Don't confuse non resident with not quickly available. I'm non resident but
usually make it in before the resident bods from other teams. If you call in
the orthopod as soon as it becomes apparent that this is a sick trauma case,
they ought to be in by the time you've got the ex fix kit out, adequate
anaesthesia and airway sorted. With specific reference to pelvic fracture
and ex fix,
1. If you feel ex fix application is something that needs doing within 30
minutes or so, maybe you should look at it being an A and E procedure rather
than an orthopaedic one, so it can get done by someone who is actually in
the department once the patient arrives.
2. However, it doesn't. Wrapping the pelvis in bandages or one of the
proprietary devices is said to work about as often as ex fix does.

With regard to general surgeons, anything that can't wait! until the
registrar makes it in from home is a consultant level case anyway (unless
someone can give me an example otherwise). With AAAs in particular, I've not
come across one done by an unsupervised trainee since they got rid of SRs.

Matt Dunn
Warwick



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