List Archives

Tue May 22 17:49:18 BST 2007

Do you think it possible to get these (fluid warmers) in all the ESV
(emergency service vehicle)? If hypothermia can be prevented by having
them, why not have them.

>
> Today's Topics:
>
>    1. Re: Level I Fluid Warmer (Ronald Gross)
>    2. RE: Level I Fluid Warmer (trauma at emergencyunit.com)
>    3. Re: Level 1 Fluid Infusor (KMATTOX at aol.com)
>    4. Level I Fluid Warmer  (bensonblues at comcast.net)
>    5. RE: Level I Fluid Warmer (Hardcastle, Tim, Dr <tch at sun.ac.za>)
>    6. Re: Herniaion of Lung (Ronald Gross)
>
>
> ----------------------------------------------------------------------
>
> Message: 1
> Date: Fri, 18 May 2007 11:47:15 -0400
> From: "Ronald Gross" <Rgross at harthosp.org>
> Subject: Re: Level I Fluid Warmer
> To: "Trauma &amp; Critical Care mailing list" <trauma-list at trauma.org>
> Message-ID: <464D9243.7FF1.00B9.0 at harthosp.org>
> Content-Type: text/plain; charset=US-ASCII
>
> Truth be told, not only have both modes of therapy (high volume infusion
> and permissive hypotension) been questioned, but depending on who you
> read, they have actually been felt to be detrimental to the patient.
> Hmmmmm........................
>
>>>> MARK FORREST <atacc.doc at btinternet.com> 5/17/2007 2:15 PM >>>
> 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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> ------------------------------
>
> Message: 2
> Date: Fri, 18 May 2007 19:03:36 +0100
> From: <trauma at emergencyunit.com>
> Subject: RE: Level I Fluid Warmer
> To: "'Trauma &amp; Critical Care mailing list'"
> 	<trauma-list at trauma.org>
> Message-ID: <003c01c79976$dbe18890$0301a8c0 at vaio>
> Content-Type: text/plain;	charset="US-ASCII"
>
> 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,
>>
>>
>> --
>> trauma-list : TRAUMA.ORG
>> To change your settings or unsubscribe visit:
>> http://www.trauma.org/index.php?/community/
> --
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>
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>
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>
>
> ------------------------------
>
> Message: 3
> Date: Fri, 18 May 2007 14:03:40 EDT
> From: KMATTOX at aol.com
> Subject: Re: Level 1 Fluid Infusor
> To: trauma-list at trauma.org, cmursic at gmail.com
> Message-ID: <d6a.692c452.337f447c at aol.com>
> Content-Type: text/plain; charset="US-ASCII"
>
>
> In a message dated 5/17/2007 11:08:50 P.M. Central Daylight Time,
> SeppelI at wahs.nsw.gov.au writes:
>
> Thanks,  Ken - just the picture I was looking for. Are you happy if I
> show it in a  public presentation (with due credit)?
> Thanks, Ian
>
>
> You or anyone on this list can show it anywhere anytime
>
> k
>
>
>
> ************************************** See what's free at
> http://www.aol.com.
>
>
> ------------------------------
>
> Message: 4
> Date: Fri, 18 May 2007 22:58:29 +0000
> From: bensonblues at comcast.net
> Subject: Level I Fluid Warmer
> To: trauma-list at trauma.org
> Message-ID:
> 	<051820072258.15533.464E2F95000862B300003CAD22165514069C0A9A040D02019C020A0D at comcast.net>
>
> Content-Type: text/plain
>
> High volume infusion, permissive hypotension, ad nauseum: It all depends.
> Dogma is something that the internists can get away with, but not those of
> us who take care of the injured. Give me a pt with a GSW to the groin and
> on-scene exsanguination, hemostasis achieved with direct pressure, but
> without a blood pressure, the early experiments by Arthur Guyton on
> hemorrhage still prevail: Aggressive volume resuscitation is more likely
> than not to decrease morbidity and mortality. However, give me a pt struck
> by an auto with multiple injuries, uncontrolled intracavitary hemorrhage,
> and no blood pressure, and with the exception of high volume transfusion
> of fresh whole blood (when was the last time you administered that?), high
> volume resuscitation is likely to contribute to hemodilution and
> coagulopathy and continued and worsening hemorrhage. I'm under the firm
> belief that it doesn't really matter what you do preoperatively (with few
> exceptions). The most important determinant of
>  surviv
> al from trauma is 1) the time it takes to get the patient to the OR and 2)
> the skills of the surgeon. I hope that this statement is without
> controversy. Every trauma victim is a little different from the next, and
> judgement should prevail. No matter what your management strategy, it
> always depends on the patient injuries, pre-existing medical problems,
> medications the patient is taking, and your available resources. In short,
> there is a role for the high-volume infuser in selected cases. It's
> utility would be greatly increased if fresh whole blood were to be used.
>
> DB
>
> ------------------------------
>
> Message: 5
> Date: Sat, 19 May 2007 06:45:46 +0200
> From: "Hardcastle, Tim, Dr <tch at sun.ac.za>" <tch at sun.ac.za>
> Subject: RE: Level I Fluid Warmer
> To: "Trauma &amp; Critical Care mailing list" <trauma-list at trauma.org>
> Message-ID:
> 	<3FE6F2A76FE75C418D3E0481CD75EA1E329066 at TYGEVS01.tyg.sun.ac.za>
> Content-Type: text/plain;	charset="iso-8859-1"
>
> 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,
>>
>>
>> --
>> trauma-list : TRAUMA.ORG
>> To change your settings or unsubscribe visit:
>> http://www.trauma.org/index.php?/community/
> --
> trauma-list : TRAUMA.ORG
> To change your settings or unsubscribe visit:
> http://www.trauma.org/index.php?/community/
>
> Confidentiality Notice
>
> This e-mail message, including any attachments, is for the sole use of the
> intended recipient(s) and may contain confidential or proprietary
> information which is legally privileged.  Any unauthorized review, use,
> disclosure, or distribution is prohibited.  If you are not the intended
> recipient, please promptly contact the sender by reply e-mail and destroy
> all copies of the original message.
> --
> trauma-list : TRAUMA.ORG
> To change your settings or unsubscribe visit:
> http://www.trauma.org/index.php?/community/
> --
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> To change your settings or unsubscribe visit:
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>
>
> _________________________________________________________________
>
> Links to North East Wales NHS Trust email disclaimers.
>
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>
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> _________________________________________________________________
>
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>
> ------------------------------
>
> Message: 6
> Date: Thu, 17 May 2007 09:09:53 -0400
> From: "Ronald Gross" <Rgross at harthosp.org>
> Subject: Re: Herniaion of Lung
> To: <trauma-list at trauma.org>
> Message-ID: <464C1BDF.7FF1.00B9.0 at harthosp.org>
> Content-Type: text/plain; charset="us-ascii"
>
> Gross, R.I; Eversgerd, J.L..  Transthoracic Lung Herniation Due to Blunt
> Trauma.
> J Trauma, May 2006; 60:1149.
>
>
>>>> rm khattar <dr_rm_khattar at yahoo.co.in> 5/17/2007 8:01 AM >>>
> How to diagnose Herniation Of Lung clinically and
> radiologically?What is the differential diagnosis?How
> to treat it?
>
>
>
> __________________________________________________________
> Yahoo! India Answers: Share what you know. Learn something new
> http://in.answers.yahoo.com/
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