actual data may say!<BR>But decide for yourself.<BR><BR>One more point which is important for prehospital providers to understand.<BR>The best measure of results is patient outcome across a group of patients.<BR>However this is not what they are like when we drop them in the ER. It is<BR>whether they get to go home and what their quality of life is long term.<BR>Some people will argue that pre-hospital providers can not be responsible<BR>for what happens in a hospital and therefore the only end point is condition<BR>on arrival at ER. This argument is just plain wrong. Just think what you<BR>would want if you were the patient? To have a "good" blood pressure on<BR>arrival at the ER or to be able to go home alive? They may not be related<BR>to each other. They may, in some cases, even be alternative
choices.<BR><BR>Finally, am I a reliable source? I think so, but maybe not. I have tried<BR>to explain my rationale/reasoning and I have told you my background for<BR>context. I have told you about data but not shown that data to you, so my<BR>words must be treated with a degree of healthy scepticism. Bottom line? -<BR>if you want to know the answer to something, try looking for some real data<BR>and critically analyse it yourself - Medline(R) is a good place to start.<BR>Failing that, ask others, but ask more than one person from more than one<BR>background, and ask them to please explain the rationale for their views.<BR>"Coz I say so!" probably doesn't cut it, if you are over 5 years old....<BR><BR>regards<BR><BR>Bill<BR><BR>Dr William M Griggs AM<BR>Director Trauma Service<BR>Royal Adelaide Hospital<BR>South Australia<BR>wgriggs@bigpond.net.au<BR><BR><BR>----- Original Message
-----<BR>From: "Forrest Robleto"<BR>To: "Trauma &, Critical Care mailing list"<BR>Sent: Tuesday, August 01, 2006 11:52 AM<BR>Subject: Re: Cease fire NOW or prehospital needle thoracotomy<BR><BR><BR>I guess I stand corrected. I got that information from a source I normally<BR>consider reliable. It sounded reasonable so I believed it.<BR><BR>Is elevation of the lower extremities useful in hypoperfusion for those of<BR>us without the ability to introduce fluids?<BR><BR><BR>On 7/31/06, docrickfry@aol.com wrote:<BR>><BR>> I disagree with this urban legend presented as some sort of authoritative<BR>> fact--please cite just ONE study showing any benefit whatever to MAST<BR>> trousers in Vietnam in improving casualty outcomes. I hope you realize<BR>> that<BR>> simply raising a blood pressure reading in no way indicates that there was<BR>> any benefit whatever?<BR>>
ERF<BR>><BR>><BR>> -----Original Message-----<BR>> From: farcpr@gmail.com<BR>> To: trauma-list@trauma.org<BR>> Sent: Mon, 31 Jul 2006 10:41 AM<BR>> Subject: Re: Cease fire NOW or prehospital needle thoracotomy<BR>><BR>><BR>> MAST trousers got pretty good results in Viet Nam with young otherwise<BR>> healthy men. When applied accross the general population they didn't fare<BR>> as well.<BR><BR><BR><BR>From: "Ian Seppelt" <SeppelI@wahs.nsw.gov.au><BR>Subject: Re: MAST/prehospital interventions - for prehospital providers<BR>CC: trauma-list@trauma.org<BR>Date: Tue, 01 Aug 2006 16:47:51 +1000<BR>To: <wgriggs@bigpond.net.au><BR><BR>Amen.<BR><BR>Cheers, Ian<BR><BR>Ian Seppelt FANZCA FJFICM<BR>Senior Staff Specialist<BR>Dept of Intensive Care Medicine<BR>The Nepean Hospital, PO Box 63 Penrith NSW 2751<BR>Clinical Lecturer, University of
Sydney<BR><BR>>>> wgriggs@bigpond.net.au 1/08/2006 3:49pm >>><BR>Hi Forrest,<BR><BR>My name is Bill Griggs. I am a medical specialist and the Director of<BR><BR>Trauma at an Australian Major Trauma Centre. I also spent 15 years<BR>working<BR>as a road paramedic and a total of over 30 years working for, and with,<BR><BR>Ambulance Services. I assume from your post and from your website that<BR>you<BR>are involved in prehospital care? I am pleased to see prehospital care<BR><BR>providers and other non-medical specialists having the "courage" (a<BR>careful<BR>and deliberate choice of word given some of the responses that one may<BR>be<BR>subjected to!) to post questions here.<BR><BR>One of the problems we have as Ambulance Officer/Paramedic/EMTs is that<BR><BR>during our training we tend to be given "facts" which for the most part<BR>we<BR>have to accept. The same can be
true for medical students.<BR>Unfortunately<BR>medicine is as much art as it is science. So, as new data are<BR>uncovered<BR>sometimes these "facts" change.<BR><BR>So, as a couple of prehospital examples....<BR>- in the past I have used MAST but based on the current data I would<BR>not do<BR>so again.<BR>- in the past I have given bicarbonate and calcium routinely for<BR>cardiac<BR>arrest but based on the current data I would not do so again.<BR><BR>I note that, for both of these interventions, I can remember individual<BR><BR>cases where there seemed to be an apparent improvement in a patient's<BR>condition which was related in time to these interventions. However<BR>the<BR>data are very clear, for any identifiable group of patients they are<BR>bad and<BR>worsen outcome. It is really important to avoid the "in my experience"<BR><BR>fallacy when there are clear data to guide
practice.<BR><BR>Did I hurt people with these (and other) interventions? Probably. Do<BR>I<BR>worry about that? A little. How do I deal with that? I try to accept<BR>that<BR>I was doing what I understood was the best treatment at the time, and<BR>that<BR>what the best treatment might be, is constantly subject to change.<BR><BR>Am I doing something in my practice now which, in 5 or 10 years time<BR>(or<BR>sooner), will be shown to be hurting people? Undoubtedly. Do I know<BR>which<BR>bit(s) of my practice that is? No. So, I am hurting some people.<BR>What are<BR>my options?<BR>(1) quit medicine and take up basket weaving or something else. (No<BR>offence<BR>intended to any avid basket weavers out there :-))<BR>(2) keep going and try to adapt my practice in the face of new evidence<BR>-<BR>this means I have to admit to myself that I may be doing things which<BR>are<BR>bad for my patients.
This is an extremely important admission because<BR>it<BR>allows me to discard bad practices when they are identified as such,<BR>and not<BR>cling to them for the sake of "tradition" or because to change would<BR>mean I<BR>have to admit I was wrong. I have already admitted I am wrong in<BR>advance!<BR><BR>With regard to you question about hypoperfused patients, one of the<BR>issues<BR>is that they are many causes of hypoperfusion. Perhaps not<BR>surprisingly,<BR>what might be good for one cause may be bad for another. To look at<BR>your<BR>example of leg raising, a person who is about to faint but who has<BR>normal<BR>blood volume may benefit from being laid flat and even from having<BR>their<BR>legs raised. This should improve perfusion to the brain and possibly<BR>prevent them fainting. However, while a person who may be about to<BR>pass out<BR>from internal blood loss could be laid
flat, raising the legs is not<BR>clearly<BR>of benefit and may actually cause harm.<BR><BR>One theory is when you are bleeding internally, the resulting lowering<BR>of<BR>your blood pressure and vasoconstriction may both act to slow the rate<BR>of<BR>ongoing bleeding - presumably a good thing! If you raise the legs and<BR><BR>"autotransfuse" the patient you may raise the blood pressure and the<BR>venous<BR>filling pressures "tricking" the body's pressure and volume receptors<BR>into<BR>decreasing the amount of vasoconstriction. In turn these two factors<BR>(raised BP and decreased vasoconstriction) turn may lead to an increase<BR>in<BR>the rate of bleeding and a hastening of the patient's death.<BR><BR>Clearly there can be many variables and what actually happens will be<BR>different from patient to patient.<BR><BR>However there are pretty good data showing that transfusing/
infusing<BR>patients who have ongoing bleeding without controlling the bleeding is<BR>a bad<BR>thing. I can provide references if you like, but a search of Medline<BR>will<BR>enable you to find articles yourself without having me filter them to<BR>provide the ones that support my own viewpoint! You do need to learn<BR>how to<BR>assess articles and their raw data, to enable you to make your own make<BR><BR>judgements. This is because, unfortunately, abstracts and conclusions<BR>seem<BR>too often to be at significant variance from what the actual data may<BR>say!<BR>But decide for yourself.<BR><BR>One more point which is important for prehospital providers to<BR>understand.<BR>The best measure of results is patient outcome across a group of<BR>patients.<BR>However this is not what they are like when we drop them in the ER. It<BR>is<BR>whether they get to go home and what their quality of
life is long<BR>term.<BR>Some people will argue that pre-hospital providers can not be<BR>responsible<BR>for what happens in a hospital and therefore the only end point is<BR>condition<BR>on arrival at ER. This argument is just plain wrong. Just think what<BR>you<BR>would want if you were the patient? To have a "good" blood pressure on<BR><BR>arrival at the ER or to be able to go home alive? They may not be<BR>related<BR>to each other. They may, in some cases, even be alternative choices.<BR><BR>Finally, am I a reliable source? I think so, but maybe not. I have<BR>tried<BR>to explain my rationale/reasoning and I have told you my background for<BR><BR>context. I have told you about data but not shown that data to you,<BR>so my<BR>words must be treated with a degree of healthy scepticism. Bottom<BR>line? -<BR>if you want to know the answer to something, try looking for some
real<BR>data<BR>and critically analyse it yourself - Medline(R) is a good place to<BR>start.<BR>Failing that, ask others, but ask more than one person from more than<BR>one<BR>background, and ask them to please explain the rationale for their<BR>views.<BR>"Coz I say so!" probably doesn't cut it, if you are over 5 years<BR>old....<BR><BR>regards<BR><BR>Bill<BR><BR>Dr William M Griggs AM<BR>Director Trauma Service<BR>Royal Adelaide Hospital<BR>South Australia<BR>wgriggs@bigpond.net.au<BR><BR><BR>----- Original Message -----<BR>From: "Forrest Robleto"<BR>To: "Trauma &, Critical Care mailing list"<BR>Sent: Tuesday, August 01, 2006 11:52 AM<BR>Subject: Re: Cease fire NOW or prehospital needle thoracotomy<BR><BR><BR>I guess I stand corrected. I got that information from a source I<BR>normally<BR>consider reliable. It sounded reasonable so I believed it.<BR><BR>Is elevation of the lower
extremities useful in hypoperfusion for those<BR>of<BR>us without the ability to introduce fluids?<BR><BR><BR>On 7/31/06, docrickfry@aol.com wrote:<BR>><BR>> I disagree with this urban legend presented as some sort of<BR>authoritative<BR>> fact--please cite just ONE study showing any benefit whatever to<BR>MAST<BR>> trousers in Vietnam in improving casualty outcomes. I hope you<BR>realize<BR>> that<BR>> simply raising a blood pressure reading in no way indicates that<BR>there was<BR>> any benefit whatever?<BR>> ERF<BR>><BR>><BR>> -----Original Message-----<BR>> From: farcpr@gmail.com<BR>> To: trauma-list@trauma.org<BR>> Sent: Mon, 31 Jul 2006 10:41 AM<BR>> Subject: Re: Cease fire NOW or prehospital needle thoracotomy<BR>><BR>><BR>> MAST trousers got pretty good results in Viet Nam with young<BR>otherwise<BR>> healthy men. When
applied accross the general population they didn't<BR>fare<BR>> as well.<BR><BR><BR>--<BR>trauma-list : TRAUMA.ORG<BR>To change your settings or unsubscribe visit:<BR>http://www.trauma.org/traumalist.html<BR><BR>######################################################################<BR>Attention:<BR>This message is intended for the addresses named and may contain<BR>confidential information. If you are not the intended recipient, please<BR>delete it and notify the sender. Views expressed in this message are<BR>those of the individual sender, and are not necessarily the views of<BR>Sydney West Area Health Service.<BR><BR><BR>This e-mail has been scanned for viruses<BR>######################################################################<BR><BR>From: <james9daly@eircom.net><BR>Subject: Re: PLEASE STOP - AMPUTATION<BR>Date: Tue, 1 Aug 2006 10:23:34 +0100<BR>To: "Trauma &
Critical Care mailing list" <trauma-list@trauma.org><BR><BR>I second this motion,<BR><BR><BR>"Trauma & Critical Care mailing list" wrote:<BR><BR><<BR>< Dr. Karim, the web master of this site has asked us nicely to STOP the<BR>< political dialogue. Many very good clinicians have dropped out. We the<BR>< majority are allowing a few terrorist to destroy a very good, yes a wonderful web<BR>< site.<BR><<BR>< I vote that effective immediately, the webmaster AMPUTATE the name and<BR>< address of any offender from this list, IMMEDIATELY and without notice,<BR>< permission, informed consent or anesthesia, JUST DO IT.<BR><<BR>< Karim needs a second to this motion, and then he can count the votes any way<BR>< he wishes.<BR><<BR>< DO NOT BE A PARTY TO THE DEATH AND DESTRUCTION of Trauma.org and<BR>< Trauma-list.<BR><<BR>< k<BR><
--<BR>< trauma-list : TRAUMA.ORG<BR>< To change your settings or unsubscribe visit:<BR>< http://www.trauma.org/traumalist.html<BR><<BR><BR><BR><BR>-----------------------------------------------------------------<BR>Find the home of your dreams with eircom net property<BR>Sign up for email alerts now http://www.eircom.net/propertyalerts<BR><BR><BR><BR>From: "STEWART, Paul" <PStewart@ambulance.nsw.gov.au><BR>Subject: RE: Cease fire NOW or pre hospital needle thoracotomy<BR>Date: Tue, 1 Aug 2006 19:45:13 +1000<BR>To: "Trauma &amp; Critical Care mailing list" <trauma-list@trauma.org><BR><BR>Good grief, what have I started... Guys it was a sarcastic dig at irrelevant diatribe.<BR>I guess my Australian sense of humour is poorly understood across international borders...<BR>Please delete!<BR>MAST suits are only of use when correctly applied to political leaders with
uncontrolled pulmonary hypertension!<BR>Cheers<BR>Paul Stewart<BR>Paramedic<BR>ASNSW<BR><BR>-----Original Message-----<BR>From: docrickfry@aol.com [mailto:docrickfry@aol.com]<BR>Sent: Tuesday, August 01, 2006 2:30 AM<BR>To: trauma-list@trauma.org<BR>Subject: Re: Cease fire NOW or pre hospital needle thoracotomy<BR><BR>I am still waiting for any data whatever to support these so authoritative allegations of benefit--in fact, it is very easy to deny the prehospital benefits of MAST trousers--they were shown in a major prospective study almost 20 years ago not only to have no benefit, but to be of harm in the preshospital setting. It is amazing that such assertions continue to be spouted nonetheless. No data exists that these bulky and dangerous garments have any benefit in tamponading bleeding any more effectively than direct manual pressure or pressure dressings. Be careful of so
blatantly ignoring the tenets of modern medicine by asserting anecdote and conjecture as proven fact. You cannot support your statment with any data whatever.<BR>ERF<BR><BR><BR>-----Original Message-----<BR>From: medic541@hotmail.com<BR>To: trauma-list@trauma.org<BR>Sent: Mon, 31 Jul 2006 11:34 AM<BR>Subject: Re: Cease fire NOW or pre hospital needle thoracotomy<BR><BR><BR>Fact, direct pressure is used in controlling blood loss we agree??? One excellent use for controlling open wound blood loss, is direct pressure . Directly, m.a.s.t trousers were probably not effective in raising pressure but decreased circulatory volume was a result from increasing the pressure in the bladders to the legs, and therefore the blood was shunted away from the lower extremity, and replaced any blood loss with a crystalloid solution. As far as an urban legend, no one can deny that they have benefits pre
hospital but are certainly not the authority in controlling hypovolemia.<BR><BR>>From: docrickfry@aol.com<BR>>Reply-To: "Trauma & Critical Care mailing list"<BR>>><BR>>To: trauma-list@trauma.org<BR>>Subject: Re: Cease fire NOW or prehospital needle thoracotomy<BR>>Date: Mon, 31 Jul 2006 10:51:32 -0400<BR>><BR>>I disagree with this urban legend presented as some sort of authoritative >fact--please cite just ONE study showing any benefit whatever to MAST >trousers in Vietnam in improving casualty outcomes. I hope you realize >that simply raising a blood pressure reading in no way indicates that there >was any benefit whatever?<BR>>ERF<BR>><BR>><BR>>-----Original Message-----<BR>>From: farcpr@gmail.com<BR>>To: trauma-list@trauma.org<BR>>Sent: Mon, 31 Jul 2006 10:41 AM<BR>>Subject: Re: Cease fire NOW or prehospital needle
thoracotomy<BR>><BR>><BR>>MAST trousers got pretty good results in Viet Nam with young otherwise<BR>>healthy men. When applied accross the general population they didn't<BR>>fare as well.<BR>><BR>>On 7/31/06, Anthony caruso wrote:<BR>> ><BR>> > Paul, Im not sure what your asking about the Mast trousers comment.<BR>> > Is it two questions or are you trying to figure out how MAST<BR>> > trousers are used in combating Blodd loss? MAST trousers were<BR>> > removed from our units and throughout the state. They were excellent<BR>> > when used for immobilization >of femurs or pelvis FX and to<BR>> > tampanade bleeding, but there were no documented cases where<BR>> > auto-transfusion took place when inflated. However, that's not to<BR>> > say that i do not disagree with brining them back.<BR>> > Needle
thoracostmy is an advanced skill that is thought to all<BR>> > paramedics when attending school. However, unless the TPX causing<BR>> > pressure changes in the chest and pressing agents the heart then<BR>> > M.A.S.T trousers would be useless in this situation. Anyway Our<BR>> > state run office of Emergency Medical Services has there hands in<BR>> > too much of the paramedics daily activities. Hope you have more luck<BR>> > than we do Regards Anthony M. Caruso Paramedic/Town Of Natick Fire<BR>> > Department, Natick Massachusetts.<BR>> > >From: "STEWART, Paul"<BR><BR>> > >Reply-To: "Trauma & Critical Care mailing list"<BR>> > ><BR>> > >To: "Trauma & Critical Care mailing list"<BR>> > >Subject: RE: Cease fire NOW or prehospital needle thoracotomy<BR>> > >Date: Mon, 31 Jul 2006 17:23:12
+1000<BR>> > ><BR>> > > Do the Israeli military permit prehospital needle thoracotomies<BR>> > >and if so, what do the arab states think about bringing back the<BR>> > >MAST suit to combat this?<BR>> > >Perhaps we could ask the political leaders to provide us with an<BR>> > >>informed comment.....<BR>> > >My delete button needs replacing.<BR>> > ><BR>> > >Regards<BR>> > >Paul Stewart<BR>> > >Paramedic<BR>> > >ASNSW<BR>> > ><BR>> > >-----Original Message-----<BR>> > >From: Ronald Gross [mailto:Rgross@harthosp.org]<BR>> > >Sent: Monday, 31 July 2006 3:53 AM<BR>> > >To: Trauma & Critical Care mailing list<BR>> > >Subject: RE: Cease fire NOW<BR>> > ><BR>> > >Eric,<BR>> > ><BR>> > >Seems
that Tom has taken the Pulitzer Prize that Rob referred to -<BR>> > >this<BR>> > one<BR>> > >is for revisionist history........<BR>> > ><BR>> > >Take care,<BR>> > >Ron<BR>> > ><BR>> > > >>> "Thomas Anthony Horan" 7/30/2006 12:54 PM<BR>> > > >>> >>><BR>> > >Dear Erick,<BR>> > ><BR>> > >What is it that you don't understand? Every nation has a right to<BR>> > >self defense. In this case 2 soldiers were captured and a war broke<BR>> > >out. Why<BR>> > now<BR>> > >why this incident? Who knows?<BR>> > ><BR>> > >BUT, there is no one on this list who doesn't want to see Israel<BR>> > >and Palestine living in peace. Although we are moved by the horrors<BR>> > >of war<BR>> > on<BR>> >
>all sides, this is something a lot more dangerous than the usual<BR>> > >arab israeli conflict. Israeli military dominance is being broken<BR>> > >and a >cease fire won't save it. Olmerts colossal miscalculation<BR>> > >has united the terrorists, reinvigorated Syrian influence in<BR>> > >lebanon, a radical Shia >is the hero of the islamic world, Iran has<BR>> > >the US ocupied in Lebanon, and<BR>> > it<BR>> > >has silenced moderates in Egypt Jordan and Saudi Arabia. Is israel<BR>> > >>safer today than 2 weeks ago, despite the killing many innocents<BR>> > >and a few terrorists?<BR>> > ><BR>> > >IE It is an unmitigated disaster.<BR>> > ><BR>> > >An eye for an eye just dosn´t work, in this particular case it is<BR>> > >two captured soldiers for a
destroyed country.<BR>> > ><BR>> > >Tom<BR>> > ><BR>> > > > ----------<BR>> > > > From: docrickfry@aol.com[SMTP:docrickfry@aol.com]<BR>> > > > Reply To: Trauma & Critical Care mailing list<BR>> > > > Sent: domingo, 30 de julho de 2006 12:36<BR>> > > > To: trauma-list@trauma.org<BR>> > > > Subject: Re: Cease fire NOW<BR>> > > ><BR>> > > > I wonder what you would think, or what we would be advocating,<BR>> > > > if >our<BR>> > >third largest city, Chicago, were being indiscriminately fired<BR>> > >upon, unprovoked, by a splinter group over the border in Canada, as<BR>> > >Haifa is >in Israel as their third largest city, with innocent<BR>> > >American citizens >daily being killed, the Chicago train
station<BR>> > >destroyed, and the rest of the world began blaming us for trying to<BR>> > >take out those rockets across the border that the Canadian<BR>> > >government could do nothing about, and calling<BR>> > for<BR>> > >US to cease fire with no comment about the group continuing to fire<BR>> > >>upon us. Think about whether you would be saying the same thing<BR>> > >(call me<BR>> > naive,<BR>> > >but I really don't think so...)--to understand another you must<BR>> > >first >be able to walk a mile in their shoes. If you can honestly<BR>> > >say that you<BR>> > would<BR>> > >still be calling on US, unilaterally to stop defending ourselves,<BR>> > >then >at least you are consistent, tho I would question your<BR>> > >sanity.. I await >the first post
somehow telling me that this<BR>> > > > is different.......????<BR>> > > > ERF<BR>> > > ><BR>> > > ><BR>> > > > -----Original Message-----<BR>> > > > From: p.bjorn@netzero.net<BR>> > > > To: trauma-list@trauma.org<BR>> > > > Sent: Sun, 30 Jul 2006 7:19 AM<BR>> > > > Subject: Re: Cease fire NOW<BR>> > > ><BR>> > > ><BR>> > > > With sincere respect, I'd challenge you to objectively itemize<BR>> > > > the accomplishments of the Israeli military over the past couple<BR>> > > > of >weeks, or for that matter the Coalition of the Willing's<BR>> > > > over the past few<BR>> > >years.<BR>> > > ><BR>> > > > You're insisting that a cease-fire would be stupid; but it's<BR>> > >
> increasingly clear that our fire-for-effect mentality hasn't<BR>> > > > done >much for the future of humanity either.<BR>> > > ><BR>> > > > Civilization hasn't much of a chance until the "good guys"<BR>> > > > remember how to act civilized. We're allowing ourselves to be<BR>> > > > drawn in the other direction -- and if you ask my opinion, it's<BR>> > > > been entirely too<BR>> > >easy to do.<BR>> > > > Who would have thought in the fall of 2001 that it might ever<BR>> > > > become difficult to distinguish who the good guys are?<BR>> > > ><BR>> > > > Pret Bjorn<BR>> > > > Bangor, ME USA<BR>> > > ><BR>> > > ><BR>> > > > ----- Original Message -----<BR>> > > > From: "Ronald Gross"<BR>> >
> > To: "Trauma & Critical Care mailing list"<BR>> > > ><BR>> > > > Sent: Sunday, July 30, 2006 12:31 PM<BR>> > > > Subject: Re: Cease fire NOW<BR>> > > ><BR>> > > ><BR>> > > > Ron also said that the only thing a cease fire now would<BR>> > > > accomplish >is to make all of the world happy that they did<BR>> > > > something, while the >bad guys have just that much more time<BR>> > > > re-arming and preparing for their<BR>> > >next attacks.<BR>> > > > Cease fires do absolutely nothing unless there is a<BR>> > > > pre-determined plan that all know both sides will accept. We<BR>> > > > know this because we have seen history repeat itself for as long as it has been recorded.<BR>> > > > Ron<BR>> > >
><BR>> > > > >>> ******** ******** 7/30/2006 6:22 AM >>>><BR>> > > > Dear listers,<BR>> > > > I think this is a trauma forum and not a political arena.<BR>> > > > Is like going to a Trauma Congress and instead of listening<BR>> > > > Trauma topics we are hearing the speakers doing political analysis.<BR>> > > ><BR>> > > > George C. Georgiou<BR>> > > > Gen.Surgeon<BR>> > > > Xanthi Gen.Hospital<BR>> > > > Greece<BR>> > > ><BR>> > > ><BR>> > > > P.S. And while we are speaking our views freely -as Ron<BR>> > > > >said-innocent people are killed in Lebanon and Israel and<BR>> > > > 700.000 refugees are suffering in Lebanon.<BR>> > > > ... at least I would rather expect someone
of you saying ,Cease<BR>> > > > fire<BR>> > >NOW.<BR>> > > ><BR>> > > > G.<BR>> > > ><BR>> > > ><BR>> > > ><BR>> > > > --<BR>> > > > trauma-list : TRAUMA.ORG<BR>> > > > To change your settings or unsubscribe visit:<BR>> > > > http://www.trauma.org/traumalist.html<BR>> > > ><BR>> > > ><BR>> > > ><BR>> > > ><BR>> > > ><BR>> > > > --<BR>> > > > trauma-list : TRAUMA.ORG<BR>> > > > To change your settings or unsubscribe visit:<BR>> > > > http://www.trauma.org/traumalist.html<BR>> > > ><BR>> > > > --<BR>> > > > trauma-list : TRAUMA.ORG<BR>> > > > To change your settings or unsubscribe visit:<BR>> > > >
http://www.trauma.org/traumalist.html<BR>> > > > >_______________________________________________________________<BR>> > > > >_______<BR>> > > > __ Check out AOL.com today. Breaking news, video search,<BR>> > > > pictures, email and IM. All on demand. Always Free.<BR>> > > > --<BR>> > > > trauma-list : TRAUMA.ORG<BR>> > > > To change your settings or unsubscribe visit:<BR>> > > > http://www.trauma.org/traumalist.html<BR>> > > ><BR>> > >--<BR>> > >trauma-list : TRAUMA.ORG<BR>> > >To change your settings or unsubscribe visit:<BR>> > >http://www.trauma.org/traumalist.html<BR>> > ><BR>> > ><BR>> > ><BR>> > ><BR>> > ><BR>> > ><BR>> > ><BR>> >
>-----------------------------------------<BR>> > >Confidentiality Notice:<BR>> > >The information in this message is intended for the named<BR>> > >recipients<BR>> > only.<BR>> > >It may contain privileged and confidential information. If you are<BR>> > >not<BR>> > the<BR>> > >intended recipient, you must not copy, distribute, take any action<BR>> > >in reliance on it or disclose any details of this message to any<BR>> > >other<BR>> > person<BR>> > >or organisation. If you have received this message in error, please<BR>> > delete<BR>> > >this copy.<BR>> > ><BR>> > >The Ambulance Service of New South Wales has enabled e-mail<BR>> > >filtering >and monitoring.<BR>> ><BR>> ><BR>> > >--<BR>> > >trauma-list :
TRAUMA.ORG<BR>> > >To change your settings or unsubscribe visit:<BR>> > >http://www.trauma.org/traumalist.html<BR>> ><BR>> > _________________________________________________________________<BR>> > Express yourself instantly with MSN Messenger! Download today - it's >FREE!<BR>> > http://messenger.msn.click-url.com/go/onm00200471ave/direct/01/<BR>> ><BR>> > --<BR>> > trauma-list : TRAUMA.ORG<BR>> > To change your settings or unsubscribe visit:<BR>> > http://www.trauma.org/traumalist.html<BR>> ><BR>><BR>><BR>>-- V/R<BR>><BR>>Forrest Robleto<BR>>R House Health & Safety<BR>>www.RHouseTraining.com<BR>>FRobleto@RhouseTraining.com<BR>>609-792-9047<BR>>--<BR>>trauma-list : TRAUMA.ORG<BR>>To change your settings or unsubscribe
visit:<BR>>http://www.trauma.org/traumalist.html<BR>>________________________________________________________________________<BR>>Check out AOL.com today. Breaking news, video search, pictures, email and >IM. All on demand. Always Free.<BR>>--<BR>>trauma-list : TRAUMA.ORG<BR>>To change your settings or unsubscribe visit:<BR>>http://www.trauma.org/traumalist.html<BR><BR>_________________________________________________________________<BR>Don't just search. Find. Check out the new MSN Search! http://search.msn.click-url.com/go/onm00200636ave/direct/01/<BR><BR>--<BR>trauma-list : TRAUMA.ORG<BR>To change your settings or unsubscribe visit:<BR>http://www.trauma.org/traumalist.html<BR>________________________________________________________________________<BR>Check out AOL.com today. Breaking news, video search, pictures, email and IM. All on demand. Always
Free.<BR><BR><BR><BR>-----------------------------------------<BR>Confidentiality Notice:<BR>The information in this message is intended for the named recipients only. It may contain privileged and confidential information. If you are not the intended recipient, you must not copy, distribute, take any action in reliance on it or disclose any details of this message to any other person or organisation. If you have received this message in error, please delete this copy.<BR><BR>The Ambulance Service of New South Wales has enabled e-mail filtering and monitoring.<BR>From: "Ronald Gross" <Rgross@harthosp.org><BR>Subject: Re: Cease fire NOT<BR>Date: Tue, 01 Aug 2006 06:48:37 -0400<BR>To: <trauma-list@trauma.org><BR><BR>For cryin' out loud! I know that you really know how to unsubscribe<BR>from this list, so we now all acknowledge your public commentary without<BR>saying a word -
and I, for one, agree with your ideas, your ideals, and<BR>your right to express them where ever you choose to do so.<BR><BR>Having said that, please do not remove your name - you have been too<BR>much of a valuable contributor and friend.<BR><BR>Just my humble opinion!<BR>Ron<BR><BR>>>> 7/31/2006 5:43 PM >>><BR>Please unsubscribe me from the list.<BR><BR>RSS<BR><BR><BR>-----Original Message-----<BR>From: karim@trauma.org<BR>To: trauma-list@trauma.org<BR>Sent: Mon, 31 Jul 2006 2:15 PM<BR>Subject: RE: Cease fire NOT<BR><BR><BR>Please don't make me start moderating list messages.<BR>There are plenty of political discussion lists out there to have this<BR>sort of<BR>discussion.<BR>Meanwhile 5-10 members are unsubscribing daily while their mailboxes<BR>are filled<BR>with these off-topic posts.<BR><BR>So please stop and focus on trauma-specific discussions - or I
will<BR>stop it.<BR><BR>Karim<BR><BR>-----Original Message-----<BR>From: trauma-list-bounces@trauma.org<BR>[mailto:trauma-list-bounces@trauma.org] On<BR>Behalf Of bensonblues@comcast.net<BR>Sent: 31 July 2006 20:04<BR>To: trauma-list@trauma.org<BR>Subject: Cease fire NOT<BR><BR><BR>The West refuses to believe or can't understand radical Islam.<BR>Christians, Jews,<BR>agnostics, atheists, and secular muslims are<BR>infidels and apostates, and in the Quran it is clear: God has ordered<BR>that they<BR>be enslaved (woman, children) or killed if they do<BR>not convert. Hezbollah purposefully "martyrs" their own civilians in<BR>order to<BR>shift public opinion via the Western media. Recall the<BR>words of bin Laden: "Americans value life; we embrace death." It is<BR>disgusting<BR>that European nations don't side with Israel in its<BR>fight for its right to exist. The Israelis know all to well
what would<BR>happen if<BR>they capitulated to the demands and desires of the<BR>radicals. And once Israel falls, the "new" Ottoman Empire, in Dr.<BR>Zawahiri's own<BR>words, will easily metastasize "...to Spain."<BR><BR>Bush was right about the "axis of evil": Radiacal Islam is a disease<BR>which<BR>threaten the life of the West. If we looked at terrorism<BR>using the medical model, a cease fire is not appropriate therapy. The<BR>surgical<BR>approach to cancer is to 'cut it out' quickly, before<BR>it metastasizes, then use medical therapy to suppress reoccurance.<BR>Ahmadinejad<BR>should be highly scrutinized for his open material<BR>support of Hezbollah, and the 'doctor' treating radical Islam might<BR>want to<BR>think about some prophylactic measures. This is the way<BR>of the world, and it will always be this way. Even us medical people<BR>have to<BR>pick sides here. Note that some
of the most important<BR>and brutal people in radical Islam have been doctors.<BR><BR>DB<BR>--<BR>trauma-list : TRAUMA.ORG<BR>To change your settings or unsubscribe visit:<BR>http://www.trauma.org/traumalist.html<BR><BR>--<BR>trauma-list : TRAUMA.ORG<BR>To change your settings or unsubscribe visit:<BR>http://www.trauma.org/traumalist.html<BR>________________________________________________________________________<BR>Check out AOL.com today. Breaking news, video search, pictures, email<BR>and IM. All on demand. Always Free.<BR>--<BR>trauma-list : TRAUMA.ORG<BR>To change your settings or unsubscribe visit:<BR>http://www.trauma.org/traumalist.html<BR><BR><BR><BR><BR><BR>From: "Ronald Gross" <Rgross@harthosp.org><BR>Subject: Re: PLEASE STOP - AMPUTATION<BR>Date: Tue, 01 Aug 2006 06:52:55 -0400<BR>To: <trauma-list@trauma.org><BR><BR>OK Ken, against my better judgement, I will
second your motion, and I<BR>will refrain from any further comment about anything political.<BR><BR>As I see it, however, the terrorists have now tried to silence free<BR>speech and have won, at least on this site.....<BR><BR>Ron<BR><BR>>>> 7/31/2006 10:28 PM >>><BR>Dr. Karim, the web master of this site has asked us nicely to STOP the<BR><BR>political dialogue. Many very good clinicians have dropped out.<BR>We the<BR>majority are allowing a few terrorist to destroy a very good, yes a<BR>wonderful web<BR>site.<BR><BR>I vote that effective immediately, the webmaster AMPUTATE the name and<BR><BR>address of any offender from this list, IMMEDIATELY and without notice,<BR><BR>permission, informed consent or anesthesia, JUST DO IT.<BR><BR>Karim needs a second to this motion, and then he can count the votes<BR>any way<BR>he wishes.<BR><BR>DO NOT BE A PARTY TO THE DEATH AND
DESTRUCTION of Trauma.org and<BR>Trauma-list.<BR><BR>k<BR>--<BR>trauma-list : TRAUMA.ORG<BR>To change your settings or unsubscribe visit:<BR>http://www.trauma.org/traumalist.html<BR><BR><BR><BR><BR><BR>From: "Ronald Gross" <Rgross@harthosp.org><BR>Subject: Fwd: ccml Re: Appendicitis/ CT<BR>Date: Tue, 01 Aug 2006 06:57:16 -0400<BR>To: <trauma-list@trauma.org><BR><BR>I have now seen everything - and I am very sad.<BR><BR>>>> 7/31/2006 11:12 PM >>><BR><BR><BR><BR><BR><BR><BR>From: "Karim Brohi" <karimbrohi@gmail.com><BR>Subject: Re: PLEASE STOP - AMPUTATION<BR>Date: Tue, 1 Aug 2006 08:07:17 +0100<BR>To: "Trauma &amp, Critical Care mailing list" <trauma-list@trauma.org><BR><BR>Ken,<BR><BR>Thanks for this. However I find temporary shunting or ligation more useful<BR>in this sort of situation - even with such a destructive lesion - resorting<BR>to
amputation as a last resort. Provided there is still some use in the<BR>extremity, some sort of damage control procedure can usually be employed. I<BR>agree though that we may have to amputate to preserve the life of the list,<BR>or to remove a functionless appendage!<BR><BR>Karim<BR><BR>On 01/08/06, Hardcastle, Tim, Dr wrote:<BR>><BR>> Ken<BR>><BR>> As per the suggestion: SECONDED! (I'm sure Tony Joseph from Down Under<BR>> would agree - he suggested this last week already!)<BR>><BR>> Tim<BR>> Dr T C Hardcastle<BR>> M.B.,Ch.B.(Stell); M.Med(Chir); FCS(SA)<BR>> Senior Surgeon / Senior Lecturer: Surgery (Trauma and ICU)<BR>> ATLS instructor and DSTC Cape Town Course Director<BR>> Intern program Coordinator: Surgery<BR>> Program Manager: Emergency Medicine (SU)<BR>> Clinical Head (Director): Diana Princess of Wales Trauma Unit<BR>> Department of
Surgery Room 4064<BR>> Tygerberg Hospital / University of Stellenbosch<BR>> PO Box 19063<BR>> Tygerberg 7505<BR>> Western Cape<BR>> South Africa<BR>> e-mail: tch@sun.ac.za<BR>> Cell: +27824681615<BR>> Office: +27219389281 or 4911 pager 0302<BR>><BR>><BR>><BR>> -----Original Message-----<BR>> From: trauma-list-bounces@trauma.org<BR>> [mailto:trauma-list-bounces@trauma.org]On Behalf Of KMATTOX@aol.com<BR>> Sent: Tuesday, August 01, 2006 4:29 AM<BR>> To: trauma-list@trauma.org<BR>> Subject: PLEASE STOP - AMPUTATION<BR>><BR>><BR>> Dr. Karim, the web master of this site has asked us nicely to STOP the<BR>> political dialogue. Many very good clinicians have dropped out. We<BR>> the<BR>> majority are allowing a few terrorist to destroy a very good, yes a<BR>> wonderful web<BR>> site.<BR>><BR>> I vote that effective
immediately, the webmaster AMPUTATE the name and<BR>> address of any offender from this list, IMMEDIATELY and without notice,<BR>> permission, informed consent or anesthesia, JUST DO IT.<BR>><BR>> Karim needs a second to this motion, and then he can count the votes<BR>> any way<BR>> he wishes.<BR>><BR>> DO NOT BE A PARTY TO THE DEATH AND DESTRUCTION of Trauma.org and<BR>> Trauma-list.<BR>><BR>> k<BR>> --<BR>> trauma-list : TRAUMA.ORG<BR>> To change your settings or unsubscribe visit:<BR>> http://www.trauma.org/traumalist.html<BR>> --<BR>> trauma-list : TRAUMA.ORG<BR>> To change your settings or unsubscribe visit:<BR>> http://www.trauma.org/traumalist.html<BR>><BR><BR>From: Tony Joseph <tjoseph@ihug.com.au><BR>Subject: Re: PLEASE STOP - AMPUTATION<BR>Date: Tue, 01 Aug 2006 21:26:48 +1000<BR>To: trauma list
<trauma-list@trauma.org><BR><BR>Thanks Tim<BR>I have held my tongue and think other forums would be better to express<BR>personal views (and I do have some)<BR>The list should remain focused<BR>Regards<BR>Tony<BR><BR><BR>On 1/8/06 2:43 PM, "Hardcastle, Tim, Dr "<BR>wrote:<BR><BR>> Ken<BR>><BR>> As per the suggestion: SECONDED! (I'm sure Tony Joseph from Down Under would<BR>> agree - he suggested this last week already!)<BR>><BR>> Tim<BR>> Dr T C Hardcastle<BR>> M.B.,Ch.B.(Stell); M.Med(Chir); FCS(SA)<BR>> Senior Surgeon / Senior Lecturer: Surgery (Trauma and ICU)<BR>> ATLS instructor and DSTC Cape Town Course Director<BR>> Intern program Coordinator: Surgery<BR>> Program Manager: Emergency Medicine (SU)<BR>> Clinical Head (Director): Diana Princess of Wales Trauma Unit<BR>> Department of Surgery Room 4064<BR>> Tygerberg Hospital /
University of Stellenbosch<BR>> PO Box 19063<BR>> Tygerberg 7505<BR>> Western Cape<BR>> South Africa<BR>> e-mail: tch@sun.ac.za<BR>> Cell: +27824681615<BR>> Office: +27219389281 or 4911 pager 0302<BR>><BR>><BR>><BR>> -----Original Message-----<BR>> From: trauma-list-bounces@trauma.org<BR>> [mailto:trauma-list-bounces@trauma.org]On Behalf Of KMATTOX@aol.com<BR>> Sent: Tuesday, August 01, 2006 4:29 AM<BR>> To: trauma-list@trauma.org<BR>> Subject: PLEASE STOP - AMPUTATION<BR>><BR>><BR>> Dr. Karim, the web master of this site has asked us nicely to STOP the<BR>> political dialogue. Many very good clinicians have dropped out. We the<BR>> majority are allowing a few terrorist to destroy a very good, yes a wonderful<BR>> web<BR>> site.<BR>><BR>> I vote that effective immediately, the webmaster AMPUTATE the name
and<BR>> address of any offender from this list, IMMEDIATELY and without notice,<BR>> permission, informed consent or anesthesia, JUST DO IT.<BR>><BR>> Karim needs a second to this motion, and then he can count the votes any way<BR>> he wishes.<BR>><BR>> DO NOT BE A PARTY TO THE DEATH AND DESTRUCTION of Trauma.org and<BR>> Trauma-list.<BR>><BR>> k<BR>> --<BR>> trauma-list : TRAUMA.ORG<BR>> To change your settings or unsubscribe visit:<BR>> http://www.trauma.org/traumalist.html<BR>> --<BR>> trauma-list : TRAUMA.ORG<BR>> To change your settings or unsubscribe visit:<BR>> http://www.trauma.org/traumalist.html<BR><BR><BR>--<BR>trauma-list : TRAUMA.ORG<BR>To change your settings or unsubscribe visit:<BR>http://www.trauma.org/traumalist.html<BR><BR><BR>---------------------------------<BR>Yahoo! Messenger with Voice. Make PC-to-Phone Calls
to the US (and 30+ countries) for 2�/min or less.<BR>--<BR>trauma-list : TRAUMA.ORG<BR>To change your settings or unsubscribe visit:<BR>http://www.trauma.org/traumalist.html<BR></FONT></BLOCKQUOTE></div></html>