Palliative trauma care: Should we always intervene?

Prehospital care and inhospital trauma care have seen some amazing advances over the last few years.  Patients are receiving critical care level interventions not just in the emergency department, but at the point of impact.  It is difficult to judge who will benefit from these interventions; patients with traumatic brain injury (TBI) can continue to improve rapidly for six months and then gradually for years after that; those with seemingly unsurvivable injuries can sometimes reach hospital discharge and go on to rehabilitation.
I am often faced with a prehospital dilemma.  Should we always provide those interventions?  Should we always go all out to save a life?  At what cost?  My critical care colleagues have said that they are seeing a new type of patient these days – the ‘palliative trauma patient’; those who my colleagues know to have injuries that will ultimately defeat them.

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It’s time to get back into blogging…

A long while ago, I tinkered with blogging, before getting distracted with real life, getting a proper job and then the rapid responsiveness of Twitter.

My old blog was an attempt at explaining life as a junior anaesthetist.  I tried writing a little clinical education work back then, well before the #FOAMed explosion, and found that those pages got the most comments and certainly the best realtime feedback from people wanting answers.  One of my articles, “Pain relief in Labour” quickly made the rounds amongst anxious mothers when the great Kirstie Allsopp retweeted me.  It was my first experience of helping others by sharing information digitally, and I was hooked.

For the last three years I have been working at a Major Trauma Centre, in the role of Consultant in Trauma Resuscitation Anaesthesia – a new role developed as part of a new system of front door trauma care, recently described in the British Journal of Anaesthesia.  It has been a truly exciting time putting this system together and we have learned a great deal.

I also respond in the prehospital environment both locally for the charity North Staffordshire BASICS, and as part of the West Midlands Ambulance MERIT service.

My plan is to try to put some of the best that I find out there on the web here, along with my own thoughts and experiences in the new subspecialty that is Trauma Resuscitation Anaesthesia (TRA).  It may take a few goes to try to get the format right, so bear with me!

Watch this space!