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Mon Jul 23 06:24:03 BST 2007

No

Actually working in countries where "clinical judgement" is still the prime reason for making decisions rather than following a written set of rules. While protocols may be helpful they are not the gold-standard of care by any means. At best they should be a guideline - deviated from by any worthy clinician with same judgement.

Tim
Dr T C Hardcastle
M.B.,Ch.B.(Stell); M.Med(Chir); FCS(SA)
Senior Surgeon / Senior Lecturer: Surgery (Trauma and ICU)
ATLS  instructor and DSTC Cape Town Course Director
Intern program Coordinator: Surgery
M.Med (Emergency Medicine) Executive Committee member
Clinical Head (Director): Diana Princess of Wales Trauma Unit
Division of Surgery (General) Room 4064
Department of Surgical Sciences
Tygerberg Hospital / University of Stellenbosch
PO Box 19063
Tygerberg 7505
Western Cape
South Africa
e-mail: tch at sun.ac.za
Cell: +27824681615
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-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org]On Behalf Of Andrew J Bowman
Sent: Monday, July 23, 2007 6:47 AM
To: Trauma &amp, Critical Care mailing list
Subject: Re: Massive Transfusion Protocol: What's in YOUR pack?

Complacency and lack of trauma foresight. (at least where I have worked in
the past)

Andrew

On 7/23/07, Errington Thompson <errington at erringtonthompson.com> wrote:
>
> Is there a reason NOT to have a massive transfusion protocol?
>
> E
>
> Errington C. Thompson, MD, FACS, FCCM
> Trauma/Surgical Critical Care
> Author - Letter to America
> Asheville, NC
>
> -----Original Message-----
> From: trauma-list-bounces at trauma.org [mailto:
> trauma-list-bounces at trauma.org]
> On Behalf Of MARK FORREST
> Sent: Sunday, July 22, 2007 7:16 PM
> To: Trauma &amp; Critical Care mailing list
> Subject: Re: Massive Transfusion Protocol: What's in YOUR pack?
>
> Hi Karim,
> The hospital protocol is actually lagging behing the labs own practice and
> they are supporting the new practices of the theatre teams:
>
> A:
> 1- After fourth unit of blood we start requesting 1:1 FFP:Blood
>
> B
> After 6 unit transfusion we now assume that you are already working on an
> established coagulopathy, especially if they are hypothermic
>
> After 6 units, request 2 FFP if  we are employing permissive anaemia
> (target
> 7-8 g/dl). If higher Hb level and haemostasis has been clinically achieved
> then may give none at this late stage.
>
> NO Factor VIIa if they have a temp less than 35 degree becasue of its
> dramatcally reduced function.
>
> C
> Lab clotting result will realistically take about 30 mins to 1 hour, which
> is obviously useless if still bleeding or operating.
>
> We have no reliable NPT and we do not currently have a TEG as our
> transfusion team believe that it is not a reliable measure
>
> Cheers
> Mark F
> UK
>
>
> ----- Original Message ----
> From: Karim Brohi <karim at trauma.org>
> To: Trauma & Critical Care mailing list <trauma-list at trauma.org>
> Sent: Sunday, 22 July, 2007 10:37:24 PM
> Subject: Massive Transfusion Protocol: What's in YOUR pack?
>
>
> Dear All,
>
> A straw poll if you don't mind on massive transfusion protocols for
> traumatic haemorrhage.  Please base your answers on your current practice
> or
> your institution's current practice, not latest research / hearsay etc:
>
> A. If you HAVE a massive transfusion protocol in your hospital:
>
>    1. Are you given packs of FFP according to how many units of blood
> have been administered?
>        (eg. 2 units of FFP after every 6 units of blood)
>
>    2. How much FFP after how much blood?
>
>    3. If your answer to (1) was NO, what's the make-up of your packs
>
> B. If you have just administered 6 units of blood:
>
>    1. Do you always give a certain amount of FFP or do you wait for
> labs? Which labs?
>
>    2. If you give FFP, how much for those 6 units would you consider
> standard?
>
>    3. What is the minimum that should be given (0 is an acceptable
> answer)
>
> C. Labs:
>
>    1. You send a PT/PTT from the ED or Operating room.  How soon do you
> get it back? (really)
>
>    2. Do you have point of care testing for PT/PTT in the ED & OR?
>
>    3. Do you do thromboelastometry routinely on bleeding trauma
> patients in the ED and OR?
>
> There are no right or wrong answers, as practice varies so widely.  I'm
> just
> trying to see the breadth of responses. So as many replies as possible
> please - even from the lurkers :-)
>
> Karim
>
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Massive Transfusion Protocol: What's in YOUR pack?