... Pis les EMS (peut-�tre) Et bien C'est pas des monolithes
� en juger par la diff�rence d'opinions ! ? OPINIONS OF TRAUMA PRACTITIONERS REGARDING PREHOSPITAL INTERVENTIONS IN CRITICALLY INJURED PATIENTS Jeffrey P. Salomone, MD; Jeffrey S. Ustin, MD; Richard A. Schieber, MD; Norman E. McSwain, Jr., MD*; David V. Feliciano, MD Emory University and Tulane University* Introduction: We surveyed trauma surgeons regarding the appropriateness of field interventions in management of the airway and of shock. Methods: A questionnaire describing clinical scenarios was mailed to a random sample of 345 members of the American Association for the Surgery of Trauma. Results: Completed surveys were returned by 182 surgeons (52.7%). The surgeons predominantly practice general/trauma surgery (85.7%) in an academic setting (70.9%). Scenario : Traumatic Brain Injury, GCS=7, <15min from trauma center (TC) Choice of Treatment : Bag-valve-mask and transport: 32.4% Attempt intubation at least once: 64.3% Scenario : Traumatic Brain Injury (TBI), GCS=7, 20-40min from TC Choice of Treatment : Bag-valve-mask and transport: 5.5% Attempt intubation at least once: 83% Scenario : Suspected TBI Monitor pulse ox: 100% GSW torso, decompensated shock Choice of Treatment : Perform spinal immobilization: 34.1% No spinal immobilization: 65.9% Scenario : GSW torso, decompensated shock, 20-40min from TC Choice of Treatment : IV fluid to maintain patient normotensive (SBP 100- 120): 31.9% IV fluid but maintain patient relatively hypotensive: 66% Scenario : Pelvic fracture (fx), decompensated shock, <15min from TC Choice of Treatment : Apply and inflate PASG: 23.6% No specific treatment for pelvic fx: 60% Scenario : Pelvic fx, decompensated shock, 20-40min from TC Choice of Treatment : Apply and inflate PASG: 52.2% No specific treatment for pelvic fx:11% Appropriate indication for prehospital use of PASG ? No indication for use of PASG: 18.7% Pelvic fx with decompensated shock: 77% Conclusions: The majority of trauma surgeons believe that EMS providers should: 1) attempt intubation for a patient with a traumatic brain injury (GCS= 7); 2) refrain from performing spinal immobilization for penetrating torso trauma; 3) treat decompensated shock with IV fluids in a patient with penetrating torso trauma, but maintain the patient in a relatively hypotensive state; 4) provide no specific treatment for a suspected pelvic fracture with decompensated shock if less than 15 minutes from a TC, but apply and inflate the PASG if 20 - 40 minutes from a TC. While there was some lack of consensus, current PHTLS guidelines were favored by a majority of trauma surgeons. Jeffrey P. Salomone, MD Emory University School of Medicine 69 Jesse Hill Jr Drive, S Atlanta, GA 30303 Phone: (404) 616-3552 Fax: (404) 616-7333 Email: [EMAIL PROTECTED] __________________________________ Do you Yahoo!? Yahoo! SiteBuilder - Free, easy-to-use web site design software http://sitebuilder.yahoo.com --- URG-L Pour quitter URG-L, envoyez un message a la liste ([EMAIL PROTECTED]) avec, COMME SUJET, le mot REMOVE (rien d'autre).
