?
>
> I was always taught (as a boy!) that early fixation of fractures
> PREVENTED
> fat embolism. So I dug out my old orthopaedic texts and there it
> is...lots
> of research, mostly by the AO people, that early surgery REDUCES fat
> embolism in particular, and respiratory failure in general. One
> reference,
> for example, but there are many others...
>
> Riska E, von Bonsdortt H, Hakkinen S (1976). Prevention of fat embolism
> by
> early internal fixation of fractures in patients with multiple injuries.
> Injury 8: 110-116.
Thank you. How does that square with the other research that both John Ryan and I allude to describing clumps of
rubbish going up the venous system? I was chatting to one of our orthopaedic surgeons today, and he commented that
he had suffered three deaths on the table from acute untreatable hypoxia as he reamed femurs, so he was convinced that
there was a link. I am coming to the conclusion that there is a major disparity here between what is observed happening
(rubbish going up veins) a clinical syndrome (FES) and the post-mortem findings (Lurpak for lungs).
> But is this really a concern for A&E folk I wonder? I'm happy to let
> the
> Ortho guys fight among themselves about that one. As long as we
> diagnose,
> resuscitate, stabilize and refer, then I'm not too fussed how they
> organise
> themselves thereafter!
This depends on the view you take of the hospital system. Care for patients with multiple trauma is IMHO some of the
most taxing work in medicine. Not only do you have to do everything correctly, you are also under extreme time pressure
which you are not in a position to influence or timetable. I believe that each hospital needs a system for ensuring that
good-quality care is given throughout the chain from admission to discharge (and indeed pre-hospital) and it would seem
to me that the A&E Consultant has a pivotal role. He or she oversees the first medical interventions, and is often heavily
involved with training and assisting in prehospital phase. If high standards are set in the resuscitation room, this rubs off
slowly but surely on the rest of the hospital - as I have never worked there I can perhaps point impartially to the Royal
London in Whitechapel as a fine example of this. Each system sets its own parameters, but I also favour the A&E-led
approach. Who asked what use A&E Consultants were again? 8-)
Best wishes,
Rowley Cottingham
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