Saturday, December 09, 2006

Going Nursical

Brilliant. The title bears no real relation to the post, but a fellow Blogonaut - the Bohemian Road Nurse - left it, and I thought it too good a phrase to lie hidden. I hope she won't mind.

So, I have returned. I've spent the last few days on a fairly intensive ATLS course. This is the Advanced Trauma Life Support course, care of the American College of Surgeons. It teaches one safe way of caring for the trauma victim. The courses are pretty good fun, but fairly hard work. Since part of my job involves looking after trauma victims (or at least the British definition - we don't have much "proper" trauma per se) I expected, and was expected to do well. Which generally increases the potential to fuck up. In front of the boss.

Well, you'll all be pleased to hear I managed to avoid all / most banana skins. I am now all shiny in the ATLS fashion. It is interesting to see that not much has changed since I first did the course six years ago. I tend to find these courses are arbitrary, as they are trying to teach a UNIVERSAL method, which is 'proven' to be safe. Trauma care is especially difficult to get evidence for - it's very hard to ethically justify depriving multiply injured patients of care to see how it affects outcome. Getting consent can be a real bitch, too! A good case in point is the use of steroids in head injuries. This was considered a gospel treatment, in the UK at least, for years. Only relatively recently has it become apparent that not only did this not improve outcome, it actually does harm. Primum non nocere? Ooops.

Consequently, as far as I can see, most of the developments in trauma care originate with the military - WWI, WWII, Vietnam, Falklands, Afghanistan and now Iraq. Wherever there's a war, there are large numbers of traumatised patients... of course, they're mostly young, fit men and women. Or pigs. It always seems to be pigs that the military surgeons practice on...

So extrapolating data to the real world, which is slowly filling with fat, older people, may not work. Even so, I was disappointed not to see any comment on issues such as permissive hypotension / hypothermia. I seem to remember these being contentious issues six years ago, and I guess the picture's no clearer.

Thanks again B.R.N


The Platypus said...

Not much "proper" trauma? You poor dears. You don't need any fancy equipment: a lead pipe, a third story window, a pint among friends: it all works. You'd think y'all would be left busy enough with that whole driving-on-the-wrong-side-of-the-road thing alone.

DrShroom said...

Well, it keeps us on our toes, but we still don't see a great deal. Although my colleagues from Birmingham assure me that some of their 'clients' know how to handle a baseball bat... maybe its just the genteel South Coast ;)

A Bohemian Road Nurse said...

You're welcome, and thank you!

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