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Mon Jul 23 20:12:18 BST 2007

It is based on reports coming out of the Iraqi conflict.

________________________________

From: trauma-list-bounces at trauma.org on behalf of Karim Brohi
Sent: Mon 7/23/2007 11:18 AM
To: Trauma &amp, Critical Care mailing list
Subject: Re: Massive Transfusion Protocol: What's in YOUR pack?

OK.  For those of you who have decided to use 1:1 FFP:RBCs, what evidence
(published) are you basing this on?

Karim

On 23/07/07, Andrew J Bowman <andrewj.bowman at gmail.com> wrote:
>
> 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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Massive Transfusion Protocol: What's in YOUR pack?