In reply to:
>80-something year-old female, RTA. Fractured sternum (fragile from steroids
for asthma), grazed (non-fractured) shins. GCS throughout. No head injury.
No abdo or pelvis problems clinically. No peripheral neuro loss. Trauma
series: NBI. Arterial Gases good. Stable obs throughout, once analgesed and
oxgygenated. 3-4 hours after arrival, admitting team decide they want to do
a DPL, despite patient remaining stable and normal abdo USS a few hours
earlier
In a stable patient, CT abdo would be a useful alternative to DPL.
>On the same subject, the general feeling at BAEM was that only in large
units seeing lots of cases would it be justified to have senior A&E staff
learning to wield Ultrasound probes
This idea has been looked into and sidelined in Leeds. Even in large units,
there is not a high enough caseload for skills to be attained and maintained
(unless one person is willing to be on call all the time for all cases!).
This is an observational comment, not particularly evidence based, and I
would be interested in what others on the list think. Certainly, friends of
mine who are radiologists (there's a confession!) are skeptical about A&E
docs learning USS as it takes so long to become competent....or is it
another case of protecting territory!
>ps: a senior nurse was once overheard explaining to a student nurse
attending a trauma call, that "the surgical registrar is about to perform a
diagnostic perineal lavage"! Does anyone have any personal experience of one
of these?
A colleague of mine at Med School fell off the back of a jet-ski whilst on
her elective and, whilst not diagnostic, had a rather traumatic one!
Andy Lockey
A&E SpR
%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%
|