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Mon May 21 17:04:57 BST 2007

Since the OR trauma system was the FIRST rural system in the US (est
1985), we  had massive transfusion protocols and used the ratio
described (some units brought at 110+ MPH from Boise by the OR Highway
Patrol) until the patient could be either operated, transported, or
died; the PRBC was not meant literally.  Take a break people.

Connie Potter, RN, MBA

-----Original Message-----
From: Hardcastle, Tim, Dr <tch at sun.ac.za> [mailto:tch at sun.ac.za] 
Sent: Friday, May 18, 2007 9:46 PM
To: Trauma &amp; Critical Care mailing list
Subject: RE: Level I Fluid Warmer

BFM

That is why the consensus is now that blood-products should not be used
in isolation. The recommended ratio is 1:1:1,i.e. 1PRBC, 1FFP and 1
platelet consentrate particularly where the transfusion load will exceed
6 PRBC. (See the J Trauma Suppl 2006 (May or June) and the ISBT-Science
Series vol 1(1) from 2006 - their new conference consensus series issue)

PRBC alone should not be used in trauma.

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
trauma at emergencyunit.com
Sent: Friday, May 18, 2007 8:04 PM
To: 'Trauma &amp; Critical Care mailing list'
Subject: RE: Level I Fluid Warmer

What nonsense. It is impossible to get control of many types of pelvis
fracture (such as the vertical shear) and so you have to give fluid to
these
patients or they exsanguinate into the pelvis. Remember - it's a bucket,
and
the bigger the bucket the more it holds. The problem comes when the
patient
gets given the wrong fluid. What the trauma patient needs is blood. What
most get is erythrocytes suspended in clotting-agent free mannitol
solution.
If we give our patients proper fresh blood - mirabile dictu, clot forms.
And
keeps forming. We have let the haematologists persuade us that they can
take
everything useful out of a bag of blood and we can give it as though it
is
blood. 

And we keep giving the rubbish. Surprise, surprise, 4 units later there
is
ooze everywhere, and 2 days later a dead patient.

BFM.

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org]
On Behalf Of Aruni Sen
Sent: 18 May 2007 11:43
To: Trauma &amp; Critical Care mailing list
Subject: RE: Level I Fluid Warmer

Volume is serious bad news in pelvis because the bleeding needs longer
time
to clot.

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org]
On Behalf Of MARK FORREST
Sent: 17 May 2007 19:15
To: Trauma &amp; Critical Care mailing list
Subject: Re: Level I Fluid Warmer

Ron....remember that high volume crystalloid is still not scientifically
proven either!!!! Mark F UK

----- Original Message ----
From: Ronald Gross <Rgross at harthosp.org>
To: trauma-list at trauma.org
Sent: Thursday, 17 May, 2007 2:38:00 PM
Subject: Re: Level I Fluid Warmer

Larry,
Remember that talk is cheap - and with "all the talk of permissive
hypotention"  that practice is still not universally accepted nor
scientifically proven......(sorry, Ken). Ron

>>> <ofiara at comcast.net> 5/16/2007 12:22 PM >>>
Yes, a Level One Fluid warmer or any type of fluid warmer has it's
place.
The question is, does a RAPID INFUSER have a place in the trauma
setting.
With all the talk of permiisve hypotention, I see a limited use in the
E.D.
Larry Ofiara, RN.

-------------- Original message -------------- 
From: "Connie Potter" <Connie at traumafoundation.org> 

> 
> Although a Level I may be a coat rack in temperate climates, in icy
cold 
> rural OR they saved more than one patient's bacon. The ED, OR had the
> same equipment saving time to transfer the patient and administer 
> PRBC's, the tubing snaps in quite easily (compared to some of the old 
> warmers), and little training was required to get them in use. 
> Remember, other parts of the US have what is called WINTER! 
> 
> Connie Potter,
> 
> 
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Level I Fluid Warmer