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Tue Jan 20 19:26:29 GMT 2009

Thanks to you, Robert, and to Dr. McSwain as well.
So now the question - why do you - or do you NOT - citrate the autotransfused blood.  I have always been taught that it is not safe to infuse non-citrated blood, but truth be told, I have never researched the literature 'cause I took my teachings as "gospel".  AS such I have ALWAYS citrated the Atrium blood prior to transfusing it.  I am now questioning those teachings, as there are some who argue each way - and I am wondering whether in the heat of battle it really matters or not.........

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] On Behalf Of Robert Schulze
Sent: Tuesday, January 20, 2009 2:15 PM
To: 'Trauma &amp; Critical Care mailing list'
Subject: Re: Autologous transfusion

We are transfusing chest tube drainage in the acute situation only, (IE the trauma bay and initially in the ICU). We use the reservoir and just hang it back up, no citrate...

Robert Schulze MD FACS
Clin Asst Dean, Asst Prof of Surgery
SUNY Downstate/Kings County Hospital

>>> "Gross, Ronald" <Ronald.Gross at bhs.org> 1/20/2009 10:11 AM >>>

A question for the list - who is transfusing chest tube drainage?  Are you citrating the blood prior to transfusion?
Ron

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] On Behalf Of Teperman, Sheldon
Sent: Saturday, January 17, 2009 10:44 AM
To: 'trauma-list at trauma.org'
Subject: RE: trauma-list Digest, Vol 67, Issue 20/ RE: Factor VII (7) clinical triggers for use in the trauma OR

Regarding factor 7.  We have just completed a two year long process of modernizing our Massive Transfusion Protocol, which I have appended. Nova nordisk is still in the midst of their somewhat troubled 100 center trauma factor seven trial, although admittedly I have not heard much about that of late.
        Our place is a busy (at times- the busiest) level one center in NYC, we see lots of penetrating trauma and also lots of very complex and tertiary OB work.  The protocol with aggressive and early use of factor seven has been used dozens of times here.  The GYN oncologists that handle our difficult OB work ( placental abruptions/accretas/abdominal pregnancies ect) are convinced that the introduction of factor seven is a "sea change".  I anecdotally  fully agree.
        I have crafted our use of factor seven in a way where there is easy access to its use (the attending Trauma surgeon directs its use-without the need for approval of the blood bank-for the first two doses). Generally speaking we call for the factor seven as the first six units are going in. The dose is a conservative one( for reasons we can go over). Where as I do agree that the key to the protocol is 1-1 tansfusion(more or less), the factor seven and plts (See Blue Journal early fall) are also critical.  Also having good equipment, well maintained and readily available and lots of people knowing how to use it ( eg Level One infuser) is key.
        Please do not distribute the attached protocol any further than this list prior to letting me know, as I would want to explain how we use it and where it fits in with the science as I understand it and practical reality...  A direct email to me would be best...Sheldon

-----Original Message-----
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Sent: Friday, January 16, 2009 7:33 AM
To: trauma-list at trauma.org
Subject: trauma-list Digest, Vol 67, Issue 20

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Today's Topics:

   1. RE: Factor VII (7) clinical triggers for use in the trauma OR
      (Duchesne, Juan C )
   2. Re: Crisis in Gaza... (Eduardo Palencia)

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

Message: 1
Date: Fri, 16 Jan 2009 06:24:36 -0600
From: "Duchesne, Juan C " <jduchesn at tulane.edu>
Subject: RE: Factor VII (7) clinical triggers for use in the trauma OR

To: "Trauma &amp" <trauma-list at trauma.org>,     "Trauma &amp"
        <trauma-list at trauma.org>
Message-ID:
        <93F431B4ABF11C43BDB776B643B691BCA2E53E at EX04.ad.tulane.edu>
Content-Type: text/plain;       charset="iso-8859-1"

Dear Marc- since the institution of Early Hemostatic Resuscitation at Charity, NO we counted only 2 cases were factor VII was used over the last 2 years, for which both patients end up dying. Based on our experience we decided to look further into this question. The below reference may be of help:
Good Luck
Juan

Current evidence based guidelines for factor VIIa use in trauma: the good, the bad, and the ugly. <https://ent.tulane.edu/pubmed/19097529?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum>

Duchesne JC, Mathew KA, Marr AB, Pinsky MR, Barbeau JM, McSwain NE.

Am Surg. 2008 Dec;74(12):1159-65.

Juan C. Duchesne MD, FACS, FCCP
Director Surgical Hospital Center
Director Tulane Surgical Intensive Care Unit AMR Regional Director Louisiana Emergency Response Network

Division of Trauma and Critical Care Surgery Tulane & LSU Department of Surgery and Anesthesiology 1430 Tulane Ave., SL-22 New Orleans LA 70112-2699 Tel. 504-988-5111 Fax. 504-988-3683

________________________________

From: trauma-list-bounces at trauma.org on behalf of Marc Matthews - MedPro MMC X
Sent: Thu 1/15/2009 9:34 PM
To: Trauma &amp
Subject: RE: Factor VII (7) clinical triggers for use in the trauma OR

All,

Does anybody have clinical triggers for the use of Factor VII (7) in the trauma OR? I am looking for any institution that has a guideline based on the literature for the triggers that they could share with me and anyone on this list server. I am looking to educate and provide economically sound advice on a very expensive medication. There have to be guidelines in trauma centers.

Anyone with a guideline or protocol regarding this would help as well as any salient pieces of advice in its use or non-use.

Thank you,

MRM

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

Message: 2
Date: Fri, 16 Jan 2009 13:32:40 +0100
From: "Eduardo Palencia" <palenciahccml at gmail.com>
Subject: Re: Crisis in Gaza...
To: "Trauma &amp, Critical Care mailing list" <trauma-list at trauma.org>
Message-ID:
        <fa3aa3010901160432n557a0c4axa1eea9f41f4a917 at mail.gmail.com>
Content-Type: text/plain; charset="iso-8859-1"

I send you the editorial of the last issue of Lancet, fixing its position about the barbarities committed for the israeli army against the health of the civilian palestinian population. They are intolerable, if some rest of humanitarian feelings remains.

Eduardo
--
Eduardo Palencia Herrej?n
Jefe de Servicio de Medicina Intensiva
Hospital "Infanta Leonor", Madrid
C/ Gran v?a del Este, 80
28031 Madrid, Spain
Tfno: +34619204428
epalenciah at salud.madrid.org

2009/1/16 Gad Shaked <shakedg at bgu.ac.il>:
> Lies again. There is a humanitarian corridor every day for 3 hours. Usually the Hamas terrorists continue firing and launching rockets during this period. The palestinians should have considered this scenario eight years when they kept attacking innocent civilians in the towns and villages adjacent to the Gaza strip, More important is the good news of this morning that the 7 year old boy sustainig a critical  head injury from a rocket that exploded next to him is improving. He underwent decompressive craniotomy as part of his damage control surgery. Another woman is also doing well after a laparotomy for multiple small and large bowel shrapnel perforations.
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Autologous transfusion