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Mon Jul 23 22:12:24 BST 2007

Tim,

These are editorials/reviews.  There's no data there!

K

On 23/07/07, Hardcastle, Tim, Dr <tch at sun.ac.za> <tch at sun.ac.za> wrote:
>
> Karim
>
> J Trauma - June 2006 suppliment, also work of John Hess!
>
> 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 Karim Brohi
> Sent: Monday, July 23, 2007 7:19 PM
> 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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