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Wed Jan 21 22:29:47 GMT 2009

Dr. Gross,

We have used autotransfusion in a few cases of massive hemothorax direct
from the drainage bottle with no untoward complications ... so far.

Jose Luis J. Danguilan, MD

On 1/21/09, Gross, Ronald <Ronald.Gross at bhs.org> wrote:
>
> 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-----
> From: trauma-list-bounces at trauma.org [mailto:
> trauma-list-bounces at trauma.org] On Behalf Of
> trauma-list-request at trauma.org
> 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.
> -------------- next part --------------
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> >
>
> ------------------------------
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Autologous transfusion