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Who's doing 1:1 blood transfusions for shock?

Daly, Ivonne dalyix2 at upmc.edu
Tue Feb 12 19:27:19 GMT 2008


Mike,

Hi. We have a protocol for the OR where we request a massive transfusion pack from the blood bank.  This  pack contains 10 PRBC and 10 FFP that are used  at a 1:1 ratio.  The anesthesiologists are on board and have done a good job at keeping up during difficult cases. We also try our best to gently remind them all the time.
Holcomb's data seems pretty good and we have also seen less bowel edema and overall less transfusions. We are able to use factor VII under extreme circumstances but we have to beg, give up an arm and a leg, and then more.
One of my collegues did some research on this topic during his fellowship and has helped us implement this more smoothly.

We tried doing 1:1 PRBC/FFP when necessary in Landstuhl, the army hospital in Germany.

Ivonne Daly, MD FACS
Asst Prof Surgery and Critical Care
University of Pittsburgh


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Today's Topics:

   1. Post Pneumonectomy Pulmonary Oedema (Matthew Reeds)
   2. Who's doing 1:1 blood transfusions for shock? (Sise, Mike MD)
   3. RE: Who's doing 1:1 blood transfusions for shock?
      (Hardcastle, Tim, Dr <tch at sun.ac.za>)
   4. RE: Who's doing 1:1 blood transfusions for shock? (Ronald Gross)
   5. CT confirmation of healing spleen (gsuywy at pacific.net.sg)


----------------------------------------------------------------------

Message: 1
Date: Tue, 12 Feb 2008 14:23:09 +0000
From: Matthew Reeds <mgreeds at reeds.uk.com>
Subject: Post Pneumonectomy Pulmonary Oedema
To: trauma-list at trauma.org
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Message: 2
Date: Tue, 12 Feb 2008 07:56:18 -0800
From: "Sise, Mike MD" <Sise.Mike at scrippshealth.org>
Subject: Who's doing 1:1 blood transfusions for shock?
To: trauma-list at trauma.org
Message-ID:
        <FEECA018557C774EB876F0D3BCB54E1B01103A4A at MSG02.corp.scripps.org>
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To all,

Who's doing 1:1 fresh frozen plasma to packed RBCs transfusions and limiting crystalloid for resuscitation in hemorrhagic shock? If you've adopted it - why? If not - why? Any and all comments requested.

Mike Sise
San Diego

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Message: 3
Date: Tue, 12 Feb 2008 18:03:44 +0200
From: "Hardcastle, Tim, Dr <tch at sun.ac.za>" <tch at sun.ac.za>
Subject: RE: Who's doing 1:1 blood transfusions for shock?
To: "Trauma &amp; Critical Care mailing list" <trauma-list at trauma.org>
Message-ID:
        <3FE6F2A76FE75C418D3E0481CD75EA1E58B094 at TYGEVS01.tyg.sun.ac.za>
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Mike

We do it as best possible - our blood bank tries their best to make it difficult. My subjective opinion is that we use less blood in total and have less abdomens left open after OR due to bowel oedema (same reason we use modern starches and geletins as resus fluids!!)

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
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 Sise, Mike MD
Sent: Tuesday, February 12, 2008 5:56 PM
To: trauma-list at trauma.org
Subject: Who's doing 1:1 blood transfusions for shock?


To all,

Who's doing 1:1 fresh frozen plasma to packed RBCs transfusions and limiting crystalloid for resuscitation in hemorrhagic shock? If you've adopted it - why? If not - why? Any and all comments requested.

Mike Sise
San Diego

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------------------------------

Message: 4
Date: Tue, 12 Feb 2008 11:15:45 -0500
From: "Ronald Gross" <Rgross at harthosp.org>
Subject: RE: Who's doing 1:1 blood transfusions for shock?
To: "Trauma &amp; Critical Care mailing list" <trauma-list at trauma.org>
Message-ID: <47B17FE1.7FF1.00B9.0 at harthosp.org>
Content-Type: text/plain; charset=US-ASCII

Mike, Tim, et all,

I think Tim and I have the same blood bank!  We, too, are going to the 1:1:1 more often than not; I do it routinely largely because that is what I was doing when I was in the sandbox, and because several of my colleagues are starting to believe, thanks to Holcomb and our early results here.  It has NOT been universally accepted, however, and I am not sure why.

Ron
>>> "Hardcastle, Tim, Dr <tch at sun.ac.za>" <tch at sun.ac.za> 2/12/2008 11:03 AM >>>
Mike

We do it as best possible - our blood bank tries their best to make it difficult. My subjective opinion is that we use less blood in total and have less abdomens left open after OR due to bowel oedema (same reason we use modern starches and geletins as resus fluids!!)

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
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 Sise, Mike MD
Sent: Tuesday, February 12, 2008 5:56 PM
To: trauma-list at trauma.org
Subject: Who's doing 1:1 blood transfusions for shock?


To all,

Who's doing 1:1 fresh frozen plasma to packed RBCs transfusions and limiting crystalloid for resuscitation in hemorrhagic shock? If you've adopted it - why? If not - why? Any and all comments requested.

Mike Sise
San Diego

"Scripps Information Security"
------------------------------------------------------------------------------
This e-mail and any files transmitted with it may contain privileged and confidential information and are intended solely for the use of the individual or entity to which they are addressed. If you are not the intended recipient or the person responsible for delivering the e-mail to the intended recipient, you are hereby notified that any dissemination or copying of this e-mail or any of its attachment(s) is strictly prohibited. If you have received this e-mail in error, please immediately notify the sending individual or entity by e-mail and permanently delete the original e-mail and attachment(s) from your computer system. Thank you for your cooperation.


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------------------------------

Message: 5
Date: Wed, 13 Feb 2008 00:31:10 +0800
From: gsuywy at pacific.net.sg
Subject: CT confirmation of healing spleen
To: "Trauma &amp; Critical Care mailing list" <trauma-list at trauma.org>
Message-ID: <20080213003110.xu1yghj5s0c4sog0 at wm3.web.pacific.net.sg>
Content-Type: text/plain; charset="iso-8859-1"

Dear all
I would appreciate the opinion of the members on the CT confirmation
of a healed ruptured spleen. The CT scan is of a 20 year old male
injured in a MVC - initial CT showing a splenic injury managed
conservatively and another 6 months later showing a ? fibrous band
joining the 2 fragments.

Is this sufficient evidence to allow him to go back to contact sports?
Or is the band expected to narrow even further in the future?

Thanks very much

Allen
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