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Gross, Ronald Ronald.Gross at bhs.orgMon Jan 26 13:04:06 GMT 2009
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John, it really HAS been a while. Are you going to the COT in March? Thanks for the input as to the citrate. I noticed that you didn't mention Pall filters - Mattox got yer tongue??? (HEHEHE) Take care, Ron -----Original Message----- From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] On Behalf Of Schulz, John Sent: Saturday, January 24, 2009 7:22 AM To: trauma-list at trauma.org Subject: Re: autotransfusion Ron Gross: been too long since I talked to you, friend! Regarding autotransfusion, just thought I'd note that we citrate it and that it made a huge difference for us a few days ago with a guy hit by a bus! John T Schulz III, MD, PhD, FACS Associate Chairman, Department of Surgery Chief, Trauma/Burns/Surgical Critical Care Director, Andrew J Panettieri Burn Center Bridgeport Hospital 267 Grant Street Bridgeport, CT 203-384-3890 pjschu at bpthosp.org -----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: Saturday, January 24, 2009 7:01 AM To: trauma-list at trauma.org Subject: trauma-list Digest, Vol 67, Issue 39 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: Autotransfusion (Gross, Ronald) 2. RE: You are Joking are you not?? (Dr Timothy Hardcastle) 3. RE: You are Joking are you not?? (Nuno Cosmelli) 4. RE: You are Joking are you not?? (Dr Timothy Hardcastle) 5. RE: You are Joking are you not?? (Paul.Harrison at sth.nhs.uk) 6. Re: Autotransfusion (kmattox at aol.com) 7. RE: Autotransfusion (Gross, Ronald) ---------------------------------------------------------------------- Message: 1 Date: Fri, 23 Jan 2009 07:27:48 -0500 From: "Gross, Ronald" <Ronald.Gross at bhs.org> Subject: RE: Autotransfusion To: "'Trauma & Critical Care mailing list'" <trauma-list at trauma.org> Message-ID: <FD2BE6867A90F543AAD02E429F878633012E5E033576 at bhsexc11.bhs.org> Content-Type: text/plain; charset="us-ascii" 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 ----------------------------------------- CONFIDENTIALITY NOTICE: This email communication and any attachments may contain confidential and privileged information for the use of the designated recipients named above. If you are not the intended recipient, you are hereby notified that you have received this communication in error and that any review, disclosure, dissemination, distribution or copying of it or its contents is prohibited. If you have received this communication in error, please reply to the sender immediately or by telephone at (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: 2 Date: Fri, 23 Jan 2009 15:13:50 +0200 (SAST) From: "Dr Timothy Hardcastle" <dr.tchardcastle at absamail.co.za> Subject: RE: You are Joking are you not?? To: "Trauma & Critical Care mailing list" <trauma-list at trauma.org> Message-ID: <52974.41.8.80.203.1232716430.squirrel at aiamail.lantic.net> Content-Type: text/plain;charset=iso-8859-1 Nuno Rather use the "developed for Africa" alternative - the SA Triage Scoring system, tested for low-income countries. Contact Prof Lee Wallis in Cape Town for the info about this. was published in SAMJ and EMJ 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 > Dear all > I need your help my Hospital in Angola is now implementing the > Manchester triage protocol, do you have any presentation with 52 flow > charts Thanks in advance for the Help NUNO > > > > -----Mensagem original----- > De: trauma-list-bounces at trauma.org > [mailto:trauma-list-bounces at trauma.org] > Em nome de Anthony Caruso > Enviada: quinta-feira, 22 de Janeiro de 2009 21:08 > Para: trauma-list at trauma.org > Assunto: Re: You are Joking are you not?? > > Ok thanks for the information. I have polytraumatized patients that > required blood in the past. Although I have never stuck around to see > what goes on down the road. My only experience with cell savers is > limited to 2 occasions on when I sat in on a CABG on my OR rotations. > Pretty cutting edge technology from what I could see. > > Thanks for info. > > Amc > Sent from my Verizon Wireless BlackBerry > > -- > trauma-list : TRAUMA.ORG > To change your settings or unsubscribe visit: > http://www.trauma.org/index.php?/community/ > -- > trauma-list : TRAUMA.ORG > To change your settings or unsubscribe visit: > http://www.trauma.org/index.php?/community/ > ------------------------------ Message: 3 Date: Fri, 23 Jan 2009 14:17:44 +0100 From: Nuno Cosmelli <nuno.cosmelli at clinicagirassol.co.ao> Subject: RE: You are Joking are you not?? To: "Trauma & Critical Care mailing list" <trauma-list at trauma.org> Message-ID: <D0B1794DC54F1740BA251293FC4A2C9C80ECFD6843 at SRVCLGMBX001.girassol.prv> Content-Type: text/plain; charset="us-ascii" Thanks Tim Do you His contact? NUNO -----Mensagem original----- De: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] Em nome de Dr Timothy Hardcastle Enviada: sexta-feira, 23 de Janeiro de 2009 13:14 Para: Trauma & Critical Care mailing list Assunto: RE: You are Joking are you not?? Nuno Rather use the "developed for Africa" alternative - the SA Triage Scoring system, tested for low-income countries. Contact Prof Lee Wallis in Cape Town for the info about this. was published in SAMJ and EMJ 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 > Dear all > I need your help my Hospital in Angola is now implementing the > Manchester triage protocol, do you have any presentation with 52 flow > charts Thanks in advance for the Help NUNO > > > > -----Mensagem original----- > De: trauma-list-bounces at trauma.org > [mailto:trauma-list-bounces at trauma.org] > Em nome de Anthony Caruso > Enviada: quinta-feira, 22 de Janeiro de 2009 21:08 > Para: trauma-list at trauma.org > Assunto: Re: You are Joking are you not?? > > Ok thanks for the information. I have polytraumatized patients that > required blood in the past. Although I have never stuck around to see > what goes on down the road. My only experience with cell savers is > limited to 2 occasions on when I sat in on a CABG on my OR rotations. > Pretty cutting edge technology from what I could see. > > Thanks for info. > > Amc > Sent from my Verizon Wireless BlackBerry > > -- > trauma-list : TRAUMA.ORG > To change your settings or unsubscribe visit: > http://www.trauma.org/index.php?/community/ > -- > trauma-list : TRAUMA.ORG > To change your settings or unsubscribe visit: > http://www.trauma.org/index.php?/community/ > -- trauma-list : TRAUMA.ORG To change your settings or unsubscribe visit: http://www.trauma.org/index.php?/community/ ------------------------------ Message: 4 Date: Fri, 23 Jan 2009 15:19:30 +0200 (SAST) From: "Dr Timothy Hardcastle" <dr.tchardcastle at absamail.co.za> Subject: RE: You are Joking are you not?? To: "Trauma & Critical Care mailing list" <trauma-list at trauma.org> Message-ID: <53670.41.8.80.203.1232716770.squirrel at aiamail.lantic.net> Content-Type: text/plain;charset=iso-8859-1 lewallis at pgwc.gov.za > Thanks Tim > Do you His contact? > NUNO > > -----Mensagem original----- > De: trauma-list-bounces at trauma.org > [mailto:trauma-list-bounces at trauma.org] > Em nome de Dr Timothy Hardcastle > Enviada: sexta-feira, 23 de Janeiro de 2009 13:14 > Para: Trauma & Critical Care mailing list > Assunto: RE: You are Joking are you not?? > > Nuno > > Rather use the "developed for Africa" alternative - the SA Triage > Scoring system, tested for low-income countries. Contact Prof Lee > Wallis in Cape Town for the info about this. was published in SAMJ and > EMJ > > 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 > >> Dear all >> I need your help my Hospital in Angola is now implementing the >> Manchester triage protocol, do you have any presentation with 52 flow >> charts Thanks in advance for the Help >> NUNO >> >> >> >> -----Mensagem original----- >> De: trauma-list-bounces at trauma.org >> [mailto:trauma-list-bounces at trauma.org] >> Em nome de Anthony Caruso >> Enviada: quinta-feira, 22 de Janeiro de 2009 21:08 >> Para: trauma-list at trauma.org >> Assunto: Re: You are Joking are you not?? >> >> Ok thanks for the information. I have polytraumatized patients that >> required blood in the past. Although I have never stuck around to >> see what goes on down the road. My only experience with cell savers >> is limited to 2 occasions on when I sat in on a CABG on my OR >> rotations. Pretty cutting edge technology from what I could see. >> >> Thanks for info. >> >> Amc >> Sent from my Verizon Wireless BlackBerry >> >> -- >> trauma-list : TRAUMA.ORG >> To change your settings or unsubscribe visit: >> http://www.trauma.org/index.php?/community/ >> -- >> trauma-list : TRAUMA.ORG >> To change your settings or unsubscribe visit: >> http://www.trauma.org/index.php?/community/ >> > > > > -- > trauma-list : TRAUMA.ORG > To change your settings or unsubscribe visit: > http://www.trauma.org/index.php?/community/ > -- > trauma-list : TRAUMA.ORG > To change your settings or unsubscribe visit: > http://www.trauma.org/index.php?/community/ > 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 ------------------------------ Message: 5 Date: Fri, 23 Jan 2009 13:27:32 -0000 From: <Paul.Harrison at sth.nhs.uk> Subject: RE: You are Joking are you not?? To: <trauma-list at trauma.org> Message-ID: <505D97789E52734987A451E86FBDD806FB0EB9 at NGHEMAIL1.sth.nhs.uk> Content-Type: text/plain; charset="us-ascii" You probably know it but maybe not by the name given. Developed by the Manchester Triage Group between 1994-1997. Produced triage methodology with intention of providing a robust process for decision making in ER to determine clinical priority to a casualty including an indicated target time to first contact with treating clinician. Flow charts to support decision making are complaint specific. This later became the UK National Triage Scale 1. Red - Immediate - see immediately minutes 2. Orange - Urgent - see within 10 minutes 3. Amber - Semi-Urgent - see within 60 minutes 4. Green - Standard - see within 120 minutes 5. Blue - Delay Acceptable - see within 240 minutes For full set of charts: Emergency Triage (1997) edited by Prof Kevin Mackway-Jones ISBN 0-729 1126-0 9th reprint (2004) -----Original Message----- From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] On Behalf Of McSwain, Norman E Jr. Sent: 23 January 2009 10:15 To: trauma-list at trauma.org Subject: Re: You are Joking are you not?? I am not familiar with this. Where can I find it to review? Typed by the thumbs of Norman on his BlackBerry Norman McSwain, MD Tulane Univ Surgery 504 988-5111 ----- Original Message ----- From: trauma-list-bounces at trauma.org <trauma-list-bounces at trauma.org> To: Trauma & Critical Care mailing list <trauma-list at trauma.org> Sent: Fri Jan 23 04:07:23 2009 Subject: RE: You are Joking are you not?? Dear all I need your help my Hospital in Angola is now implementing the Manchester triage protocol, do you have any presentation with 52 flow charts Thanks in advance for the Help NUNO -----Mensagem original----- De: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] Em nome de Anthony Caruso Enviada: quinta-feira, 22 de Janeiro de 2009 21:08 Para: trauma-list at trauma.org Assunto: Re: You are Joking are you not?? Ok thanks for the information. I have polytraumatized patients that required blood in the past. Although I have never stuck around to see what goes on down the road. My only experience with cell savers is limited to 2 occasions on when I sat in on a CABG on my OR rotations. Pretty cutting edge technology from what I could see. Thanks for info. Amc Sent from my Verizon Wireless BlackBerry -- trauma-list : TRAUMA.ORG To change your settings or unsubscribe visit: http://www.trauma.org/index.php?/community/ -- trauma-list : TRAUMA.ORG To change your settings or unsubscribe visit: http://www.trauma.org/index.php?/community/ -- trauma-list : TRAUMA.ORG To change your settings or unsubscribe visit: http://www.trauma.org/index.php?/community/ ------------------------------ Message: 6 Date: Fri, 23 Jan 2009 14:30:54 +0000 From: kmattox at aol.com Subject: Re: Autotransfusion To: "Trauma & Critical Care mailing list" <trauma-list at trauma.org> Message-ID: <2068452551-1232721087-cardhu_decombobulator_blackberry.rim.net-11367563 32- at bxe126.bisx.prod.on.blackberry> Content-Type: text/plain 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 & 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 ----------------------------------------- CONFIDENTIALITY NOTICE: This email communication and any attachments may contain confidential and privileged information for the use of the designated recipients named above. If you are not the intended recipient, you are hereby notified that you have received this communication in error and that any review, disclosure, dissemination, distribution or copying of it or its contents is prohibited. If you have received this communication in error, please reply to the sender immediately or by telephone at (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. -- trauma-list : TRAUMA.ORG To change your settings or unsubscribe visit: http://www.trauma.org/index.php?/community/ ------------------------------ Message: 7 Date: Fri, 23 Jan 2009 09:36:14 -0500 From: "Gross, Ronald" <Ronald.Gross at bhs.org> Subject: RE: Autotransfusion To: "trauma-list at trauma.org" <trauma-list at trauma.org> Message-ID: <FD2BE6867A90F543AAD02E429F878633012E5E041162 at bhsexc11.bhs.org> Content-Type: text/plain; charset="us-ascii" My guess is that there are (cause the Great State of Connecticut is way too small to single handedly keep Pall in business)...........maybe even in the Great State of Texas - but they fear the wrath of Mattox!! Just to be clear, the Pall filters are used on the blood collected and autotransfused from the Pleurovac/Atrium chest drainage. Ron ________________________________________ From: trauma-list-bounces at trauma.org [trauma-list-bounces at trauma.org] On Behalf Of kmattox at aol.com [kmattox at aol.com] Sent: Friday, January 23, 2009 9:30 AM To: Trauma & Critical Care mailing list Subject: Re: Autotransfusion 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 & 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 ----------------------------------------- CONFIDENTIALITY NOTICE: This email communication and any attachments may contain confidential and privileged information for the use of the designated recipients named above. If you are not the intended recipient, you are hereby notified that you have received this communication in error and that any review, disclosure, dissemination, distribution or copying of it or its contents is prohibited. If you have received this communication in error, please reply to the sender immediately or by telephone at (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. -- trauma-list : TRAUMA.ORG To change your settings or unsubscribe visit: http://www.trauma.org/index.php?/community/ -- trauma-list : TRAUMA.ORG To change your settings or unsubscribe visit: http://www.trauma.org/index.php?/community/ ------------------------------ -- trauma-list : TRAUMA.ORG To change your settings or unsubscribe visit: http://www.trauma.org/index.php?/community/ End of trauma-list Digest, Vol 67, Issue 39 ******************************************* -- trauma-list : TRAUMA.ORG To change your settings or unsubscribe visit: http://www.trauma.org/index.php?/community/
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