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Thu Jan 22 13:50:35 GMT 2009

Norman,
I have forwarded this e-mail to our transfusion committee . Should be an interesting meeting!!
Thanks,
Ron

________________________________
From: McSwain, Norman E Jr. <nmcswai at tulane.edu>
Sent: Thursday, January 22, 2009 8:39 AM
To: Trauma &amp <trauma-list at trauma.org>
Subject: RE: Autologous transfusion

Ron

Preferences and principles again (and always) Anwer the 4 questions and you have what you need to proceed

The PRINCIPLE is the patient needs blood you have his/hers....give it
The PREFERENCE  is what is best under the circumstances
* Situation-
--------Where are you? what are the rules (if any)?
* Condition
---------How quickly does the patient need the blood?
*Skill and Knowldege of the provider
---------Do you have skill to give the blood? What does the literature say
* Equipment available
---------Is there citrate available? Is heparin available?

These questions most likely are answered in advance.

PRICNIPLE - DO WHAT IS BEST FOR THE PATIENT UNDER THE CIRCUMSTANCES

Norman

Norman McSwain MD
Trauma Director, Charity Hospital
Professor of Surgery, Tulane University
New Orleans LA
504 988 5111
norman.mcswain at tulane.edu<mailto:norman.mcswain at tulane.edu>

________________________________
From: trauma-list-bounces at trauma.org on behalf of Gross, Ronald
Sent: Thu 1/22/2009 6:00 AM
To: 'Trauma &amp; Critical Care mailing list'
Subject: RE: Autologous transfusion

I have been doing this for years - my only question was as to the need to citrate the autotransfused blood.  I had ALWAYS citrated the collected blood, and yet there are some that say it is not necessary......and so the question is simply, is it safe NOT to citrate the blood.  My transfusion service director would have a fit if we didn't!

Therefore, the "art and science" of non-evidence based medicine!

Ron

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] On Behalf Of Jose Luis Danguilan
Sent: Wednesday, January 21, 2009 5:30 PM
To: Trauma &amp, Critical Care mailing list
Subject: Re: Autologous transfusion

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 --------------
> A non-text attachment was scrubbed...
> Name: 2008 01 Lancet Editorial The medical conditions in Gaza.pdf
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> 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