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<P>Dr Moore,<BR><BR></P>
<P>In your last trauma list response you briefly mentioned morphine nebs as a treatment for rib fractures in the elderly. I am aware of some solid data regarding morphine nebs in the treatment of dyspnea in terminal lung cancer or even cystic fibrosis patients. Is there any good data out there supporting it's use in rib fractures or flail chest? <BR><BR> T. Shepherd </P>
<P> Los Angeles, CA</P>
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<DIV>NOTHING SPLENDID Has Ever Been Achieved Except By Those Who DARED BELIEVE THAT SOMETHING INSIDE THEM Was Superior to CIRCUMSTANCE</DIV>
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From: <I>Moore677@aol.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: Subacute Care Surgery (was trauma activation and stratification)</I><BR>Date: <I>Thu, 12 Oct 2006 09:29:31 EDT</I><BR>>Agree with Dr. Gross..............the trauma patient is ours (unless isolated<BR>>ortho with a minor mechanism), regardless of whether we operate or not --<BR>>even if the trauma mechanism plays a minor role (i.e. ground-level fall in a<BR>>patient with ICH on ASA/plavix/coumadin and requires emergent reversal, GLF in an<BR>>elderly patient with rib fractures who might benefit from an epidural or<BR>>morphine nebs, etc.)..............these patients need an intensivist, and in the<BR>>U.S. (at least at the majority of Level I and II centers), it is the
trauma<BR>>intensivist/surgeon<BR>><BR>>Dell.........................<BR>><BR>><BR>>Forrest O. Moore, MD<BR>>Division of Trauma & Surgical Critical Care<BR>>East Texas Medical Center<BR>>1020 E. Idel<BR>>Tyler, TX 75701<BR>>Cell (903) 279-2123<BR>><BR>><BR>>In a message dated 10/12/2006 8:32:09 AM Eastern Standard Time,<BR>>Rgross@harthosp.org writes:<BR>>Hi Tony,<BR>>lets make one thing clear here - Mattox is NEVER provocative.....<BR>>YEAH, RIGHT! ;-)<BR>>All kidding aside, I think that we are relatively spoiled here at<BR>>Hartford. We still follow the "15 minute rule" - in fact we are in<BR>>house and frequently beat the patient in the doors because of our pager<BR>>alert system. We also stay with the patient from arrival to ICU to<BR>>discharge, whether the patient gets an operation or not. And unless
the<BR>>patient really does have an isolated ortho or neurologic injury that<BR>>requires surgery, the patients usually stay on our service for the<BR>>duration. So my comments are, clearly, coming from my point of bias.<BR>>On the other hand, if I did not believe that this is the way it should<BR>>be, I clearly would not have come here and stayed here........Now it is<BR>>my turn to be provocative as I afffirm my very strong conviction that<BR>>trauma is a surgical disease, and should be managed by surgeons.<BR>>Best wishes,<BR>>Ron<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></div><br clear=all><hr> <a href="http://g.msn.com/8HMAENUS/2749??PS=47575" target="_top">Be seen and heard with Windows Live Messenger and Microsoft LifeCams </a> </html>