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Thu Jan 22 08:47:28 GMT 2009

I note Dr Christos' comments in an adjacent thread - I am still unsure how
to do this in a modern, well-equipped Australian hospital and if it is
likely that I will encounter a situation in which it is indicated.

bRAD

On Thu, Jan 22, 2009 at 6:44 PM, Bradley Morris <bradleypmorris at gmail.com>wrote:

> For the complete novice, how is this done?
> Is the blood transferred from the drain to another vessel to hang? How does
> one do this in a sterile fashion? What devices are there to enable this?
> Do you use a filter? T
> These questions have often arisen whilst treating haemothoraces (but have
> never been necessary in my limited experience thus far).
>
> Kind regards from an inexperienced observer,
>
> Brad Morris
> Surgical Registrar
> Australia
>
>   On Thu, Jan 22, 2009 at 8:29 AM, Jose Luis Danguilan <
> jdanguilan at gmail.com> wrote:
>
>> 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
>> >
>> > Send trauma-list mailing list submissions to
>> >        trauma-list at trauma.org
>> >
>> > To subscribe or unsubscribe via the World Wide Web, visit
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>> >
>> > You can reach the person managing the list at
>> >        trauma-list-owner at trauma.org
>> >
>> > When replying, please edit your Subject line so it is more specific than
>> > "Re: Contents of trauma-list digest..."
>> >
>> >
>> > 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 --------------
>> > A non-text attachment was scrubbed...
>> > Name: 2008 01 Lancet Editorial The medical conditions in Gaza.pdf
>> > Type: application/pdf
>> > Size: 105643 bytes
>> > Desc: not available
>> > URL: <
>> >
>> http://list.mistral.net/pipermail/trauma-list/attachments/20090116/c9114c27/attachment.pdf
>> > >
>> >
>> > ------------------------------
>> >
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>> > End of trauma-list Digest, Vol 67, Issue 20
>> > *******************************************
>> >
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Autologous transfusion