When a patient is injured, it's up to the paramedics to determine if the patient is injured badly enough to call "a trauma" or not. If they believe he is potentially severely injured, he comes to me. Not bad enough, he goes to the ER to see an ER doctor, and if that person finds injuries that need further care, he consults me.
In trauma we follow certain protocols. It helps us avoid mistakes and it bails us out of innumerable problems. The major protocol couldn't be easier to remember: ABCDE.
A: Airway. Secure the airway, #1 priority, always.
B: Breathing. Is the patient doing it? If not, do it for him.
C: Circulation. Is the patient's heart beating? If not, do it for him.
D: Disability. What's the neurological status?
E: Exposure. Completely disrobe the patient and look for hidden injuries.
You always start with A and you do NOT move on until you're satisfied it's ok. If the patient isn't responding to your treatment appropriately, start back at A and figure out what you missed.
Easy, right? Well...not so much for some people, mainly ER doctors in my observations.
A few weeks ago I had a STAT consult from an ER doc on a patient with multiple stab wounds. Though I was already attending to 5 other seriously injured victims, I immediately ran to the main ER to see a very calm-looking man lying quite comfortably on his stretcher with his right arm and left leg nicely bandaged. Turns out he was stabbed in a bar fight, but no one had looked at his wounds yet.
I unwrapped his arm and leg and found three tiny 1cm stab wounds, none of them bleeding. At all.
I called the ER doc over and asked her if she had evaluated the wounds yet. "No, I just heard multiple stabbings and I called you."
Right. Like I wasn't busy enough.
Apparently to her, the protocol is:
C: Consult trauma surgeon
Stories about general surgery, trauma surgery, dumb patients, dumb doctors, and dumb shit from the dumb world around us.
Friday, 3 February 2012
Subscribe to: Post Comments (Atom)
I'll start this post by answering a few questions that may or may not be burning in your mind: No, I'm not dead. No, I didn't g...
EDIT NOVEMBER 1 2017: GINGER'S LIST HAS BEEN UPDATED TO 142 PAPERS. I HAVE ADDED ALL THE NEW ONES IN ORDER. NEW PAPERS ARE PREFACED BY *...
How many true surprises are there in life? This was the question I asked Mrs. Bastard when she was pregnant with our first child and wanted ...
EDIT: New and improved version, now with 83 of your favourite myths. Ooooooh boy. I have no idea what kind of rabbit hole I'm entering...
I've never read a blog, or anything really, as interesting as yours.ReplyDelete
Rachel, not that this isn't a wonderfully engrossing blog, it is, but your comment makes me sad. I wonder, have you read many books? Your comment suggests you can't possibly have done more than skim the surface. I assure you, a world of "interesting" awaits you, if you'll only look.ReplyDelete
I do read. I read a lot, actually. But there's something about this blog that captivates me, probably because I'm a nursing student and love the medical field. The fact that I find this blog one of the most interesting things to read is my personal opinion and I don't believe anyone should say it makes him or her sad.ReplyDelete