Friday, 2 March 2007

Another Life Saved!!!!

Yet again our Trust, or more correctly ITU surpasses its self in its ability to F*%K up trauma care management. Well, rephrase that, certain itu members have the innate ability to bugger up the patients process.

Trauma shout, man verses bus. Exceptionally agitated with head, facial and chest injuries. Typical pre-alert, just agitated male. It took 7 people to hold down this ten stone man, who did not have english as his first language. I think he was saying 'I need a tube', but hey the gasman wasn't listening. The team leader; ED Physician states this man needs RSI and a tube, our Consultant stated this man needed a tube, even I stated that he needed a tube. (Incidently his shattered mandible was causing an interesting gurgling to emit from this patient). Seconds led to minutes, and after 15 minutes the ITU SHO said he needed to check with his consultant before tubing!!!!!! (who was not in resus). Hmmm thats a new ATLS guideline is it. He would have no hesitation tubing a 95 yr old purple plus, but baulked at this. Idiot.

Eventually he was tubed and ventilated.
Injuries as follows:

Mandibular # (in 3 places),
CT NAD (wait for the difuse axonal injury to develop....),
R Pneumothorax,
R Acetabular # (comminuted).

Significant traumatic injuries.

The Pneumothorax was going to be managed conservatively, but he is receiving IPPV therefore an indication for urgent chest drainage. This had to be pushed to be done, and then it was placed sub cutaneously.

The decision then was to extubate and place on a ward. I argued so stongly to get him on HDU, but our Trust has amalgamated ICU and HDU, and it is nigh on impossible to get onto the unit. Post extubation he gurgled for 10 minutes requiring suction, a joke.

This man went to a surgical ward (no monitor etc), and fortunately was still alive the next day. It is so frustrating that the people who manage trauma effectively, i.e. us the ED staff are run roughshod over by clinicians who have no comprehension of polytrauma and its effects. ATLS guidelines, textbooks, even Blue Peter give definitive guidance on Trauma Management. Can there be any clinical justification in these clinicians management and 'ownership' of the ET tubes. No there cannot, I trust to God that there won't be an incident when someone will die by virtue of this route. I and my more clued on colleagues cannot be available all the time, if only the book is followed!!!

Needless to say I suffered major trauma to my foot as I kicked the wall in frustration. Not a good shift.

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