In-Reply-To: <[log in to unmask]>
The evidence from the USA (Sue Stern's group) is in my opinion after
listening to her talking in Vancouver is weak in the extreme. Her
experimental model is the (halothane) anaesthetised pig with a 4cm
laceration in the aorta. This bears absolutely no relationship to our
experience, which is very rarely pure exsanguination; there is associated
blunt tissue damage and other injuries. She claims that her anaesthetic is
cardiostable, which is patent nonsense to anyone who has ever used
halothane (as I have extensively in the human, although I concede that my
experience in the porcine model is limited, there is a lot of work from
the 60s and 70s on the action of halothane)What we do know is that there
are two things that will worsen outcome from a head injury; the first is
hypoxia and the second is hypoperfusion. Please do not run away with the
idea that no blood pressure is good. In the young fit male with a single
bullet wound he can take a degree of hypotension. In the 75 year old with
multiple injuries, a normal bp of 160/95 and widespread atheroma this is
emphatically not the case. Remember, only 17% of trauma calls in the US
are blunt trauma; in my returns from MTOS I have yet to have a single
penetrating injury.
Best wishes,
Rowley Cottingham
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Clinical Governance. Just say no.
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