List Archives

Thu May 24 02:10:11 BST 2007

It is more LYMPHOCYTES that are affected by stress..

> Date: Wed, 23 May 2007 10:29:31 +0200> From: mls at webmail.co.za> To: trauma-list at trauma.org> Subject: adrenal insufficiency > > I happen to be paramedic in South Africa, we use adrenalin in the> prehospital setting, however some poeple say we over use to it,they say we> use it to do the hand over with a patient still having a pulse.> > What I will like to know is(from any one who has expirience in the field)> when would you say we shouldnt use adrenalin and when do think we should,> incase when a patient is in cardaic arrest, we should test whether it is> sufficient in the BC,what do you think.> >> > ----------------------------------------------------------------------> >> > Message: 1> > Date: Tue, 22 May 2007 10:24:47 -0400> > From: "Hall, John R" <John_R_Hall at Wellmont.org>> > Subject: RE: adrenal insufficiency> > To: "Trauma &amp; Critical Care mailing list" <trauma-list at trauma.org>> > Message-ID:> > <79561B43C52DBC4C9C74FEF221B12331017E8660 at whsnt15.wmdomain1.wellmont.org>> >> > Content-Type: text/plain; charset="iso-8859-1"> >> > An easy way to "check" for adrenal insufficiency is to look at the eos on> > your WBC. If the person is "normal", they should be suppressed due to> > adrenal steroids (usually elevated post shock, icu, etc). If they are> > elevated, it is almost diagnostic for adrenal insufficiency in the ICU> > (barring a few zebras)> > j> >> > ________________________________> >> > From: trauma-list-bounces at trauma.org on behalf of Rangraj Setlur> > Sent: Tue 5/15/2007 9:15 AM> > To: Trauma &amp, Critical Care mailing list> > Subject: Re: adrenal insufficiency> >> >> >> > I'm sure it exists, but theres also the possibility that what being seen> > is> > vasopressin deficiency.> > rangraj> > On 5/13/07, Roy Danks <roydanks at hotmail.com> wrote:> >>> >> Absolutely...low flow state. Without a doubt. well described in the> >> acute burn patient as well.> >>> >> RD> >>> >>> >>> >> > Date: Sun, 13 May 2007 14:12:31 +0100> From: kazakosgm at yahoo.gr> To:> >> trauma-list at trauma.org> Subject: adrenal insufficiency> > Dear all,> I'd> >> like to ask if any of you have ever suspected relative adrenal> >> insufficiency> >> after profound hemorrhagic shock (even if you didn't administered> >> steroids).> >> Thank you in advance, > George M. Kazakos DVM, PhD.> > > George M.> >> Kazakos> >> DVM, PhD, > Anesthesia and Intensive Care Unit, > Companion Animal> >> Clinic, >> >> Dept. Clinical Sciences, > Faculty of Veterinary Medicine, > Aristotle> >> University of Thessaloniki, > 11 St. Voutyra str., > 54627 Thessaloniki,> >> >> >> Greece> > ---------------------------------> ?????????????? Yahoo!>> >> ?????????? ?? ?????????? ???? ???? (spam); ?? Yahoo! Mail ???????? ???> >> ???????? ?????? ????????? ???? ??? ??????????? ????????? >> >> http://login.yahoo.com/config/mail?.intl=gr > --> trauma-list :> >> TRAUMA.ORG>> >> To change your settings or unsubscribe visit:>> >> http://www.trauma.org/index.php?/community/> >> _________________________________________________________________> >> Create the ultimate e-mail address book. Import your contacts to Windows> >> Live Hotmail.> >>> >> www.windowslive-hotmail.com/learnmore/managemail2.html?locale=en-us&ocid=TXT_TAGLM_HMWL_reten_impcont_0507--> >> trauma-list : TRAUMA.ORG> >> To change your settings or unsubscribe visit:> >> http://www.trauma.org/index.php?/community/> >>> >> >> >> > --> > Lt Col Rangraj Setlur> > Associate Professor> > Department of Anaesthesiology and Critical Care> > Armed Forces Medical College> > Pune> > India> >> >> > -------------- next part --------------> > A non-text attachment was scrubbed...> > Name: not available> > Type: application/ms-tnef> > Size: 6430 bytes> > Desc: not available> > Url :> > http://list.mistral.net/pipermail/trauma-list/attachments/20070522/4046b661/attachment-0001.bin> >> > ------------------------------> >> > Message: 2> > Date: Tue, 22 May 2007 20:35:16 +0530> > From: "Rangraj Setlur" <rangraj at gmail.com>> > Subject: Re: adrenal insufficiency> > To: "Trauma &amp, Critical Care mailing list" <trauma-list at trauma.org>> > Message-ID:> > <60fef5240705220805x23306704yee62a583fdfbff27 at mail.gmail.com>> > Content-Type: text/plain; charset=ISO-8859-1; format=flowed> >> > Dr Hall, thats a fascinating statement. Do you have any references which> > back that up? what level of eosinophils would you consider as elevated in> > a> > setting of sepsis? we do differentials for eosinophilia in india because> > of> > tropical eosinophilia, but i'd never thought of looking specifically at> > eosinophils in this setting.> > thanks,> > rangraj> >> > On 5/22/07, Hall, John R <John_R_Hall at wellmont.org> wrote:> >>> >> An easy way to "check" for adrenal insufficiency is to look at the eos> >> on> >> your WBC. If the person is "normal", they should be suppressed due to> >> adrenal steroids (usually elevated post shock, icu, etc). If they are> >> elevated, it is almost diagnostic for adrenal insufficiency in the ICU> >> (barring a few zebras)> >> j> >>> >> ________________________________> >>> >> From: trauma-list-bounces at trauma.org on behalf of Rangraj Setlur> >> Sent: Tue 5/15/2007 9:15 AM> >> To: Trauma &amp, Critical Care mailing list> >> Subject: Re: adrenal insufficiency> >>> >>> >>> >> I'm sure it exists, but theres also the possibility that what being seen> >> is> >> vasopressin deficiency.> >> rangraj> >> On 5/13/07, Roy Danks <roydanks at hotmail.com> wrote:> >> >> >> > Absolutely...low flow state. Without a doubt. well described in the> >> > acute burn patient as well.> >> >> >> > RD> >> >> >> >> >> >> >> > > Date: Sun, 13 May 2007 14:12:31 +0100> From: kazakosgm at yahoo.gr> To:> >> > trauma-list at trauma.org> Subject: adrenal insufficiency> > Dear all,>> >> I'd> >> > like to ask if any of you have ever suspected relative adrenal> >> insufficiency> >> > after profound hemorrhagic shock (even if you didn't administered> >> steroids).> >> > Thank you in advance, > George M. Kazakos DVM, PhD.> > > George M.> >> Kazakos> >> > DVM, PhD, > Anesthesia and Intensive Care Unit, > Companion Animal> >> Clinic, >> >> > Dept. Clinical Sciences, > Faculty of Veterinary Medicine, > Aristotle> >> > University of Thessaloniki, > 11 St. Voutyra str., > 54627> >> Thessaloniki,> >> >> >> > Greece> > ---------------------------------> ?????????????? Yahoo!>> >> > ?????????? ?? ?????????? ???? ???? (spam); ?? Yahoo! Mail ???????? ???> >> > ???????? ?????? ????????? ???? ??? ??????????? ????????? >> >> > http://login.yahoo.com/config/mail?.intl=gr > --> trauma-list :> >> TRAUMA.ORG>> >> > To change your settings or unsubscribe visit:>> >> > http://www.trauma.org/index.php?/community/> >> > _________________________________________________________________> >> > Create the ultimate e-mail address book. Import your contacts to> >> Windows> >> > Live Hotmail.> >> >> >> >> >> www.windowslive-hotmail.com/learnmore/managemail2.html?locale=en-us&ocid=TXT_TAGLM_HMWL_reten_impcont_0507--> >> > trauma-list : TRAUMA.ORG> >> > To change your settings or unsubscribe visit:> >> > http://www.trauma.org/index.php?/community/> >> >> >>> >>> >>> >> --> >> Lt Col Rangraj Setlur> >> Associate Professor> >> Department of Anaesthesiology and Critical Care> >> Armed Forces Medical College> >> Pune> >> India> >>> >>> >>> >> --> >> trauma-list : TRAUMA.ORG> >> To change your settings or unsubscribe visit:> >> http://www.trauma.org/index.php?/community/> >>> >>> >> >> > --> > Lt Col Rangraj Setlur> > Associate Professor> > Department of Anaesthesiology and Critical Care> > Armed Forces Medical College> > Pune> > India> >> >> > ------------------------------> >> > Message: 3> > Date: Tue, 22 May 2007 12:47:36 -0400> > From: "William Bromberg" <brombwi1 at memorialhealth.com>> > Subject: RE: [ccm-l] "Sicko" premise> > To: "Trauma &amp; Critical Care mailing list" <trauma-list at trauma.org>> > Message-ID: <4652E6680200003A00002BB2 at memorialhealth.com>> > Content-Type: text/plain; charset=US-ASCII> >> > Seriously, how many times do you have to sniff dog dirt to make a fairly> > solid prediction that the next pile STILL won't smell like roses.> >> > William J. Bromberg, MD, FACS> > Chair, EAST Practice Management Guidelines Committee> > Savannah Surgical Group> > 912 350-7412> >> >>>> "Thomas Anthony Horan" <thoran at sarah.br> 05/21/07 6:12 PM >>>> > Charles,> >> > What a treat this topic has been, a forcefull K diatriabe against a movie> > he has not seen, supported by someone who never will.> >> > Such arrogance leaves me in awe.> >> > Tom> >> >> ----------> >> From:> >> trauma-list-bounces at trauma.org[SMTP:trauma-list-bounces at trauma.org] on> >> behalf of KMATTOX at aol.com[SMTP:KMATTOX at aol.com]> >> Reply To: Trauma &amp; Critical Care mailing list> >> Sent: segunda-feira, 21 de maio de 2007 16:48> >> To: trauma-list at trauma.org> >> Subject: Re: [ccm-l] "Sicko" premise> >>> >>> >> In a message dated 5/21/2007 12:03:09 P.M. Central Daylight Time,> >> c_brault at yahoo.com writes:> >>> >>> >> Especialyinthe sensethatthe USAas a disproportionate> >> problem with:> >> drinking while driving, drug misuse, availability of guns and other> >> weapons> >> especially when there is a mxture of ETOH, drugs, and excitement,> >> driving> >> fast, etc.> >>> >>> >>> >> We can all learn a valuable lesson from Australia.> >>> >> k> >>> >>> >>> >> ************************************** See what's free at> >> http://www.aol.com.> >> --> >> 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/> >> >> >> >> > ------------------------------> >> > Message: 4> > Date: Tue, 22 May 2007 18:49:18 +0200 (SAST)> > From: mls at webmail.co.za> > Subject: Re: trauma-list Digest, Vol 47, Issue 26> > To: trauma-list at trauma.org> > Message-ID:> > <43460.196.21.60.122.1179852558.squirrel at mail.webmail.co.za>> > Content-Type: text/plain;charset=iso-8859-1> >> > 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,> >>>> >>>> >>> --> >>> 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/> >> --> >> 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.> >>> >>> >> ------------------------------> >>> >> 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/> >> --> >> 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/> >> --> >> trauma-list : TRAUMA.ORG> >> To change your settings or unsubscribe visit:> >> http://www.trauma.org/index.php?/community/> >>> >>> >> _________________________________________________________________> >>> >> Links to North East Wales NHS Trust email disclaimers.> >>> >> Cymraeg www.newalesnhstrust.org.uk/index.php?page=aildisclaimer&lang=> >>> >> English www.newalesnhstrust.org.uk/index.php?page=aildisclaimer&lang=> >> _________________________________________________________________> >>> >> --> >> trauma-list : TRAUMA.ORG> >> To change your settings or unsubscribe visit:> >> http://www.trauma.org/index.php?/community/> >>> >>> >>> >> ------------------------------> >>> >> 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/> >> --> >> trauma-list : TRAUMA.ORG> >> To change your settings or unsubscribe visit:> >> http://www.trauma.org/index.php?/community/> >>> >>> >> _________________________________________________________________> >>> >> Links to North East Wales NHS Trust email disclaimers.> >>> >> Cymraeg www.newalesnhstrust.org.uk/index.php?page=aildisclaimer&lang=> >>> >> English www.newalesnhstrust.org.uk/index.php?page=aildisclaimer&lang=> >> _________________________________________________________________> >>> >> --> >> 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/> >>> >>> >> ------------------------------> >>> >> 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/> >> --> >> 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.> >> -------------- next part --------------> >> A non-text attachment was scrubbed...> >> Name: Figure 2A.jpg> >> Type: image/jpeg> >> Size: 30839 bytes> >> Desc: not available> >> Url :> >> http://list.mistral.net/pipermail/trauma-list/attachments/20070517/c915dfce/Figure2A.jpg> >> -------------- next part --------------> >> A non-text attachment was scrubbed...> >> Name: Figure 1.JPG> >> Type: image/jpeg> >> Size: 772830 bytes> >> Desc: not available> >> Url :> >> http://list.mistral.net/pipermail/trauma-list/attachments/20070517/c915dfce/Figure1.jpg> >>> >> ------------------------------> >>> >> --> >> trauma-list : TRAUMA.ORG> >> To change your settings or unsubscribe visit:> >> http://www.trauma.org/index.php?/community/> >>> >> End of trauma-list Digest, Vol 47, Issue 26> >> *******************************************> >>> >> >> >> > -------------------------------------------> > South Africas premier free email service - www.webmail.co.za> > ------------------------------------------------------------------> > For super low premiums, click here http://www.webmail.co.za/dd.pwm> >> >> >> > ------------------------------> >> > Message: 5> > Date: Tue, 22 May 2007 12:52:45 -0400> > From: "Ronald Gross" <Rgross at harthosp.org>> > Subject: RE: [ccm-l] "Sicko" premise> > To: "Trauma &amp; Critical Care mailing list" <trauma-list at trauma.org>> > Message-ID: <4652E79C.7FF1.00B9.0 at harthosp.org>> > Content-Type: text/plain; charset=US-ASCII> >> > Hey Bill,> >> > Which pile are you referring to????> >> > Ron> >> >>>> "William Bromberg" <brombwi1 at memorialhealth.com> 5/22/2007 12:47 PM> >>>> >>>> > Seriously, how many times do you have to sniff dog dirt to make a fairly> > solid prediction that the next pile STILL won't smell like roses.> >> > William J. Bromberg, MD, FACS> > Chair, EAST Practice Management Guidelines Committee> > Savannah Surgical Group> > 912 350-7412> >> >>>> "Thomas Anthony Horan" <thoran at sarah.br> 05/21/07 6:12 PM >>>> > Charles,> >> > What a treat this topic has been, a forcefull K diatriabe against a movie> > he has not seen, supported by someone who never will.> >> > Such arrogance leaves me in awe.> >> > Tom> >> >> ----------> >> From:> >> trauma-list-bounces at trauma.org[SMTP:trauma-list-bounces at trauma.org] on> >> behalf of KMATTOX at aol.com[SMTP:KMATTOX at aol.com]> >> Reply To: Trauma &amp; Critical Care mailing list> >> Sent: segunda-feira, 21 de maio de 2007 16:48> >> To: trauma-list at trauma.org> >> Subject: Re: [ccm-l] "Sicko" premise> >>> >>> >> In a message dated 5/21/2007 12:03:09 P.M. Central Daylight Time,> >> c_brault at yahoo.com writes:> >>> >>> >> Especialyinthe sensethatthe USAas a disproportionate> >> problem with:> >> drinking while driving, drug misuse, availability of guns and other> >> weapons> >> especially when there is a mxture of ETOH, drugs, and excitement,> >> driving> >> fast, etc.> >>> >>> >>> >> We can all learn a valuable lesson from Australia.> >>> >> k> >>> >>> >>> >> ************************************** See what's free at> >> http://www.aol.com.> >> --> >> 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/> >> >> > --> > 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.> >> >> > ------------------------------> >> > Message: 6> > Date: Tue, 22 May 2007 12:56:26 -0400> > From: "Ronald Gross" <Rgross at harthosp.org>> > Subject: Re: trauma-list Digest, Vol 47, Issue 26> > To: <trauma-list at trauma.org>> > Message-ID: <4652E87A.7FF1.00B9.0 at harthosp.org>> > Content-Type: text/plain; charset=US-ASCII> >> > Level I - no way. Too big.> > Hot Line, sure it is small enough. The real question, however, is do we> > believe the resuscitators or the non-resuscitators. If we believe the> > latter, then there would never be any need for either> > anywhere...........unless you needed a coat hanger!> >> >>>> <mls at webmail.co.za> 5/22/2007 12:49 PM >>>> > 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,> >>>> >>>> >>> --> >>> 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/> >> --> >> 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.> >>> >>> >> ------------------------------> >>> >> 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/> >> --> >> 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/> >> --> >> trauma-list : TRAUMA.ORG> >> To change your settings or unsubscribe visit:> >> http://www.trauma.org/index.php?/community/> >>> >>> >> _________________________________________________________________> >>> >> Links to North East Wales NHS Trust email disclaimers.> >>> >> Cymraeg www.newalesnhstrust.org.uk/index.php?page=aildisclaimer&lang=> >>> >> English www.newalesnhstrust.org.uk/index.php?page=aildisclaimer&lang=> >> _________________________________________________________________> >>> >> --> >> trauma-list : TRAUMA.ORG> >> To change your settings or unsubscribe visit:> >> http://www.trauma.org/index.php?/community/> >>> >>> >>> >> ------------------------------> >>> >> 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/> >> --> >> trauma-list : TRAUMA.ORG> >> To change your settings or unsubscribe visit:> >> http://www.trauma.org/index.php?/community/> >>> >>> >> _________________________________________________________________> >>> >> Links to North East Wales NHS Trust email disclaimers.> >>> >> Cymraeg www.newalesnhstrust.org.uk/index.php?page=aildisclaimer&lang=> >>> >> English www.newalesnhstrust.org.uk/index.php?page=aildisclaimer&lang=> >> _________________________________________________________________> >>> >> --> >> 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/> >>> >>> >> ------------------------------> >>> >> 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/> >> --> >> 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.> >> -------------- next part --------------> >> A non-text attachment was scrubbed...> >> Name: Figure 2A.jpg> >> Type: image/jpeg> >> Size: 30839 bytes> >> Desc: not available> >> Url :> >> http://list.mistral.net/pipermail/trauma-list/attachments/20070517/c915dfce/Figure2A.jpg> >> -------------- next part --------------> >> A non-text attachment was scrubbed...> >> Name: Figure 1.JPG> >> Type: image/jpeg> >> Size: 772830 bytes> >> Desc: not available> >> Url :> >> http://list.mistral.net/pipermail/trauma-list/attachments/20070517/c915dfce/Figure1.jpg> >>> >> ------------------------------> >>> >> --> >> trauma-list : TRAUMA.ORG> >> To change your settings or unsubscribe visit:> >> http://www.trauma.org/index.php?/community/> >>> >> End of trauma-list Digest, Vol 47, Issue 26> >> *******************************************> >>> >> >> >> > -------------------------------------------> > South Africas premier free email service - www.webmail.co.za> > ------------------------------------------------------------------> > For super low premiums, click here http://www.webmail.co.za/dd.pwm> >> > --> > 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.> >> >> > ------------------------------> >> > Message: 7> > Date: Tue, 22 May 2007 13:08:53 -0400> > From: "Anthony Caruso" <Medic541 at hotmail.com>> > Subject: RE: trauma-list Digest, Vol 47, Issue 26> > To: "'Trauma &amp; Critical Care mailing list'"> > <trauma-list at trauma.org>> > Message-ID: <BAY141-DAV27DEA3D7B0818B2DEDC7799360 at phx.gbl>> > Content-Type: text/plain; charset="US-ASCII"> >> > We have the fluid warmers in our ambulances. However, the one that this> > group has been referring about, is a high volume infuser that is able to> > warm fluids as well. The warmers in the ambulance comes with an issue.> > The> > fluid must be rotated every month (per DPH). I believe the thought behind> > it is that it might become un sterile after a month has passed.> > Thanks,> > Anthony Caruso EMT-P> >> > P.S, I believe the names of the fluid warmer for the ambulances is called> > a> > "hot sac".> >> > -----Original Message-----> > From: trauma-list-bounces at trauma.org> > [mailto:trauma-list-bounces at trauma.org]> > On Behalf Of mls at webmail.co.za> > Sent: Tuesday, May 22, 2007 12:49 PM> > To: trauma-list at trauma.org> > Subject: Re: trauma-list Digest, Vol 47, Issue 26> >> >> > 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,> >>>> >>>> >>> --> >>> 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/> >> --> >> 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.> >>> >>> >> ------------------------------> >>> >> 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/> >> --> >> 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/> >> --> >> trauma-list : TRAUMA.ORG> >> To change your settings or unsubscribe visit:> >> http://www.trauma.org/index.php?/community/> >>> >>> >> _________________________________________________________________> >>> >> Links to North East Wales NHS Trust email disclaimers.> >>> >> Cymraeg www.newalesnhstrust.org.uk/index.php?page=aildisclaimer&lang=> >>> >> English www.newalesnhstrust.org.uk/index.php?page=aildisclaimer&lang=> >> _________________________________________________________________> >>> >> --> >> trauma-list : TRAUMA.ORG> >> To change your settings or unsubscribe visit:> >> http://www.trauma.org/index.php?/community/> >>> >>> >>> >> ------------------------------> >>> >> 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:> >>> >> <051820072258.15533.464E2F95000862B300003CAD22165514069C0A9A040D02019C> >> 020A0D 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.

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