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Sun Jan 25 06:03:02 GMT 2009

Ken

I do - but ONLY for reinfusing non-anti-coag'ed blood from chest tubes -
we don't use the pleurovac; in SA the system is a glass or plastic bottle
with 500ml N/S and no routine suction. The Pall filter is used to catch up
the big clots.

I have not seen low platelets, but I accpet that you may have shown
differently.

Tim
Dr T C Hardcastle
M.B., Ch.B. (Stell); M. Med. (Chir) (Stell); FCS (SA)
Principal Specialist Trauma Surgeon /
Honorary Lecturer UKZN Dept Surgery
Deputy Director - IALCH Trauma Service
Durban - South Africa
> Does anyone besides doctors in Conneteccutt still use the 20 and 40 micron
> grid filters in addition to the usual blood gross filters.
>
> K
>
>
> Sent via BlackBerry by AT&T
>
> -----Original Message-----
> From: "Gross, Ronald" <Ronald.Gross at bhs.org>
>
> Date: Fri, 23 Jan 2009 07:27:48
> To: 'Trauma &amp; Critical Care mailing list'<trauma-list at trauma.org>
> Subject: RE: Autotransfusion
>
>
> Christos,
> Thanks for the summary, and references!
> Take care,
> Ron
>
>
> -----Original Message-----
> From: trauma-list-bounces at trauma.org
> [mailto:trauma-list-bounces at trauma.org] On Behalf Of Christos Giannou
> Sent: Thursday, January 22, 2009 5:04 PM
> To: trauma-list at trauma.org
> Subject: Re: Autotransfusion
>
> Dear friends,
>
> When I receive my mailing there is a repitition, sometimes several, of the
> various postings. Sorry, if in the middle of them all, I have missed
> someone.
>
> Dr McSwain gave a succinct summary of the indications: critical patient,
> lack of blood in-time. We don't perform an autotransfusion for a small
> haemothorax 500-1000 ml; crystalloids should suffice. The need is usually
> a
> straight forward clinical observation; life-threatening shock in a chest
> or
> abdominal trauma patient, or ectopic pregnancy, and not enough time to
> obtain blood or none is available. He also confirmed (thank you for the
> references) the anecdotal evidence of our Russian colleague (Professor
> Minoushin, formerly of the St Petersburg Military Medical Academy) about
> enteric contamination.
>
> Again, I have tried with and without anticoagulants, and it doesn't seem
> to
> matter; again confirmed by several colleagues.
>
> As for Brad, and whether his well-equipped Australian hospital would ever
> require such a technique, he may well need it in the out-back some day.
> Nonetheless, if you have the BRAT or Cell Saver, or the autotransfusion
> module on Pleur-Evac, so much the better. Otherwise, two situations
> present
> themselves: abdomen and chest.
>
> Peter in Italy, when working in Africa, keeps a large soup ladle
> sterilised
> and in his emergency equipment set. A kidney dish will also do very well.
> What is really useful is a metal funnel. I line this with my 6 layers of
> gauze compresses and place it into my glass bottle and ladle or scoop the
> blood into it. Fills quite easily.
>
> The metal funnel, gauze compresses, and bottle can also be put directly
> underneath the open end of the chest tube. (I include a sketch from an
> article in Tropical Doctor.) Alternatively, you can collect the blood in a
> urine bag or, as several colleagues have mentioned, the drainage
> reservoir.
> Having diagnosed a massive haemothorax clinically that will probably
> require
> autotransfusion, I do not have an underwater seal in the reservoir if I am
> using this.
>
> The most important thing is to be prepared. In the ICRC, we try to arrange
> some sort of autotransfusion device to be available before any patients
> arrive.
>
> A few other references:
>
> Ahmed AM, Sabrie MH, Baldan M. Autotransfusion in penetrating chest war
> trauma with haemothorax: the Keysaney Hospital experience. East Cent Afr J
> Surg 2003;8:51-54.
>
>
>
> Baldan M, Giannou C, Rizzardi G, Irmay F, Sasin V. Autotransfusion from
> haemothorax after penetrating chest trauma: a simple life-saving
> procedure.
> Tropical Doctor 2006; 36: 21-22.
>
>
>
> Carrol P. Salvaging blood from the chest. RN 1996;59:32-39.
>
>
>
> Cheesbrough M. Blood transfusion practice. In: Cheesbrough M, ed. District
> Laboratory Practice in Tropical Countries. Part 2. UK: Cambridge
> UniversityPress, 2000: 354.
>
>
>
> Cook J, Sankaran B, Wasunna AEO. Fluid and electrolyte therapy, blood
> transfusion, and management of shock. Chest. In: Cook J, Sankaran B,
> Wasunna
> AEO, eds. General Surgery at the District Hospital. Geneva: WHO, 1988:
> 43-92.
>
>
>
> King M, Bewes P, Cairns J, Thornton J. The surgery of pregnancy:
> autotransfusion. In: King M, Bewes P, Cairns J, Thornton J. eds. Primary
> Surgery: Non Trauma. Vol. 1. Oxford: Oxford University Press, 1993: 241.
>
>
>
> Jevtic M, Petrovic M, Ignjatovic D, et al. Treatment of wounded in the
> combat zone. J Trauma 1996;40:173-176.
>
>
>
> Oltjen AM, Santrach PJ. Autologous transfusion techniques. J Intraven Nurs
> 1997;20:305-310.
>
>
>
> Parker-Williams EJ. Autologous blood transfusion. Postgrad Doctor Africa
> 1989;11:52-55.
>
>
>
> Marquis MC, Gyger D. Autotransfusions peroperatoires en zone rurales
> africaines: une solution d'urgence. Labor Med 1998;9:284-285.
>
>
>
> Roostar L. Clinical pictures of penetrating chest injuries: infusion
> therapy
> and haemotransfusion. In: Roostar L. Gunshot Chest Injuries. Tartu,
> Estonia:
> Tartu University Press, 1996: 33-34.
>
>
>
> cheers
>
> --
> christos giannou
> Monemvasia Lakonia
> 23070 Greece
> tel & fax: (++30) 27320-61772
> mob: (++30) 69 74 83 28 18
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