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If They Could Only All Be Taken To Rampart Hospital

Tue, 04/06/2010 - 7:09am

Trauma surgery for me is a whole lotta non-operative care interspersed with occasional surgery for things like a ruptured spleen. This is because I don't practice in a large urban center, and most of the trauma patients I care for have suffered blunt force injuries rather than penetrating ones.

For most of the non-physician population, the idea of trauma surgery is heavily influenced by television—shows like "E.R.," "Grey's Anatomy," and the like (I am asked at least weekly whether I enjoy these shows; I haven't seen a medical drama since "Emergency" ended its run in the 70's). Like other dramas, these shows try to maximize tension to keep the viewer interested; in trauma, there is nothing quite like a gunshot victim to achieve that goal. Lots of blood and screaming, along with an intense urgency to getting a patient off to the operating room.....where they are miraculously saved every time.

Every time. Except in real life, where some patients die of their gunshot wound (GSW). Sometimes, the reasons are obvious—shot through the heart or the head with a fatal brain injury. Sometimes, the reasons are harder to understand—see a description of irreversible coagulopathy here. As for the rest, we don't have all of the answers, though not for a lack of searching.

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