>OK, so I know most of you have got better things to do on a Saturday
>evening than watch telemedicine, but for any of you out there who are
>sad anoraks like me and watched yesterday's episode of Casualty (10th
>Jan), 2 questions re. their portrayal of resus (which is usually very
>good)....
>
As it turns out I was doing a locum in Fort Augustus and was stuck in the
hotel, so I saw it (honestly, I don't often watch it because it's
chronically crap - not just medically but dramatically as well it drives
me crazy!)
>1) In the case of the young victim of an isolated r-sided chest gun-shot
>wound, with blood pouring out his drain and grade 4 hypovolaemic shock
>progressing to EMD arrest despite gallons of fluid/O-neg, would anyone
>have been brave enough to do the "ER" thing and "crack the chest"?
Er...thankfully I missed that bit, but penetrating thoracic trauma with
cardiac arrest requires a thoracotamy right away. I've seen a few done but
even on my bravest day I'd be unlikely to try it (and would probably have to
base my technique on ER episodes, heaven help the poor patient but
watching ER is more fun and at least the staff in ER <look> competent!).
I guess Richard is the best person to have around at this point. The HEMS
team have performed a successfull street thoracotomy I think.
>2) In the next bay along was a young female fitting after a head injury,
>unconscious since time of injury and, if my memory serves, sats of 94%
>on a trauma mask. Would anyone else have RSI'd her stat on her way to
>CT? Those nice docs and nurses on Casualty seemed to do very little
>except arrange a plain SXR, or had I fallen asleep through the crucial
>bit?
>
Post head injury seizures are difficult to deal with. Probably not unless
her seizure went on for a while or her sats fell further (or paco2 was up on
blood gasses). RSI doesn't actually stop seizures, it just stops the
muscular activity. They didn't seem to have given her anything for the
seizures at all though.
I'll be interested to see what the others say about this (assuming anyone
else is sad enough to reply to your posting).
Actually, I saw her fall and it wasn't that bad, so they probably rightly
assumed she was putting it on and they were pseudoseizures (since she was an
actress, then by definition they must have been).
>I must get out more!
I used to have an episode of "Cardiac Arrest" on video which we used as a
teaching session kick off (I think it had 10 common A+E conditions
humerously depicted in less minutes IIRC).
Robbie Coull
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