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Mon Jul 23 07:19:06 BST 2007

We did not even have them as guidelines.

Andrew

On 7/23/07, Hardcastle, Tim, Dr <tch at sun.ac.za> <tch at sun.ac.za> wrote:
>
> 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
> Office: +27219389281 or 4911 pager 0302
>
>
>
> -----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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