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<P>I agree Errington. I would in fact go further by saying that the ICU/HDU is THE ONLY place for patients who need resuscitation but DON'T need<BR>
the operating room (unless they are going to interventional radiology for embolisation etc.) </P>
<P>Further to Ken's comment on the role of the A&E/ED department "waving to the patient", this I fully agree with and wholeheartedly support. However I would say that the A&E does actually have ONE useful purpose - for the receptionist to book the patient into the hospital. They can also ensure that the order for massive transfusion packs is made IMMEDIATELY for them to be sent STRAIGHT to theatre/OR for the patient (for those hospitals that implement the 1:1 transfusion protocol.) I'll happily conceed that this is in fact two purposes.</P>
<P>Matthew</P>
<P>____________________________________________________________<BR>
<STRONG>KMATTOX at aol.com</STRONG> <A title="Operating Room Resuscitations" href="mailto:trauma-list%40trauma.org?Subject=Operating%20Room%20Resuscitations&In-Reply-To=">KMATTOX at aol.com </A><BR>
<I>Thu Jan 31 03:26:29 GMT </I></P>
<P>BINGO. Great point. For any trauma patient that is not going to be <BR>
able to be dismissed from the ER following minor treatment for a minor injury, <BR>
there is NO REASON TO KEEP THAT PATIENT IN THE ER ANY LONGER THAN IT TAKES TO <BR>
COMPLETE THE LOGISTICS OR PAPERWORK TO GET THEM TO THE OR, ICU, FLOOR, IR, <BR>
OR OTHER LOCATION. <BR>
<BR>
Kenneth L. Mattox, MD<BR>
Houston<BR>
<BR>
<BR>
In a message dated 1/30/2008 9:23:48 P.M. Central Standard Time, <BR>
<A href="http://list.mistral.net/mailman/listinfo/trauma-list">errington at erringtonthompson.com</A> writes:<BR>
<BR>
The ICU is a great place for patients who need resuscitation but DON'T need<BR>
the operating room. <BR>
<BR>
E</P>
<P>____________________________________________________________<BR>
In a message dated 1/30/2008 9:23:48 P.M. Central Standard Time, <BR>
<A href="http://list.mistral.net/mailman/listinfo/trauma-list">errington at erringtonthompson.com</A> writes:</P>
<P>I would add that those patient that don't need to go to the OR but still<BR>
need significant resuscitation maybe better in the ICU than the ER or<BR>
anywhere else. For the most part trauma surgeons run their own ICU's.<BR>
These are the nurses that have heard your lectures. They come to your<BR>
conferences. They know what you want. <BR>
<BR>
The ICU is a great place for patients who need resuscitation but DON'T need<BR>
the operating room. <BR>
<BR>
E<BR>
<BR>
Errington C. Thompson, MD, FACS, FCCM<BR>
Trauma/Surgical Critical Care<BR>
Author - Letter to America<BR>
Asheville, NC<BR>
<BR>
-----Original Message-----<BR>
From: <A href="http://list.mistral.net/mailman/listinfo/trauma-list">trauma-list-bounces at trauma.org</A> [mailto:<A href="http://list.mistral.net/mailman/listinfo/trauma-list">trauma-list-bounces at trauma.org</A>]<BR>
On Behalf Of Ronald Gross<BR>
Sent: Wednesday, January 30, 2008 6:52 AM<BR>
To: <A href="http://list.mistral.net/mailman/listinfo/trauma-list">trauma-list at trauma.org</A><BR>
Subject: Re: Operating Room Resuscitations<BR>
<BR>
Yeah - what HE said! ;-)<BR>
<BR>
Matt, you and I are on the same page here - but you said it far better than<BR>
I did - Thanks!<BR>
<BR>
Take care,<BR>
Ron<BR>
<BR>
>>><I> Matthew Reeds <<A href="http://list.mistral.net/mailman/listinfo/trauma-list">mgreeds at reeds.uk.com</A>> 1/30/2008 5:27 AM >>><BR>
</I><BR>
Mike & Ron,<BR>
When pontificating over the treatment that I give to any patient, I always<BR>
try to ask what I would want for myself and apply this to give the best<BR>
treatment to each patient. I would NOT want to be in an A&E/ED resuscitation<BR>
room but would "rather" be in either theatre/OR, ITU/HDU, the ward or<BR>
radiology (depending upon my injury) having the proper treatment that I<BR>
need. This is what I would strive for with any of my patients.<BR>
Therefore I see NO reason for the patient to remain in A&E/ED for<BR>
resuscitation. As Ron says, if the patient needs surgery, then off to<BR>
theatre/OR they go. If they need non-operative resuscitation, then off to<BR>
ITU or HDU they go for the care required. [This frees up theatre/OR<BR>
resources and time as Mike says if surgery is not required for better<BR>
utilisation.] Radiology resuscitation is ONLY required for THERAPEUTIC<BR>
intervention such as angio for pelvic haemorrhage and stabilisation (if the<BR>
extra-peritoneal pelvic packing approach is NOT used etc.)<BR>
><I>From my experience, there is NO need/role for A&E/ED resuscitation - if the<BR>
</I>patient is that sick, then they need to be elsewhere (e.g. theatre/OR,<BR>
ITU/HDU etc.)<BR>
Even for major haemorrhage that requires surgery, these UNSTABLE patients<BR>
SHOULD be rapidly transported to theatre/OR for surgery for emergency<BR>
treatment. I would NOT NORMALLY advocate A&E/ED operating UNLESS absolutely<BR>
necessary which has happened to me on a couple of occasions [such as cardiac<BR>
arrest secondary to IVC transection at the bifurcation from multiple stab<BR>
wounds from a bayonet in a 19 year old male.] He had been "down" for 3 mins<BR>
when he arrived in A&E by paramedics/EMT and there was no way we could<BR>
transfer him to theatre/OR on the top floor (11th floor) and at the other<BR>
end of the hospital to save him - a fault of the hospital design. Therefore<BR>
we performed a laparotomy in the A&E/ED resus room and got him back with<BR>
RAPID abdominal packing and then transferred to theatre just as rapidly.<BR>
However, this should be a RARE occasion and ONLY be absolutely necessary to<BR>
imminently save life rather than be the norm. In essence this comes down to<BR>
clinical acumen, experience and ability of the clinician to use sound<BR>
judgment and I agree with Mike, that if the patient doesn't need surgery,<BR>
then theatre/OR is not the best place to resuscitate the patient - they<BR>
should be in the ITU/HDU instead.<BR>
<BR>
Matthew<BR>
Surgery U.K.</P>
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