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Perhaps pretibial lacerations may turn out to be a relatively poor example. These are sometimes wuite difficult injuries to manage with a significant amount of short term morbidity. Hopefully, there will be some good evidence out in the next couple of months looking at more aggressive management of these injuries. An RCT is soon to be published looking at the compression bandaging of pretibial lacs (after vascular assessment with ultrasound) and shows a significant benefit. The study was done locally by a collegue in burns/plastics. I'll post the URL for the paper as soon as it is published, but it does seem to be a potentially very useful intervention. Watch this space! Simon Simon Carley SpR in Emergency Medicine Manchester Royal Infirmary England [log in to unmask] Evidence based Emergency Medicine http://www.bestbets.org ----- Original Message ----- From: dodgydoc <[log in to unmask]> To: <[log in to unmask]> Sent: Monday, June 04, 2001 8:18 PM Subject: scanning without tubing > interesting range of views and wise words in response > to my provocative mail on the old minors/majors > subject, thanks all of you. Sorry about your long > standing girlfriend Cliff! > The minor injuries most certainly do currently belong > in the E.D. in the UK, and the pretibial lacs are > welcome in ours, they just dont need to see a doc, > especially a consultant, which leaves me free to see > the sickies.. > End subject. > > New subject > Friday. 5 oclock. Elderly patient witnessed collapse > at home 1 hour ago, GCS 3. Clinically ICB with poor > prognosis. Family on their way. > Would anyone zip her through the CT straight away, > assuming compliant radiologist, without an ET tube? > We often do these 'poor prognosis' scans without > intubation, with the patient on their side, always > accompanied by ED consultant. Is this heresy? > You get images which are not perfect but good enough > to see significant haemorrhage. Avoids the indignity > and delays of a tube which will only be removed > afterwards...if you can remove it. We miss out on rsi > experience as a consequence - in fact it was a year > working with an aggressive tuber of anything alive or > recently alive which made me go down this road. > > The family were greatly relieved to find that we hadnt > aggressively treated her as she had told them she'd > haunt them if they allowed doctors to keep her alive > artifically! > I expect the range of opinion will range from 'never > ever - I'm calling the clinical governance police' to > 'done it for years'. Just keep my girlfriend out of > it, alright? > > Steve Meek > Bath > > __________________________________________________ > Do You Yahoo!? > Get personalized email addresses from Yahoo! Mail - only $35 > a year! http://personal.mail.yahoo.com/ >