The ATLS (Advanced Trauma Life Support) book finally came. I am thrilled. It’s huge, at least an inch thick. There are paragraph explanations about every kind of traumatic injury you can imagine, and bullet-point instructions for doing every kind of trauma-related procedure. It strikes me as funny that someone would try to explain how to start an IJ central line (internal jugular) on paper: “advance the needle caudally, in a line 30 degrees anterior etc sagittal plane etc. . .”

The schedule for the ATLS class looks splendid: thirty minutes to explain everything you need to know about abdominal trauma, forty minutes for thoracic trauma (extra ten minutes for thoracotomy, I guess!). The afternoon session is hands-on: how to do pericardiocentesis, needle decompression, cricothyroidotomy, peritoneal lavage. Absolutely splendid. This is what I wanted to learn, and here it is, right up front.

The accompanying triage worksheets are rather grimmer. Scenario 1: a gas explosion at a construction site, five people injured: one with decreased breath sounds, one unconscious, one bleeding out from a leg injury. Who do you treat first? Scenario 2: a car crash, five victims, rushed to your 100-bed ER, where you are the only doctor, and you have one nurse and one nurse’s aide. When I got to the description of the fourth patient, who appeared to be in active labor, I decided that the correct answer was not, try to deal with them all at once, or in order, but: call the ICU and tell them to send any extra nurses down, and call labor and delivery and tell them to send someone down. I don’t want to play by these “only you and one nurse” rules. I don’t think even Charity Doc’s ER is that badly staffed.

Advertisements