List Archives

Thu Jan 22 16:38:22 GMT 2009

  We do use the pleurevac autotransfusion device. ( probably not as much as we should).  It's a question of predicting how much blood your gonna get out and then using the slightly bulkier and less available auto Plurevac( and remembering the gosh done thing).  We have never citrated the blood and as you say, in the heat of battle it does not seem to matter.
         On the other hand, I don't use the cell saver in trauma cases as much as I used to.  Not so much cause of the enteric issue(Norm had me convinced on that way back)., but rather those cells really get beat up ( you don't have time to suction gently) and I have found the pt can hemolyze post op(with big and otherwise unexplainable bumps in their Bili.  Plus, we use an outside company and it creates a lot of distraction in the OR, trying to get the thing up and running...Shel

-----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: Thursday, January 22, 2009 8:47 AM
To: trauma-list at trauma.org
Subject: trauma-list Digest, Vol 67, Issue 35

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Today's Topics:

   1. RE: Autologous transfusion (Gross, Ronald)
   2. RE: trauma-list Digest, Vol 67, Issue 34 (Sise, Mike MD)
   3. RE: trauma-list Digest, Vol 67, Issue 34 (Gross, Ronald)
   4. RE: Autologous transfusion (McSwain, Norman E Jr.)
   5. RE: trauma-list Digest, Vol 67, Issue 34 (McSwain, Norman E Jr.)
   6. RE: trauma-list Digest, Vol 67, Issue 34 (McSwain, Norman E Jr.)
   7. RE: trauma-list Digest, Vol 67, Issue 34 (Gross, Ronald)

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

Message: 1
Date: Thu, 22 Jan 2009 07:00:16 -0500
From: "Gross, Ronald" <Ronald.Gross at bhs.org>
Subject: RE: Autologous transfusion
To: "'Trauma &amp; Critical Care mailing list'"
        <trauma-list at trauma.org>
Message-ID:
        <FD2BE6867A90F543AAD02E429F878633012E5E03355B at bhsexc11.bhs.org>
Content-Type: text/plain; charset="us-ascii"

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
>
> Send trauma-list mailing list submissions to
>        trauma-list at trauma.org
>
> To subscribe or unsubscribe via the World Wide Web, visit
>        http://list.mistral.net/mailman/listinfo/trauma-list
> or, via email, send a message with subject or body 'help' to
>        trauma-list-request at trauma.org
>
> 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=EntrezSystem
> 2.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/c91
> 14c27/attachment.pdf
> >
>
> ------------------------------
>
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------------------------------

Message: 2
Date: Thu, 22 Jan 2009 04:22:59 -0800
From: "Sise, Mike MD" <Sise.Mike at scrippshealth.org>
Subject: RE: trauma-list Digest, Vol 67, Issue 34
To: trauma-list at trauma.org
Message-ID:
        <FEECA018557C774EB876F0D3BCB54E1B01103F3F at MSG02.corp.scripps.org>
Content-Type: text/plain; charset="iso-8859-1"

Regarding using the autotransufion module on Pleur-Evac drainage system for hemothorax - I thought everyone used it. Am I reading this discussion correctly? We use it for all hemothoraces on the right, all but a very few on the left - no if we suspect an enteric spill from a combined chest and abdominal injury. Not uncommon to pull 2 to 4 units and reinfuse promptly through a filter. Any credible evidence against this? What's the consensus out there? Who does and who does not use this autotransfusion approach?

Mike Sise
San Diego

________________________________

From: trauma-list-bounces at trauma.org on behalf of trauma-list-request at trauma.org
Sent: Thu 1/22/2009 4:00 AM
To: trauma-list at trauma.org
Subject: trauma-list Digest, Vol 67, Issue 34

Send trauma-list mailing list submissions to
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------------------------------

Message: 3
Date: Thu, 22 Jan 2009 07:41:08 -0500
From: "Gross, Ronald" <Ronald.Gross at bhs.org>
Subject: RE: trauma-list Digest, Vol 67, Issue 34
To: "trauma-list at trauma.org" <trauma-list at trauma.org>
Message-ID:
        <FD2BE6867A90F543AAD02E429F878633012E5E04114A at bhsexc11.bhs.org>
Content-Type: text/plain;       charset="iso-8859-1"

Mike,
I'm NOT questioning autotransfusing blood from the pleurovac, and while we/I also don't give contaminated blood, if my memory serves me right, there was an old paper by McSwain that failed to show worse outcomes when infusing contaminated blood (but I seem think that wasa caninestudy...). My only question is regarding the needto add citrate to shedblood prior to autotransfusion. I always did, but I am now hearing that there are some that say thzt citrate is not necessary & they don't add it - ever.

What say you?

Ron

________________________________
From: Sise, Mike MD <Sise.Mike at scrippshealth.org>
Sent: Thursday, January 22, 2009 7:23 AM
To: trauma-list at trauma.org <trauma-list at trauma.org>
Subject: RE: trauma-list Digest, Vol 67, Issue 34

Regarding using the autotransufion module on Pleur-Evac drainage system for hemothorax - I thought everyone used it. Am I reading this discussion correctly? We use it for all hemothoraces on the right, all but a very few on the left - no if we suspect an enteric spill from a combined chest and abdominal injury. Not uncommon to pull 2 to 4 units and reinfuse promptly through a filter. Any credible evidence against this? What's the consensus out there? Who does and who does not use this autotransfusion approach?

Mike Sise
San Diego

________________________________
From: trauma-list-bounces at trauma.org on behalf of trauma-list-request at trauma.org
Sent: Thu 1/22/2009 4:00 AM
To: trauma-list at trauma.org
Subject: trauma-list Digest, Vol 67, Issue 34

Send trauma-list mailing list submissions to
        trauma-list at trauma.org

To subscribe or unsubscribe via the World Wide Web, visit
        http://list.mistral.net/mailman/listinfo/trauma-list
or, via email, send a message with subject or body 'help' to
        trauma-list-request at trauma.org

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        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..."
-----------------------------------------
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(413) 794-0000 and destroy all copies of this communication and any attachments. For further information regarding Baystate Health's privacy policy, please visit our Internet web site at http://www.baystatehealth.com.

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

Message: 4
Date: Thu, 22 Jan 2009 07:38:15 -0600
From: "McSwain, Norman E Jr." <nmcswai at tulane.edu>
Subject: RE: Autologous transfusion
To: "Trauma &amp" <trauma-list at trauma.org>
Message-ID:
        <B79C02DCC4FA074DB02381DF1C5D60BA01D28200 at EX07.ad.tulane.edu>
Content-Type: text/plain; charset="iso-8859-1"

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
>
> Send trauma-list mailing list submissions to
>        trauma-list at trauma.org
>
> To subscribe or unsubscribe via the World Wide Web, visit
>        http://list.mistral.net/mailman/listinfo/trauma-list
> or, via email, send a message with subject or body 'help' to
>        trauma-list-request at trauma.org
>
> 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=EntrezSystem
> 2.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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> >
>
> ------------------------------
>
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> End of trauma-list Digest, Vol 67, Issue 20
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------------------------------

Message: 5
Date: Thu, 22 Jan 2009 07:38:49 -0600
From: "McSwain, Norman E Jr." <nmcswai at tulane.edu>
Subject: RE: trauma-list Digest, Vol 67, Issue 34
To: "Trauma &amp" <trauma-list at trauma.org>
Message-ID:
        <B79C02DCC4FA074DB02381DF1C5D60BA01D28201 at EX07.ad.tulane.edu>
Content-Type: text/plain; charset="iso-8859-1"

Enteric spill does not matter. We showed several years ago the transfusing blood with enteric contents and giving the patient antibiotics has the same infection rate as using banked blood alone

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 Sise, Mike MD
Sent: Thu 1/22/2009 6:22 AM
To: trauma-list at trauma.org
Subject: RE: trauma-list Digest, Vol 67, Issue 34

Regarding using the autotransufion module on Pleur-Evac drainage system for hemothorax - I thought everyone used it. Am I reading this discussion correctly? We use it for all hemothoraces on the right, all but a very few on the left - no if we suspect an enteric spill from a combined chest and abdominal injury. Not uncommon to pull 2 to 4 units and reinfuse promptly through a filter. Any credible evidence against this? What's the consensus out there? Who does and who does not use this autotransfusion approach?

Mike Sise
San Diego

________________________________

From: trauma-list-bounces at trauma.org on behalf of trauma-list-request at trauma.org
Sent: Thu 1/22/2009 4:00 AM
To: trauma-list at trauma.org
Subject: trauma-list Digest, Vol 67, Issue 34

Send trauma-list mailing list submissions to
        trauma-list at trauma.org

To subscribe or unsubscribe via the World Wide Web, visit
        http://list.mistral.net/mailman/listinfo/trauma-list
or, via email, send a message with subject or body 'help' to
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------------------------------

Message: 6
Date: Thu, 22 Jan 2009 07:41:40 -0600
From: "McSwain, Norman E Jr." <nmcswai at tulane.edu>
Subject: RE: trauma-list Digest, Vol 67, Issue 34
To: "Trauma &amp" <trauma-list at trauma.org>
Message-ID:
        <B79C02DCC4FA074DB02381DF1C5D60BA01D28202 at EX07.ad.tulane.edu>
Content-Type: text/plain; charset="iso-8859-1"

Human study of penetrating trauma

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 6:41 AM
To: trauma-list at trauma.org
Subject: RE: trauma-list Digest, Vol 67, Issue 34

Mike,
I'm NOT questioning autotransfusing blood from the pleurovac, and while we/I also don't give contaminated blood, if my memory serves me right, there was an old paper by McSwain that failed to show worse outcomes when infusing contaminated blood (but I seem think that wasa caninestudy...). My only question is regarding the needto add citrate to shedblood prior to autotransfusion. I always did, but I am now hearing that there are some that say thzt citrate is not necessary & they don't add it - ever.

What say you?

Ron

________________________________
From: Sise, Mike MD <Sise.Mike at scrippshealth.org>
Sent: Thursday, January 22, 2009 7:23 AM
To: trauma-list at trauma.org <trauma-list at trauma.org>
Subject: RE: trauma-list Digest, Vol 67, Issue 34

Regarding using the autotransufion module on Pleur-Evac drainage system for hemothorax - I thought everyone used it. Am I reading this discussion correctly? We use it for all hemothoraces on the right, all but a very few on the left - no if we suspect an enteric spill from a combined chest and abdominal injury. Not uncommon to pull 2 to 4 units and reinfuse promptly through a filter. Any credible evidence against this? What's the consensus out there? Who does and who does not use this autotransfusion approach?

Mike Sise
San Diego

________________________________
From: trauma-list-bounces at trauma.org on behalf of trauma-list-request at trauma.org
Sent: Thu 1/22/2009 4:00 AM
To: trauma-list at trauma.org
Subject: trauma-list Digest, Vol 67, Issue 34

Send trauma-list mailing list submissions to
        trauma-list at trauma.org

To subscribe or unsubscribe via the World Wide Web, visit
        http://list.mistral.net/mailman/listinfo/trauma-list
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When replying, please edit your Subject line so it is more specific than "Re: Contents of trauma-list digest..."
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------------------------------

Message: 7
Date: Thu, 22 Jan 2009 08:45:15 -0500
From: "Gross, Ronald" <Ronald.Gross at bhs.org>
Subject: RE: trauma-list Digest, Vol 67, Issue 34
To: "trauma-list at trauma.org" <trauma-list at trauma.org>
Message-ID:
        <FD2BE6867A90F543AAD02E429F878633012E5E041156 at bhsexc11.bhs.org>
Content-Type: text/plain;       charset="iso-8859-1"

Getting old sucks! So much for my memory....could you send that reference?

________________________________
From: McSwain, Norman E Jr. <nmcswai at tulane.edu>
Sent: Thursday, January 22, 2009 8:42 AM
To: Trauma &amp <trauma-list at trauma.org>
Subject: RE: trauma-list Digest, Vol 67, Issue 34

Human study of penetrating trauma

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 6:41 AM
To: trauma-list at trauma.org
Subject: RE: trauma-list Digest, Vol 67, Issue 34

Mike,
I'm NOT questioning autotransfusing blood from the pleurovac, and while we/I also don't give contaminated blood, if my memory serves me right, there was an old paper by McSwain that failed to show worse outcomes when infusing contaminated blood (but I seem think that wasa caninestudy...). My only question is regarding the needto add citrate to shedblood prior to autotransfusion. I always did, but I am now hearing that there are some that say thzt citrate is not necessary & they don't add it - ever.

What say you?

Ron

________________________________
From: Sise, Mike MD <Sise.Mike at scrippshealth.org>
Sent: Thursday, January 22, 2009 7:23 AM
To: trauma-list at trauma.org <trauma-list at trauma.org>
Subject: RE: trauma-list Digest, Vol 67, Issue 34

Regarding using the autotransufion module on Pleur-Evac drainage system for hemothorax - I thought everyone used it. Am I reading this discussion correctly? We use it for all hemothoraces on the right, all but a very few on the left - no if we suspect an enteric spill from a combined chest and abdominal injury. Not uncommon to pull 2 to 4 units and reinfuse promptly through a filter. Any credible evidence against this? What's the consensus out there? Who does and who does not use this autotransfusion approach?

Mike Sise
San Diego

________________________________
From: trauma-list-bounces at trauma.org on behalf of trauma-list-request at trauma.org
Sent: Thu 1/22/2009 4:00 AM
To: trauma-list at trauma.org
Subject: trauma-list Digest, Vol 67, Issue 34

Send trauma-list mailing list submissions to
        trauma-list at trauma.org

To subscribe or unsubscribe via the World Wide Web, visit
        http://list.mistral.net/mailman/listinfo/trauma-list
or, via email, send a message with subject or body 'help' to
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trauma-list Digest, Vol 67, Issue 35-Autologus transfusion