Monday, September 24, 2007

People in the ER are insulated from actually watching the accidents that bring patients through their doors, but car racing and super slow motion replays remind us how much trauma the body can withstand. John Force’s crash into the wall at the NHRA Fall Nationals on the weekend was graphic reminder of the power and horror of racing.

And while his injuries were adding, EMTs and paramedics were starting the assessment and treatment plans that have allowed trauma victims to survive all across the country. Just as pit crews are assigned jobs and follow script, so do those caring for those with multiple trauma. The ABCs of trauma care prevent care providers from being distracted by a broken bone or an ugly looking laceration.

The approach to trauma resuscitation is highly choreographed, especially in the ER. First, the ABCs. Is the patient’s airway, open, are they breathing, do they have a blood pressure or pulse. If the answer to any of these is no, then something has to be done immediately to fix it, otherwise, there won’t be any need to sew a cut or set a broken bone. A quick initial survey is done to get a gestalt of the patient and look for life threatening injuries. A slower secondary survey will follow, with a checklist made of stuff to diagnose and fix.

In larger hospitals with trauma teams, a host of doctors, nurses, technicians and therapists swoop down on the patient. When the diagnoses are sorted out, people drift off and are replaced by specialists to deal with specific injuries. In a small, rural hospital, the swooping may be done by a single doc and nurse team who stabilize the patient enough to transfer to a major facility. Interestingly, though, the single doc follows the same script during the initial evaluation and treatment as the hoards of docs in the larger hospital.

Technology has made some of the looking easier. Ultrasound and CT scan come in handy to look inside the head, chest and abdomen. Organs, blood vessels and bones can be seen in 3D, either reassuring that no disaster is imminent or proving that it is. Not so long ago, exploratory surgery was the norm. Now it’s more selective and focused, except in those people too unstable to wait for technology to do its stuff. Technology takes time and some trauma victims are sorely lacking in that option.

And once the dust settles, it becomes time to look after broken bones and lacerated skin. And while John Force’s orthopedic injuries were tallied and made press, the forgotten part of his care was the first few minutes that many times make the difference between life and death. It makes no difference if a broken leg is splinted beautifully, if somebody forgot to see if the patient was breathing.

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