Friday, September 26, 2008

Trauma score of 21

I just recently had one of those cases that just tears at your heart. Sometimes it hurts so bad that being cynical almost becomes a defense mechanism. I can't help but refer to one of the great tomes of Surgery, "A Chance to Cut is a Chance to Cure". From its chapters is the trauma scale. This is the trauma scoring system as related and handing down through Rip Pfeiffer M.D. and the veterans of Parkland with a few of my own added in. By calculating the total points received per patient the following guidelines were established in determining the patient's chance of surviving a major trauma. This system explains the reason why one chances of survival are inversely proportional to ones value to society. In other words why the minister dies and the gangbanger lives.

Chances of Survival

0-5 points.............................30%
5-12 points...........................60%
Greater than 12 points.......95%

Etoh level
100-299 2 points
300 or more 4 points
Injured while riding motorcycle
with helmet 1 point
without helmet 2 points
Arrives wearing biker T shirt 1 point
Patient comes from or going to jain 4 points
Spouse in jain 1 point
Arrives by helecopter between 1 and 5 am 1 point
Known by at least 5 people in the ER 1 point
Tatoo (1 point each, maximun of 5 unless homemade then add one additional point)
Tatoos/teeth greater than 1 1 point
Mis-spelled tatoo 1 point
Tatoo on face 2 points
Warrants for arrest (2 points for each, total 6points)
Emergency contacts listed on triage form (1 point for an attorney, 3 for bail bondsman)
Last bath more than 2 weeks ago 1 point
Has two children with same name 1 point
Previously shot or stabbed (2 points each episode, maximum 6)
Knows where the best veins are 1 point
Arrives with iv already in 1 point
Allergic to Kwell 1 point
Smokes more than one carton/day 1 point
Drinks a case/beer/day 1 point
Seeking disability 1 point
Allergic to Talwin, Codeine, Toradol 1 point
Covered in vomit (1 point if their own, 2 if from someone else)


SeaSpray said...

Awww...Throckmorton...I'm sorry you had one of those cases. I'm sorry you are hurting over it.

That tells me you are a good doctor...because you care.

We all have our own way of dealing with pain. I can appreciate cynicism being a way for med folks to handle those feelings. And sometimes just going off somewhere and have a good cry gets it out too. Whether you talk about it, blog or need a release.

I give you a lot of credit and have much respect for those in your profession. You've worked so hard to get to where you are and you have so many responsibilities on so many fronts. And is there anything more valuable than a human life?

Patients entrust their care to physicians. It is a sacred thing. And you develop bonds. And even if you don't bond.. everything in you must be geared toward saving that life.

You're in a profession that facilitates healing, saves lives and it must be so very frustrating, disturbing, and hurt so much .. when you can't save someone. It goes against what you're trained to do.

I imagine it is tough in the OR when you have a difficult case. Surgeons are BRAVE in my opinion. The buck stops with you. It's all in your hands...literally.

I think we die...when we're meant to die. There isn't any rhyme or reason to it. I even think if a patient dies in surgery...and it actually was the surgeon's fault through some negligent act... that it still wasn't the surgeon that killed the patient. What you say?

Oh sure...the facts will point to the surgeon...but I think only God can take a life and only he knows when that will be. The surgery was just the means through which it happened.

How many times have you seen patients die..that really should not have...or pt's live...that everyone believed would not pull through?

All that being said, even though I am a fatalist in believing when it's your's your time... I have been afraid to have a surgery that I may need... but that's another story.

I appreciated your cynical humor.

It used to make me crazy when I would see girls had spelled a word out on their fingers (like LOVE)by tattooing themselves with an ink pen. Ooooh That's attractive...NOT!

Hugs for (((((Throckmorton))))) and I hope you feel better soon. :)

SeaSpray said...

P.S.-"Knows where the best veins are 1 point"

I get one point for that. I direct anyone having difficulty drawing blood to one area on the inside of r arm where it bends for a spigot that releases blood every time.

Of course that backfires if I become an admit with a tele monitor because I continually set it off with IV in that location... but I am adept at resetting it. I'm just sayin... ;)

No wonder the minister dies with a scale like that.