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Thu Jan 22 10:09:52 GMT 2009

Sterile drainage bottle and with filter. But only in extreme circumstances
--- hypovolemic patient and no avialble banked blood.

Jose Luis J. Danguilan, MD

On 1/22/09, 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
> > >
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> 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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Autologous transfusion