Acute Care Surgery in the Rural Setting
A 25-year-old pregnant patient is brought to the trauma bay after sustaining devastating injuries in a motor vehicle crash. The patient was intubated in the field. She is in the third trimester (34 weeks) and has what is thought to be a lethal closed head injury (Glasgow Coma Scale of 3). While in the trauma bay, she has a precipitous and sustained drop in blood pressure, refractory to body positioning and fluid resuscitation. Which of the following should emergency management do at this time?
Emergency cesarean section
Computed tomography evaluation of the abdomen
Initiation of pressors
Immediate transfer to a tertiary facility (20 miles)
Initiation of do not resuscitate order
KeywordsTrauma Center General Surgeon Rural Setting Necrotizing Fasciitis Rural Hospital
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
Unable to display preview. Download preview PDF.
- 2.Ricketts T, Johnson-Webb K, Taylor P. Definitions of Rural: A Handbook for Health Policy Makers and Researchers. Rockville, MD: Office of Rural Health Policy, 1998.Google Scholar
- 3.Larson E, Johnson K, Norris T, et al. State of The Health Workforce in Rural America: Profiles and Comparisons. Seattle, WA: WWAMI Rural Health Research Center, 2002.Google Scholar
- 4.Grossman D, Hart L, Rivara F. From the Roadside to the Bedside: The Regionalization of Motor Vehicle Trauma Care in a Remote Rural County. Seattle, WA: WWAMI Rural Health Working Paper Series, Working Paper 24, 1993.Google Scholar
- 12.Sharar S, Luna G, Rice C, et al. Air transport following surgical stabilization: an extension of regionalized trauma care. J Trauma 1998; 28(6):794–798.Google Scholar
- 24.Callaghan J. A twenty-five year survey of a solo practice in rural surgical care. J Am Coll Surg 1998; 44(6):984–990.Google Scholar
- 26.Reid J, McGowan J, Ricci M, et al. Desktop teleradiology in support of rural orthopedic care. Proc AMIA Ann Fall Symp 1997; 4:403–407.Google Scholar
- 29.Thompson M, Lynge D, Larson E, et al. Characterizing the General Surgery Workforce in Rural America. Seattle,WA: WWAMI Rural Health Working Paper Series, Working Paper 77, 2004: 1–11.Google Scholar
- 30.Hunter J, Deveney K. Training the rural surgeon: a proposal. Bull Am Coll Surg 2003; 88(5):14–17.Google Scholar
© Springer Science+Business Media, LLC 2007