Nick, you are quite right and I haven't written it accurately. Apologies. 
The point I am identifying is the point immediately lateral to the apex of 
the anterior  triangle, between the heads of sternocleidomastoid but 
closer to the medial head.

> *From:* Andy Webster <[log in to unmask]>
> *To:* [log in to unmask]
> *Date:* Fri, 3 Jun 2005 06:38:50 +0800
> 
> This is a multi-part message in MIME format.
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> I would presume the triangle between the sternal and clavicular head of
> sternomastoid
> 
>  
> 
> Andy Webster
> 
> Registrar in Emergency Medicine
> 
> Sir Charles Gairdner Hospital
> 
>   _____  
> 
> From: Accident and Emergency Academic List
> [mailto:[log in to unmask]] On Behalf Of Nick Jenkins
> Sent: 02 June 2005 16:34
> To: [log in to unmask]
> Subject: Re: Bone injection guns
> 
>  
> 
> Could I ask an ignorant question????    When Rowley says Anterior 
> Triangle
> are we talking Anatomical anterior triangle (midline with right and left
> sternomastoids and mandible as it's boundaries - in which case 'low in 
> the
> anterior triangle' is strictly midline - or the triangle between the 
> sternal
> and clavicular head of sternomastoid?
> 
> Genuine question and not trying to be a smartass - these lines aren't my
> strongest and any advice is welcome - as long as I don't get the wrong 
> end
> of the stick!!
> 
> Nick Jenkins 
> A&E Consultant, Abergavenny 
> http://www.emergencynhh.co.uk 
> 
> -----Original Message----- 
> From: Accident and Emergency Academic List 
> [mailto:[log in to unmask]]On Behalf Of Dunn Matthew Dr. (RJC) 
> A & E - SwarkHosp-TR Sent: 02 June 2005 09:20 To: 
> [log in to unmask] Subject: Re: Bone injection guns 
> 
>  
> 
> > Could not disagree more. It's training issue; I can obtain internal 
> > jugular access with a straight single pipe like a Wallace in under 10 
> > seconds. There are three key points. 
> > 
> > 1. Head down. 
> > 
> > 2. Go low in the anterior triangle. 
> > 
> > 3. Aim for the opposing femoral head. 
> > 
> > Guaranteed; venous puncture every time. 
> 
> I'd add: 
> Go for the right side (straighter course, further from the lung and 
> thoracic
> 
> duct) 
> Don't overrotate or overextend the neck 
> Take your finger off the artery (which seems to be the commonest reason 
> for failure) Not guaranteed every time. Some patients have anomalous 
> veins; some have no vein; some have a vein that collapses with 
> inspiration or the pressure of the needle. There are certainly a few 
> where it is impossible for anyone to put a jugular line in. Ultrasound 
> should identify these in a couple of seconds. Not saying there's 
> anything wrong with an experienced person putting in the jugular line. 
> However, if someone's not that slick with it (as was suggested by the 
> original post), there are other routes (each with their own problems) 
> that could also be considered. My post was in reply to a post saying 
> that the BIG was a lot faster than an IJ line. If you can get a line in 
> in 10 seconds, it isn't. If you can't, you
> 
> might want to think about a different technique. These days, US 
> guidance will prevent most of the failures, and speed you up in some 
> cases. 
> 
> > Sorry Matt, don't agree. One of the many things I have 
> > learned about trauma 
> > (whilst working in South Africa) was that the only vein you 
> > can rely on to 
> > stay open is the subclavian. 
> 
> Doesn't always stay open. I've seen failures to put in subclavians, and 
> have
> 
> scanned a few collapsed or absent veins. Also, veins that stay open 
> when the
> 
> pressure's negative tend to suck in air. Not an absolute 
> contraindication, but a relative one. Down to individual skill with the 
> approach. Advantage of
> 
> cut down is that it is the only way you can reliably cannulate a 
> collapsed vein. Reason for long saph at the groin is that it's probably 
> the quickest (in an unconscious patient) and easiest place to cut down. 
> There are host of
> 
> reasons why you wouldn't put in a either a femoral line or a long saph 
> cut down, but they're both useful techniques to know. In cases where 
> it's impossible to use your favourite technique, it's worth having a 
> couple of backups, though- so femoral line, long saphenous cut down and 
> IO needles all
> 
> have their place. 
> My other point was that if you're not certain and you're in difficulty, 
> assess whether it's better to go in and risk complications or get 
> someone more experienced with the balance of a longer wait and higher 
> complication risk. If you make the call as soon as you've assessed that 
> the patient is sick enough to maybe need a central line; and start 
> prepping while you're waiting, the extra wait shouldn't be long. As 
> before, these days we've got ultrasound. Means you can tell which veins 
> will be easy before you put needle (or knife) to flesh. 
> 
> > Another issue I want to clear up is I never said we were 
> > using BIG/Fast-1 in 
> > trauma. The majority of IO attempts were made for arrests. 
> 
> Now there I'm with you. In non traumatic adult arrests I go for the 
> subclavian myself (although with very few exceptions I remain to be 
> convinced of the benefits of giving anything IV in the early stages of 
> an adult cardiac arrest). I'd thought of the adult IOs for trauma as 
> that was what I'd heard about most (mainly from Israel) 
> 
>  
> 
> > I agree that you may need an anaesthetic registrar there from 
> > an airway 
> > point of view (although we never did in Jo'burg) but as 
> > emergency physicians 
> > shouldn't we be capable of running a trauma? 
> 
> Yes. My post was in response to a post suggesting that the IOs were 
> useful if there wasn't an A and E consultant present and (probably 
> central) venous cannulation was beyond the skills of the A and E middle 
> grade. It is entirely possible to get a job as an A and E middle grade 
> with little experience in central line insertion. If you can't get an A 
> and E consultant
> 
> in fast enough (and some are neither resident nor living close to their 
> hospitals), you ought to have an anaesthetic registrar to hand. 
> As an aside, the term "running a trauma" is one we maybe ought to be 
> moving away from. Trauma is essentially a surgical disease- treatment 
> takes place in an operating theatre. All we do is to make an initial 
> assessment of severity of the trauma, make sure the patient is 
> ventilating OK and speed up
> 
> the process of controlling the bleeding. The surgeon runs the trauma 
> (in an ideal situation), we serve as a support speciality (like 
> anaesthetics and radiology). No evidence that pre- op fluids benefit 
> trauma cases; some papers showing they worsen outcome. From time to 
> time you have to accept that you aren't the one who saves the patient. 
> 
> Matt Dunn 
> Warwick 
> 
>  
> 
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> <title>RE: Bone injection guns</title>
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> <div class=3DSection1>
> 
> <p class=3DMsoNormal><font size=3D2 color=3Dnavy face=3DArial><span =
> style=3D'font-size:
> 10.0pt;font-family:Arial;color:navy'>I would presume the triangle =
> between the
> sternal and clavicular head of =
> sternomastoid<o:p></o:p></span></font></p>
> 
> <p class=3DMsoNormal><font size=3D2 color=3Dnavy face=3DArial><span =
> style=3D'font-size:
> 10.0pt;font-family:Arial;color:navy'><o:p>&nbsp;</o:p></span></font></p>
> 
> <div>
> 
> <p class=3DMsoNormal><font size=3D2 color=3Dnavy face=3DArial><span =
> style=3D'font-size:
> 10.0pt;font-family:Arial;color:navy'>Andy Webster</span></font><font
> color=3Dnavy><span style=3D'color:navy'><o:p></o:p></span></font></p>
> 
> <p class=3DMsoNormal><font size=3D2 color=3Dnavy face=3DArial><span =
> style=3D'font-size:
> 10.0pt;font-family:Arial;color:navy'>Registrar in Emergency =
> Medicine</span></font><font
> color=3Dnavy><span style=3D'color:navy'><o:p></o:p></span></font></p>
> 
> <p class=3DMsoNormal><st1:place w:st=3D"on"><st1:PlaceName =
> w:st=3D"on"><font size=3D2
>   color=3Dnavy face=3DArial><span =
> style=3D'font-size:10.0pt;font-family:Arial;
>   color:navy'>Sir</span></font></st1:PlaceName><font size=3D2 =
> color=3Dnavy
>  face=3DArial><span =
> style=3D'font-size:10.0pt;font-family:Arial;color:navy'> <st1:PlaceName
>  w:st=3D"on">Charles</st1:PlaceName> <st1:PlaceName =
> w:st=3D"on">Gairdner</st1:PlaceName>
>  <st1:PlaceType =
> w:st=3D"on">Hospital</st1:PlaceType></span></font></st1:place><o:p></o:p
> >=
> </p>
> 
> </div>
> 
> <div>
> 
> <div class=3DMsoNormal align=3Dcenter style=3D'text-align:center'><font 
> =
> size=3D3
> face=3D"Times New Roman"><span style=3D'font-size:12.0pt'>
> 
> <hr size=3D2 width=3D"100%" align=3Dcenter tabindex=3D-1>
> 
> </span></font></div>
> 
> <p class=3DMsoNormal><b><font size=3D2 face=3DTahoma><span =
> style=3D'font-size:10.0pt;
> font-family:Tahoma;font-weight:bold'>From:</span></font></b><font =
> size=3D2
> face=3DTahoma><span style=3D'font-size:10.0pt;font-family:Tahoma'> =
> <st1:PersonName
> w:st=3D"on">Accident and Emergency Academic List</st1:PersonName>
> [mailto:[log in to unmask]] <b><span =
> style=3D'font-weight:bold'>On Behalf
> Of </span></b>Nick Jenkins<br>
> <b><span style=3D'font-weight:bold'>Sent:</span></b> 02 June 2005 =
> 16:34<br>
> <b><span style=3D'font-weight:bold'>To:</span></b> =
> [log in to unmask]<br>
> <b><span style=3D'font-weight:bold'>Subject:</span></b> Re: Bone =
> injection guns</span></font><o:p></o:p></p>
> 
> </div>
> 
> <p class=3DMsoNormal><font size=3D3 face=3D"Times New Roman"><span =
> style=3D'font-size:
> 12.0pt'><o:p>&nbsp;</o:p></span></font></p>
> 
> <p><font size=3D2 face=3D"Times New Roman"><span =
> style=3D'font-size:10.0pt'>Could I
> ask an ignorant question????&nbsp;&nbsp;&nbsp; When Rowley says Anterior
> Triangle are we talking Anatomical anterior triangle (midline with 
> right =
> and
> left sternomastoids and mandible as it's boundaries - in which case 
> 'low =
> in the
> anterior triangle' is strictly midline - or the triangle between the =
> sternal
> and clavicular head of sternomastoid?</span></font><o:p></o:p></p>
> 
> <p><font size=3D2 face=3D"Times New Roman"><span =
> style=3D'font-size:10.0pt'>Genuine
> question and not trying to be a smartass - these lines aren't my =
> strongest and
> any advice is welcome - as long as I don't get the wrong end of the =
> stick!!</span></font><o:p></o:p></p>
> 
> <p><font size=3D2 face=3D"Times New Roman"><span =
> style=3D'font-size:10.0pt'>Nick
> Jenkins</span></font> <br>
> <font size=3D2><span style=3D'font-size:10.0pt'>A&amp;E Consultant, =
> Abergavenny</span></font>
> <br>
> <font size=3D2><span style=3D'font-size:10.0pt'><a
> href=3D"http://www.emergencynhh.co.uk" =
> target=3D"_blank">http://www.emergencynhh.co.uk</a></span></font>
> <o:p></o:p></p>
> 
> <p><font size=3D2 face=3D"Times New Roman"><span =
> style=3D'font-size:10.0pt'>-----Original
> Message-----</span></font> <br>
> <font size=3D2><span style=3D'font-size:10.0pt'>From: <st1:PersonName =
> w:st=3D"on">Accident
>  and Emergency Academic List</st1:PersonName></span></font> <br>
> <font size=3D2><span style=3D'font-size:10.0pt'>[<a
> href=3D"mailto:[log in to unmask]">mailto:[log in to unmask]
> C=
> .UK</a>]On
> Behalf Of Dunn Matthew Dr. (RJC) A</span></font> <br>
> <font size=3D2><span style=3D'font-size:10.0pt'>&amp; E - =
> SwarkHosp-TR</span></font>
> <br>
> <font size=3D2><span style=3D'font-size:10.0pt'>Sent: 02 June 2005 =
> 09:20</span></font>
> <br>
> <font size=3D2><span style=3D'font-size:10.0pt'>To: =
> [log in to unmask]</span></font>
> <br>
> <font size=3D2><span style=3D'font-size:10.0pt'>Subject: Re: Bone =
> injection guns</span></font>
> <o:p></o:p></p>
> 
> <p class=3DMsoNormal><font size=3D3 face=3D"Times New Roman"><span =
> style=3D'font-size:
> 12.0pt'><o:p>&nbsp;</o:p></span></font></p>
> 
> <p><font size=3D2 face=3D"Times New Roman"><span =
> style=3D'font-size:10.0pt'>&gt;
> Could not disagree more. It's training issue; I can obtain internal =
> </span></font><br>
> <font size=3D2><span style=3D'font-size:10.0pt'>&gt; jugular access 
> with =
> a straight
> single pipe like a Wallace in under 10 </span></font><br>
> <font size=3D2><span style=3D'font-size:10.0pt'>&gt; seconds. There are 
> =
> three key
> points.</span></font> <br>
> <font size=3D2><span style=3D'font-size:10.0pt'>&gt; </span></font><br>
> <font size=3D2><span style=3D'font-size:10.0pt'>&gt; 1. Head =
> down.</span></font> <br>
> <font size=3D2><span style=3D'font-size:10.0pt'>&gt; </span></font><br>
> <font size=3D2><span style=3D'font-size:10.0pt'>&gt; 2. Go low in the =
> anterior
> triangle.</span></font> <br>
> <font size=3D2><span style=3D'font-size:10.0pt'>&gt; </span></font><br>
> <font size=3D2><span style=3D'font-size:10.0pt'>&gt; 3. Aim for the =
> opposing
> femoral head. </span></font><br>
> <font size=3D2><span style=3D'font-size:10.0pt'>&gt; </span></font><br>
> <font size=3D2><span style=3D'font-size:10.0pt'>&gt; Guaranteed; venous 
> =
> puncture
> every time.</span></font> <o:p></o:p></p>
> 
> <p><font size=3D2 face=3D"Times New Roman"><span =
> style=3D'font-size:10.0pt'>I'd add:</span></font>
> <br>
> <font size=3D2><span style=3D'font-size:10.0pt'>Go for the right side =
> (straighter
> course, further from the lung and thoracic</span></font> <br>
> <font size=3D2><span style=3D'font-size:10.0pt'>duct)</span></font> <br>
> <font size=3D2><span style=3D'font-size:10.0pt'>Don't overrotate or =
> overextend the
> neck</span></font> <br>
> <font size=3D2><span style=3D'font-size:10.0pt'>Take your finger off 
> the =
> artery
> (which seems to be the commonest reason for</span></font> <br>
> <font size=3D2><span style=3D'font-size:10.0pt'>failure)</span></font> =
> <br>
> <font size=3D2><span style=3D'font-size:10.0pt'>Not guaranteed every =
> time. Some
> patients have anomalous veins; some have no</span></font> <br>
> <font size=3D2><span style=3D'font-size:10.0pt'>vein; some have a vein =
> that
> collapses with inspiration or the pressure of</span></font> <br>
> <font size=3D2><span style=3D'font-size:10.0pt'>the needle. There are =
> certainly a
> few where it is impossible for anyone to</span></font> <br>
> <font size=3D2><span style=3D'font-size:10.0pt'>put a jugular line in. =
> Ultrasound
> should identify these in a couple of</span></font> <br>
> <font size=3D2><span style=3D'font-size:10.0pt'>seconds. Not saying =
> there's
> anything wrong with an experienced person</span></font> <br>
> <font size=3D2><span style=3D'font-size:10.0pt'>putting in the jugular =
> line.
> However, if someone's not that slick with it</span></font> <br>
> <font size=3D2><span style=3D'font-size:10.0pt'>(as was suggested by 
> the =
> original
> post), there are other routes (each with</span></font> <br>
> <font size=3D2><span style=3D'font-size:10.0pt'>their own problems) 
> that =
> could also
> be considered.</span></font> <br>
> <font size=3D2><span style=3D'font-size:10.0pt'>My post was in reply to 
> =
> a post
> saying that the BIG was a lot faster than an</span></font> <br>
> <font size=3D2><span style=3D'font-size:10.0pt'>IJ line. If you can get 
> =
> a line in
> in 10 seconds, it isn't. If you can't, you</span></font> <br>
> <font size=3D2><span style=3D'font-size:10.0pt'>might want to think =
> about a
> different technique. These days, <st1:country-region =
> w:st=3D"on"><st1:place
>  w:st=3D"on">US</st1:place></st1:country-region> guidance</span></font> 
> > > =
> <br>
> <font size=3D2><span style=3D'font-size:10.0pt'>will prevent most of 
> the =
> failures,
> and speed you up in some cases. </span></font><o:p></o:p></p>
> 
> <p><font size=3D2 face=3D"Times New Roman"><span =
> style=3D'font-size:10.0pt'>&gt;
> Sorry Matt, don't agree. One of the many things I have =
> </span></font><br>
> <font size=3D2><span style=3D'font-size:10.0pt'>&gt; learned about =
> trauma</span></font>
> <br>
> <font size=3D2><span style=3D'font-size:10.0pt'>&gt; (whilst working in 
> =
> <st1:country-region
> w:st=3D"on"><st1:place w:st=3D"on">South =
> Africa</st1:place></st1:country-region>)
> was that the only vein you </span></font><br>
> <font size=3D2><span style=3D'font-size:10.0pt'>&gt; can rely on =
> to</span></font> <br>
> <font size=3D2><span style=3D'font-size:10.0pt'>&gt; stay open is the =
> subclavian. </span></font><o:p></o:p></p>
> 
> <p><font size=3D2 face=3D"Times New Roman"><span =
> style=3D'font-size:10.0pt'>Doesn't
> always stay open. I've seen failures to put in subclavians, and =
> have</span></font>
> <br>
> <font size=3D2><span style=3D'font-size:10.0pt'>scanned a few collapsed 
> =
> or absent
> veins. Also, veins that stay open when the</span></font> <br>
> <font size=3D2><span style=3D'font-size:10.0pt'>pressure's negative 
> tend =
> to suck in
> air. Not an absolute contraindication,</span></font> <br>
> <font size=3D2><span style=3D'font-size:10.0pt'>but a relative one. 
> Down =
> to
> individual skill with the approach. Advantage of</span></font> <br>
> <font size=3D2><span style=3D'font-size:10.0pt'>cut down is that it is =
> the only way
> you can reliably cannulate a collapsed</span></font> <br>
> <font size=3D2><span style=3D'font-size:10.0pt'>vein. Reason for long =
> saph at the
> groin is that it's probably the quickest</span></font> <br>
> <font size=3D2><span style=3D'font-size:10.0pt'>(in an unconscious =
> patient) and
> easiest place to cut down. There are host of</span></font> <br>
> <font size=3D2><span style=3D'font-size:10.0pt'>reasons why you 
> wouldn't =
> put in a
> either a femoral line or a long saph cut</span></font> <br>
> <font size=3D2><span style=3D'font-size:10.0pt'>down, but they're both =
> useful
> techniques to know. In cases where it's</span></font> <br>
> <font size=3D2><span style=3D'font-size:10.0pt'>impossible to use your =
> favourite
> technique, it's worth having a couple of</span></font> <br>
> <font size=3D2><span style=3D'font-size:10.0pt'>backups, though- so =
> femoral line,
> long saphenous cut down and IO needles all</span></font> <br>
> <font size=3D2><span style=3D'font-size:10.0pt'>have their place. =
> </span></font><br>
> <font size=3D2><span style=3D'font-size:10.0pt'>My other point was that 
> =
> if you're
> not certain and you're in difficulty,</span></font> <br>
> <font size=3D2><span style=3D'font-size:10.0pt'>assess whether it's =
> better to go in
> and risk complications or get someone</span></font> <br>
> <font size=3D2><span style=3D'font-size:10.0pt'>more experienced with =
> the balance
> of a longer wait and higher complication</span></font> <br>
> <font size=3D2><span style=3D'font-size:10.0pt'>risk. If you make the =
> call as soon
> as you've assessed that the patient is</span></font> <br>
> <font size=3D2><span style=3D'font-size:10.0pt'>sick enough to maybe =
> need a central
> line; and start prepping while you're</span></font> <br>
> <font size=3D2><span style=3D'font-size:10.0pt'>waiting, the extra wait 
> =
> shouldn't
> be long.</span></font> <br>
> <font size=3D2><span style=3D'font-size:10.0pt'>As before, these days =
> we've got
> ultrasound. Means you can tell which veins</span></font> <br>
> <font size=3D2><span style=3D'font-size:10.0pt'>will be easy before you 
> =
> put needle
> (or knife) to flesh.</span></font> <o:p></o:p></p>
> 
> <p><font size=3D2 face=3D"Times New Roman"><span =
> style=3D'font-size:10.0pt'>&gt;
> Another issue I want to clear up is I never said we were =
> </span></font><br>
> <font size=3D2><span style=3D'font-size:10.0pt'>&gt; using BIG/Fast-1 =
> in</span></font>
> <br>
> <font size=3D2><span style=3D'font-size:10.0pt'>&gt; trauma. The =
> majority of IO
> attempts were made for arrests.</span></font> <o:p></o:p></p>
> 
> <p><font size=3D2 face=3D"Times New Roman"><span =
> style=3D'font-size:10.0pt'>Now there
> I'm with you. In non traumatic adult arrests I go for the</span></font> 
> > =
> <br>
> <font size=3D2><span style=3D'font-size:10.0pt'>subclavian myself =
> (although with
> very few exceptions I remain to be</span></font> <br>
> <font size=3D2><span style=3D'font-size:10.0pt'>convinced of the =
> benefits of giving
> anything IV in the early stages of an</span></font> <br>
> <font size=3D2><span style=3D'font-size:10.0pt'>adult cardiac arrest). =
> I'd thought
> of the adult IOs for trauma as that was</span></font> <br>
> <font size=3D2><span style=3D'font-size:10.0pt'>what I'd heard about =
> most (mainly
> from <st1:country-region w:st=3D"on"><st1:place =
> w:st=3D"on">Israel</st1:place></st1:country-region>)</span></font>
> <o:p></o:p></p>
> 
> <p class=3DMsoNormal><font size=3D3 face=3D"Times New Roman"><span =
> style=3D'font-size:
> 12.0pt'><o:p>&nbsp;</o:p></span></font></p>
> 
> <p><font size=3D2 face=3D"Times New Roman"><span =
> style=3D'font-size:10.0pt'>&gt; I
> agree that you may need an anaesthetic registrar there from =
> </span></font><br>
> <font size=3D2><span style=3D'font-size:10.0pt'>&gt; an =
> airway</span></font> <br>
> <font size=3D2><span style=3D'font-size:10.0pt'>&gt; point of view =
> (although we
> never did in Jo'burg) but as </span></font><br>
> <font size=3D2><span style=3D'font-size:10.0pt'>&gt; emergency =
> physicians</span></font>
> <br>
> <font size=3D2><span style=3D'font-size:10.0pt'>&gt; shouldn't we be =
> capable of
> running a trauma?</span></font> <o:p></o:p></p>
> 
> <p><font size=3D2 face=3D"Times New Roman"><span =
> style=3D'font-size:10.0pt'>Yes. My
> post was in response to a post suggesting that the IOs were =
> useful</span></font>
> <br>
> <font size=3D2><span style=3D'font-size:10.0pt'>if there wasn't an A 
> and =
> E
> consultant present and (probably central) venous</span></font> <br>
> <font size=3D2><span style=3D'font-size:10.0pt'>cannulation was beyond =
> the skills
> of the A and E middle grade. It is</span></font> <br>
> <font size=3D2><span style=3D'font-size:10.0pt'>entirely possible to 
> get =
> a job as
> an A and E middle grade with little</span></font> <br>
> <font size=3D2><span style=3D'font-size:10.0pt'>experience in central =
> line
> insertion. If you can't get an A and E consultant</span></font> <br>
> <font size=3D2><span style=3D'font-size:10.0pt'>in fast enough (and 
> some =
> are
> neither resident nor living close to their</span></font> <br>
> <font size=3D2><span style=3D'font-size:10.0pt'>hospitals), you ought 
> to =
> have an
> anaesthetic registrar to hand.</span></font> <br>
> <font size=3D2><span style=3D'font-size:10.0pt'>As an aside, the term =
> &quot;running
> a trauma&quot; is one we maybe ought to be moving</span></font> <br>
> <font size=3D2><span style=3D'font-size:10.0pt'>away from. Trauma is =
> essentially a
> surgical disease- treatment takes place</span></font> <br>
> <font size=3D2><span style=3D'font-size:10.0pt'>in an operating 
> theatre. =
> All we do
> is to make an initial assessment of</span></font> <br>
> <font size=3D2><span style=3D'font-size:10.0pt'>severity of the trauma, 
> =
> make sure
> the patient is ventilating OK and speed up</span></font> <br>
> <font size=3D2><span style=3D'font-size:10.0pt'>the process of =
> controlling the
> bleeding. The surgeon runs the trauma (in an</span></font> <br>
> <font size=3D2><span style=3D'font-size:10.0pt'>ideal situation), we =
> serve as a
> support speciality (like anaesthetics and</span></font> <br>
> <font size=3D2><span style=3D'font-size:10.0pt'>radiology). No evidence 
> =
> that pre-
> op fluids benefit trauma cases; some</span></font> <br>
> <font size=3D2><span style=3D'font-size:10.0pt'>papers showing they =
> worsen outcome.
> From time to time you have to accept</span></font> <br>
> <font size=3D2><span style=3D'font-size:10.0pt'>that you aren't the one 
> =
> who saves
> the patient.</span></font> <o:p></o:p></p>
> 
> <p><font size=3D2 face=3D"Times New Roman"><span =
> style=3D'font-size:10.0pt'>Matt Dunn</span></font>
> <br>
> <font size=3D2><span style=3D'font-size:10.0pt'>Warwick</span></font> =
> <o:p></o:p></p>
> 
> <p class=3DMsoNormal><font size=3D3 face=3D"Times New Roman"><span =
> style=3D'font-size:
> 12.0pt'><o:p>&nbsp;</o:p></span></font></p>
> 
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