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Vaccination

Gross, Ronald Ronald.Gross at baystatehealth.org
Wed Nov 24 16:49:48 GMT 2010


"The problem with giving immediate postop due to patient population,  everyone thinks they have received it and essentially they have not."

John,

Realistically speaking , unless I am completely out to lunch (and I certainly have been accused of that!!), given the present "evidence" about the timing of post-splenectomy vaccinations, I am not sure we can actually say when it is best to give the vaccines.

Happy Thanksgiving to you and yours, and all those on the list!

Ron
-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] On Behalf Of Jrhmdtraum at aol.com
Sent: Wednesday, November 24, 2010 11:44 AM
To: trauma-list at trauma.org
Subject: Re: Vaccination

We did a published study at MIEMS in the early 80s.  As I remember
(getting harder with age), if you vaccinate immediately postop,    there are little
titers when tested.  Probably secondary to innate high  steroids then from
adrenal stimulation, etc.  You need to wait a couple of  weeks.  The problem
with giving immediate postop due to patient population,  everyone thinks
they have received it and essentially they have not.
Happy Turkey Day

John R. Hall, M.D., FCCM, FACS
Professor of Surgery


In a message dated 11/24/2010 11:27:54 A.M. Eastern Standard Time,
trauma-list-request at trauma.org writes:

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Today's Topics:

1. Re:  splenectomy and vaccination (Krin135 at aol.com)
2. Re:  splenectomy and vaccination (Dr Timothy Hardcastle)
3. RE:  MAST, Pret (Bjorn, Pret)
4. Re: splenectomy and vaccination  (Nikahat  Jahan)


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

Message:  1
Date: Tue, 23 Nov 2010 13:49:47 EST
From: Krin135 at aol.com
Subject:  Re: splenectomy and vaccination
To: trauma-list at trauma.org
Message-ID:  <104c41.13d84e8.3a1d66cb at aol.com>
Content-Type: text/plain;  charset="US-ASCII"

when I was practicing in Louisiana, we tried to give  ours their first dose

of pneumovax by the time they were 13...and  that was in the days *before*
it was mandated....but then, we had a  high percentage of folks with at
least
Sickle Cell  Trait...

ck


In a message dated 11/23/10 12:46:56 Central  Standard Time,
nmcswai at tulane.edu writes:

Should  all  our drug dealer get prophylactic vaccine. Should this be
included in   their first jail sentence?

Norman
Norman McSwain MD,   FACS
Professor, Tulane School of Medicine
Trauma Director, Spirit  of  Charity Trauma Center, ILH/MCLNO
norman.mcswain at tulane.edu
504  988  5111


-----Original Message-----
From:   trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org]  On  Behalf Of Gross, Ronald
Sent: Tuesday, November 23, 2010 8:21  AM
To:  'Trauma-List [TRAUMA.ORG]'
Subject: RE: splenectomy  and  vaccination

Nikahat,

Your questions are good, but  unfortunately  have no really good answers.
Having said that, most  folks would agree that  the vaccines work best
prior to splenectomy,  and so to answer your 2rd  question first one could
assume that if you  think that a patient has a high  likelihood of failing
non-operative  management (NOM) you could/should  vaccinate the patient;
whether  there is enough time for the vaccine to be  effective prior to
the  (emergency) splenectomy in the face of failed NOM is   still
questionable.

As to the timing of giving the vaccines   post-operatively, there is
literature out there that says they should  be  given at 2 weeks post-op,
but it is not Class I evidence.  I  tend to  give the vaccines in the
recovery room (sorry PACU) because  (1) our trauma  population can be less
than "reliable" for follow-up,  and I know that they  have gotten the
vaccines prior to discharge, (2)  we don't forget to give  the vaccine
prior to discharge, and lastly  (3) the patient doesn't have a  fever from
the vaccine that delays  discharge and increases their hospital  LOS.

Not really good  science, but I think it is good medicine,   IMHO.

Ron

-----Original Message-----
From:   trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org]  On  Behalf Of Nikahat Jahan
Sent: Tuesday, November 23, 2010 9:06  AM
To:  Trauma-List [TRAUMA.ORG]
Subject: splenectomy and  vaccination

Dear  All
1. What is the current guideline on  immunizations after  emergency
splenectomy. (Pneumococcal,  menigococcal, H Infuenza B) and the  timing
and
type of vaccine-  heptavalent conjugated Pneumococcal vaccine  Vs 23
valent?
2.  Should a trauma patient with splenic injury who is  being  managed
conservatively- but might end up with a splenectomy later-   also recieve
Pneumococcal vaccine?
3. How long should the  antibiotic  prophylaxis be continued and what
drugs
should be   used?
thanks
nikahat
--
Lt Col Nikahat Jahan
Classified  Spl  (Anaesthesiology)
Indian Army
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------------------------------

Message:  2
Date: Wed, 24 Nov 2010 12:20:09 +0200 (SAST)
From: "Dr Timothy  Hardcastle" <dr.tchardcastle at absamail.co.za>
Subject: Re: splenectomy  and vaccination
To: "Trauma-List \[TRAUMA.ORG\]"  <trauma-list at trauma.org>
Message-ID:
<50579.196.35.102.165.1290594009.squirrel at aiamail.lantic.net>
Content-Type:  text/plain;charset=iso-8859-1

Nikahat

This is the South African  current teaching:
Only Pneumovax 23 at day 14 post-injury or on day of  discharge whichever
comes first. Only add H-inf B if under 13 and not  immunized. Only use
Meningococcal in endemic areas (South Africa is not  such an area) as the
Pneumovax cross-covers well.

Heptavalent is not  effective - use 23-valent. No role in the  patient with
a spleen still  inside - no proven benefit.

Tim
Dr T C Hardcastle
M.B., Ch.B.  (Stell); M. Med. (Chir) (Stell); FCS (SA)
Principal Specialist Trauma  Surgeon /
Honorary Senior Lecturer UKZN Dept Surgery
Deputy Director -  IALCH Trauma Service
Durban, South Africa

> Dear All
> 1.  What is the current guideline on immunizations after emergency
>  splenectomy. (Pneumococcal, menigococcal, H Infuenza B) and the timing
and
> type of vaccine- heptavalent conjugated Pneumococcal vaccine Vs 23
valent?
> 2. Should a trauma patient with splenic injury who is being  managed
> conservatively- but might end up with a splenectomy later-  also recieve
> Pneumococcal vaccine?
> 3. How long should the  antibiotic prophylaxis be continued and what drugs
> should be  used?
> thanks
> nikahat
> --
> Lt Col Nikahat  Jahan
> Classified Spl (Anaesthesiology)
> Indian  Army



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

Message: 3
Date:  Wed, 24 Nov 2010 08:49:08 -0500
From: "Bjorn, Pret"  <pbjorn at emh.org>
Subject: RE: MAST, Pret
To: "Trauma-List  [TRAUMA.ORG]" <trauma-list at trauma.org>
Message-ID:
<9CCE32ECAAFDEB4DA01EC771B6AD951B0D4FCA59 at VALIER.me.emh.org>
Content-Type:  text/plain;   charset="us-ascii"

Mine is one of those major  trauma centers that see blunt trauma (about
95%).  We don't use  PASG's, and discretely make fun of providers who do.

Actively  compressing the abdomen and pelvis from without is an
insufficiently  understood maneuver, and probably carries its own
consequences in terms of  perfusion and ventilation and access.
Approaching venous pressures deep in  the abdomen without doing
collateral systemic or direct tissue damage may  not even be possible
with MAST.  It's another sexy hypothesis that  probably doesn't live up
to expectations in vivo.  Worse still, the  bulk and physics of PASG's
are ill suited to ER, IR or OR  environs.

Splint (or ex-fix) the injury and make your way to  embolization.  As for
splinting, our providers regard pneumatic  compression as clinically and
functionally inferior to commercial binders  or simple bedsheets.

Pret Bjorn, RN
Bangor, ME  USA



-----Original Message-----
From:  trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On  Behalf Of John Hall
Sent: Tuesday, November 23, 2010 8:15 AM
To:  trauma-list at trauma.org
Subject: MAST, Pret

The incidence of massive  pelvic fractures is exceedingly small, as
Lewis's study demonstrated.   Prett, sheets work well on most pelvic fxs
to "stabilize" them.  The  problem is that you cannot get them up to > 40
mm Pressure (or >  venous pressure) as you can the MAST.  Many major
trauma centers (eg  MIEMS) that see primary blunt trauma have "case
reports" of such use (eg  MIEMS: firefighter run over by ladder truck
with shattered  pelvis).

Sent from my iPad

John R. Hall, M.D., F.A.C.S.,  F.C.C.M
Professor of Surgery


On Nov 22, 2010, at 10:56 PM,  trauma-list-request at trauma.org wrote:

> Send trauma-list mailing  list submissions to
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>
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>
> When replying, please edit your Subject line so it is more  specific
> than "Re: Contents of trauma-list digest..."
>
>
> Today's Topics:
>
>   1. RE: trauma-list  Digest, Vol 89, Issue 9 (McSwain, Norman E)
>   2. Invitation  to connect on LinkedIn (shafiq chughtai via LinkedIn)
>   3.  Re: Invitation to connect on LinkedIn (Dave Napoliello)
>   4.  Bobby Smith wants to stay in touch on LinkedIn
>       (Bobby Smith via LinkedIn)
>   5. Re: Invitation to connect on  LinkedIn (Farid Pouralikhan)
>   6. Re: Invitation to connect  on LinkedIn (Raul Medina Mireles MD)
>   7. RE: Invitation to  connect on LinkedIn (Doc Holiday)
>   8. RE: Invitation to  connect on LinkedIn (Hector Gullen)
>   9. Re: Invitation to  connect on LinkedIn (listasmsd)
>  10. Instrument sets (Stephen  Richey)
>  11. Re: Instrument sets (Scott Bricker)
>   12. Re: Instrument sets (Stephen Richey)
>  13. Re: Instrument sets  (KMATTOX at aol.com)
>  14. Re: Instrument sets  (KMATTOX at aol.com)
>  15. Re: Instrument sets  (Krin135 at aol.com)
>
>
>  ----------------------------------------------------------------------
>
> Message: 1
> Date: Mon, 15 Nov 2010 09:00:32 -0600
>  From: "McSwain, Norman E" <nmcswai at tulane.edu>
> Subject: RE:  trauma-list Digest, Vol 89, Issue 9
> To: "Trauma-List [TRAUMA.ORG]"  <trauma-list at trauma.org>
> Message-ID:
>     <B79C02DCC4FA074DB02381DF1C5D60BA040F8381 at EX07.ad.tulane.edu>
>  Content-Type: text/plain;   charset="us-ascii"
>
> The  outcome was blood loss and by implication, hemorrhage control
>
>  Norman
> Norman McSwain MD, FACS
> Professor, Tulane School of  Medicine
> Trauma Director, Spirit of Charity Trauma Center, ILH/MCLNO
> norman.mcswain at tulane.edu
> 504 988 5111
>
>
> -----Original Message-----
> From:  trauma-list-bounces at trauma.org
> [mailto:trauma-list-bounces at trauma.org]  On Behalf Of McSwain, Norman E
> Sent: Monday, November 15, 2010 8:58  AM
> To: Trauma-List [TRAUMA.ORG]
> Subject: RE: trauma-list  Digest, Vol 89, Issue 9
>
> The only study done on this was the  study done several years ago by
> Lewis Flint. Although a small study,  he showed benefit. To my
knowledge
> this is the only outcome study  done on any type of pelvic splinting.
All
> the rest only show  closure of the fracture
>
> Norman
> Norman McSwain MD,  FACS
> Professor, Tulane School of Medicine
> Trauma Director,  Spirit of Charity Trauma Center, ILH/MCLNO
>  norman.mcswain at tulane.edu
> 504 988 5111
>
> -----Original  Message-----
> From: trauma-list-bounces at trauma.org
>  [mailto:trauma-list-bounces at trauma.org] On Behalf Of Bjorn, Pret
> Sent:  Monday, November 15, 2010 5:52 AM
> To: Trauma-List [TRAUMA.ORG]
>  Subject: RE: trauma-list Digest, Vol 89, Issue 9
>
> I've never  been much of a believer in the whole intrapelvic volume /
> abdominal  tamponade thing.  It's an interesting theory, but a theory
>  nonetheless.  In my experience, there's enough space and
>  compressible/displaceable viscera in the abdomen and retroperitoneum
>  that regardless of how you swaddle these patients, blood will probably
>  find a way.
>
> As I see it, he main indication for pelvic  fixation is immobilization
of
> the fractures and minimization of  secondary bleeding.  And at least in
> this regard, PASG's are a  comical oversolution.
>
> Use a sheet.
>
>  Pret
>
>
> -----Original Message-----
> From:  trauma-list-bounces at trauma.org
> [mailto:trauma-list-bounces at trauma.org]  On Behalf Of John Hall
> Sent: Saturday, November 13, 2010 2:13  PM
> To: trauma-list at trauma.org
> Subject: Re: trauma-list Digest,  Vol 89, Issue 9
>
>
> The PSAG are VERY effective for  severe pelvic fractures. In fact, they
> are probably the most effective  Rx.  Just the "abd" part over the
> pelvis!
> Sent from my  iPad
>
> John R. Hall, M.D., F.A.C.S., F.C.C.M
> Professor  of Surgery
>
>
> On Nov 13, 2010, at 10:08 AM,  trauma-list-request at trauma.org wrote:
>
>> 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: pasg question (McSwain, Norman  E)
>>  2. RE: pasg question (Bjorn, Pret)
>>  3.  Re: Role of Steroids in Spinal Cord Inj (listasmsd)
>>  4. RE:  Role of Steroids in Spinal Cord Inj (Bjorn, Pret)
>>  5. Tendon  strength (Stephen Richey)
>>  6. Re: Tendon strength  (listasmsd)
>>  7. Homemade ultrasound training model  (listasmsd)
>>
>>
>>
----------------------------------------------------------------------
>>
>> Message: 1
>> Date: Mon, 8 Nov 2010 13:05:42  -0600
>> From: "McSwain, Norman E"  <nmcswai at tulane.edu>
>> Subject: Re: pasg question
>>  To: "Trauma-List \\[TRAUMA.ORG\\]" <trauma-list at trauma.org>
>>  Message-ID: <fb69b053-6857-4269-9396-123ccffbac0c at blur>
>>  Content-Type: text/plain; charset="UTF-8"
>>
>> What i  wrote is the current,7th edition, standards OF PHTLS. This is
> not  Norman's opinion, although i do agree with these standards
>> Norman
>>
>> Sent via DROID on Verizon Wireless
>>
>> -----Original message-----
>> From: "Gross, Ronald"  <Ronald.Gross at baystatehealth.org>
>> To:  "'trauma-list at trauma.org'" <trauma-list at trauma.org>
>> Sent:  Mon, Nov 8, 2010 18:49:02 GMT+00:00
>> Subject: Re: pasg  question
>>
>> I know and love Dr. McSwain and respect his  opinion more than
> most....but even Norm can be  "misguided"....
>> ;-)
>> Typed (poorly) with my thumbs on  my Blackberry!
>>
>> ----- Original Message  -----
>> From: Sue F [mailto:suefigearo at gmail.com]
>> Sent:  Monday, November 08, 2010 01:38 PM
>> To: Trauma-List [TRAUMA.ORG]  <trauma-list at trauma.org>
>> Subject: Re: pasg  question
>>
>> And it most certainly will kill the patient,  unless in OR or ER
trauma
> with
>> surgeon ready to open  and fix the problem.  Dr. McSwain, in an
earlier
>  post,
>> summed up nicely the only current recommendations for use in  the
> prehospital
>> environment and I would urge folks to read  what he wrote.  He is the
> medical
>> director for PHTLS  and acutely aware of the only circumstances in
> which they
>>  are indicated.
>>
>> Sue
>>
>> On Mon,  Nov 8, 2010 at 5:21 AM, Gross, Ronald <
>>  Ronald.Gross at baystatehealth.org> wrote:
>>
>>>  Pret,
>>> I like your technique for removing the PSAG - it most  certainly will
>>> prevent future misguided  use.....
>>> Ron
>>> Typed (poorly) with my thumbs on  my Blackberry!
>>>
>>> From: Pret Bjorn  [mailto:p.bjorn at tds.net]
>>> Sent: Sunday, November 07, 2010 05:03  PM
>>> To: 'Trauma-List [TRAUMA.ORG]'  <trauma-list at trauma.org>
>>> Subject: RE: pasg  question
>>>
>>> Wrong.  Putting them on  invites, compounds, or causes all manner of
> misery.
>>>  All else being equal, patients are more likely to die with PASG?s
>  than
>>> without.  We?ve known this for ten or twenty years  at least.  Ask
Dr.
>>> Mattox.
>>>
>>> Taking them off is easy.  Use scissors.
>>>
>>> Pret Bjorn, RN
>>> Bangor, ME USA
>>>
>>> ________________________________
>>> From:  trauma-list-bounces at trauma.org [mailto:
>>>  trauma-list-bounces at trauma.org] On Behalf Of Blueflightmedic
>>>  Sent: Sunday, November 07, 2010 2:40 PM
>>> To: 'Trauma-List  [TRAUMA.ORG]'
>>> Subject: RE: pasg question
>>>
>>> Umm. It?s not the putting on but the taking off that  causes
problems.
>>> Except putting it on takes longer than  doing up Tina Turner?s stays.
>>> Allegedly.
>>>
>>> ________________________________
>>> From:  trauma-list-bounces at trauma.org [mailto:
>>>  trauma-list-bounces at trauma.org] On Behalf Of McSwain, Norman E
>>>  Sent: 07 November 2010 15:14
>>> To: Trauma-List  [TRAUMA.ORG]
>>> Cc: PHTLS r
>>> Subject: RE: pasg  question
>>>
>>>
>>> PASG is included  only as a box note in the 7th edition of PHTLS. Its
>  use
>>> is:
>>>
>>> "In the following  three conditions, the PASG may have significant
>  benefit
>>> in patients with shock from blood  loss.
>>> 1. Suspected pelvic fractures associated with blood  pressure <90
mmHg
>>> to....... decrease the volume of the  pelvis........
>>> 2. Suspected intraperitoneal  hemorrhage.......this may result in
> slowing or
>>>  cessation of hemorrhage (tampanade)......
>>> 3. Suspected  retroperitoneal hemorrhage....this device may cause
>>>  tampanade.....
>>>
>>> The PASG is probably  significantly less effective than direct
> pressure or
>>>  pressure dressing...in control of external hemorrhage for the
>  extremities"
>>>
>>> There are other parts of  the  box that includes physiology,
>>> contraindications and  deflation. This is significantly less
attention
>  that
>>> placed on PASG in the 4,5, and 6th editions of  PHTLS
>>>
>>> Norman
>>> Medical Director  PHTLS
>>>
>>> Norman McSwain, MD,  FACS
>>> Trauma Director, Spirit of Charity Trauma Center,  ILH/MCLNO
>>> 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
schecters at gmail.com
>>> Sent: Sun 11/7/2010 7:56  AM
>>> To: Trauma-List [TRAUMA.ORG]
>>> Subject:  Re:pasg question
>>>
>>> Folks,  in the latest  edition of  pepid under PASG it says under
>>> indications "  1. PASG use is strongly encouraged in the current
> PHTLS.".  So
>>> is it coming back or did it not ever go  away?
>>> Sent from my Verizon Wireless BlackBerry
>>>  --
>>> trauma-list : TRAUMA.ORG
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>>>  http://www.trauma.org/index.php?/community/
>>>
>>>
>  ----------------------------------------------------------------------
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>  http://baystatehealth.org/annualreport
>>>
>>>
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>>
>>
>>
>>
>> --
>> Sue (Roundy) Figearo,  M.Ed., EMT-P(ret.)
>> President, High Sierra Resources
>>  email:  suefigearo at gmail.com
>> Past President, Nevada Emergency  Medical Assoc.
>> President & Captain (ret.), Dayton (NV)  Volunteer Fire Department
>>
>>
>> All email  checked by Norton Anti-Virus
>>
>>
>> "I am the  master of my house and what my wife says shall be done."
>> Frank  Thornton Olmstead
>> --
>> trauma-list :  TRAUMA.ORG
>> To change your settings or unsubscribe  visit:
>> http://www.trauma.org/index.php?/community/
>>
>>
----------------------------------------------------------------------
>>  Please view our annual report at
>  http://baystatehealth.org/annualreport
>>
>>
>>  CONFIDENTIALITY NOTICE: This e-mail 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
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>>
>>  ------------------------------
>>
>> Message: 2
>>  Date: Mon, 8 Nov 2010 14:10:05 -0500
>> From: "Bjorn, Pret"  <pbjorn at emh.org>
>> Subject: RE: pasg question
>> To:  "Trauma-List [TRAUMA.ORG]" <trauma-list at trauma.org>
>>  Message-ID:
>>    <9CCE32ECAAFDEB4DA01EC771B6AD951B0D2F206B at VALIER.me.emh.org>
>>  Content-Type: text/plain;   charset="us-ascii"
>>
>> Jeez.  Joking.  Have a Coke and a smile.
>>
>> My point was that PASG's shouldn't be used in the first  place.  I
> think
>> Dr. McSwain's missive was more  intended to illustrate the gradual and
>> inevitable extinction of  the device.  Surely each of the three very
>> conditional  indications are rhetorically tidy, but probably have
>> precious  little basis in fact: long experience insists that
>> intraabdominal  or retroperitoneal hemorrhage will find a way, and
that
>>  encasing the victim in a compression device has little to recommend
>  it.
>>
>> Pret
>>
>> -----Original  Message-----
>> From: trauma-list-bounces at trauma.org
>>  [mailto:trauma-list-bounces at trauma.org] On Behalf Of Sue F
>> Sent:  Monday, November 08, 2010 1:38 PM
>> To: Trauma-List  [TRAUMA.ORG]
>> Subject: Re: pasg question
>>
>>  And it most certainly will kill the patient, unless in OR or  ER
trauma
>> with
>> surgeon ready to open and fix the  problem.  Dr. McSwain, in an
earlier
>> post,
>>  summed up nicely the only current recommendations for use in the
>>  prehospital
>> environment and I would urge folks to read what he  wrote.  He is the
>> medical
>> director for PHTLS and  acutely aware of the only circumstances in
> which
>>  they
>> are indicated.
>>
>> Sue
>>
>> On Mon, Nov 8, 2010 at 5:21 AM, Gross, Ronald <
>>  Ronald.Gross at baystatehealth.org> wrote:
>>
>>>  Pret,
>>> I like your technique for removing the PSAG - it most  certainly will
>>> prevent future misguided  use.....
>>> Ron
>>> Typed (poorly) with my thumbs on  my Blackberry!
>>>
>>> From: Pret Bjorn  [mailto:p.bjorn at tds.net]
>>> Sent: Sunday, November 07, 2010 05:03  PM
>>> To: 'Trauma-List [TRAUMA.ORG]'  <trauma-list at trauma.org>
>>> Subject: RE: pasg  question
>>>
>>> Wrong.  Putting them on  invites, compounds, or causes all manner of
>>  misery.
>>> All else being equal, patients are more likely to die  with PASG's
>> than
>>> without.  We've known this  for ten or twenty years at least.  Ask
Dr.
>>>  Mattox.
>>>
>>> Taking them off is easy.  Use  scissors.
>>>
>>> Pret Bjorn, RN
>>>  Bangor, ME USA
>>>
>>>  ________________________________
>>> From:  trauma-list-bounces at trauma.org [mailto:
>>>  trauma-list-bounces at trauma.org] On Behalf Of Blueflightmedic
>>>  Sent: Sunday, November 07, 2010 2:40 PM
>>> To: 'Trauma-List  [TRAUMA.ORG]'
>>> Subject: RE: pasg question
>>>
>>> Umm. It's not the putting on but the taking off that  causes
problems.
>>> Except putting it on takes longer than  doing up Tina Turner's stays.
>>> Allegedly.
>>>
>>> ________________________________
>>> From:  trauma-list-bounces at trauma.org [mailto:
>>>  trauma-list-bounces at trauma.org] On Behalf Of McSwain, Norman E
>>>  Sent: 07 November 2010 15:14
>>> To: Trauma-List  [TRAUMA.ORG]
>>> Cc: PHTLS r
>>> Subject: RE: pasg  question
>>>
>>>
>>> PASG is included  only as a box note in the 7th edition of PHTLS. Its
>>  use
>>> is:
>>>
>>> "In the following  three conditions, the PASG may have significant
>>  benefit
>>> in patients with shock from blood  loss.
>>> 1. Suspected pelvic fractures associated with blood  pressure <90
mmHg
>>> to....... decrease the volume of the  pelvis........
>>> 2. Suspected intraperitoneal  hemorrhage.......this may result in
>> slowing or
>>>  cessation of hemorrhage (tampanade)......
>>> 3. Suspected  retroperitoneal hemorrhage....this device may cause
>>>  tampanade.....
>>>
>>> The PASG is probably  significantly less effective than direct
> pressure
>>  or
>>> pressure dressing...in control of external hemorrhage for  the
>> extremities"
>>>
>>> There are other  parts of the  box that includes physiology,
>>>  contraindications and deflation. This is significantly  less
attention
>> that
>>> placed on PASG in the 4,5,  and 6th editions of PHTLS
>>>
>>>  Norman
>>> Medical Director PHTLS
>>>
>>>  Norman McSwain, MD, FACS
>>> Trauma Director, Spirit of Charity  Trauma Center, ILH/MCLNO
>>> 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
schecters at gmail.com
>>> Sent: Sun 11/7/2010 7:56  AM
>>> To: Trauma-List [TRAUMA.ORG]
>>> Subject:  Re:pasg question
>>>
>>> Folks,  in the latest  edition of  pepid under PASG it says under
>>> indications "  1. PASG use is strongly encouraged in the current
>> PHTLS.".  So
>>> is it coming back or did it not ever go  away?
>>> Sent from my Verizon Wireless BlackBerry
>>>  --
>>> trauma-list : TRAUMA.ORG
>>> To change your  settings or unsubscribe visit:
>>>  http://www.trauma.org/index.php?/community/
>>>
>>>
>  ----------------------------------------------------------------------
>>>  Please view our annual report at
>>  http://baystatehealth.org/annualreport
>>>
>>>
>>> CONFIDENTIALITY NOTICE: This e-mail communication and  any
attachments
>> may
>>> contain confidential and  privileged information for the use of the
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>>> policy, please visit our Internet site at  http://baystatehealth.org.
>>> --
>>> trauma-list :  TRAUMA.ORG
>>> To change your settings or unsubscribe  visit:
>>> http://www.trauma.org/index.php?/community/
>>
>>
>>
>>
>> --
>> Sue  (Roundy) Figearo, M.Ed., EMT-P(ret.)
>> President, High Sierra  Resources
>> email:  suefigearo at gmail.com
>> Past  President, Nevada Emergency Medical Assoc.
>> President & Captain  (ret.), Dayton (NV) Volunteer Fire Department
>>
>>
>> All email checked by Norton Anti-Virus
>>
>>
>> "I am the master of my house and what my wife says shall be  done."
>> Frank Thornton Olmstead
>> --
>>  trauma-list : TRAUMA.ORG
>> To change your settings or unsubscribe  visit:
>> http://www.trauma.org/index.php?/community/
>>
>>
>>
>>
>>  ------------------------------
>>
>> Message: 3
>>  Date: Tue, 9 Nov 2010 06:55:03 -0430
>> From: "listasmsd"  <listasmsd at gmail.com>
>> Subject: Re: Role of Steroids in  Spinal Cord Inj
>> To: "Trauma-List [TRAUMA.ORG]"  <trauma-list at trauma.org>
>> Message-ID:  <B05C9154310F495EA9D883AC75562109 at sceptre>
>> Content-Type:  text/plain;   charset="iso-8859-1"
>>
>>  Pret,
>> I ?m just curious. If you go to his Yale site, Dr. Bracken  is into
> gynecology research. What strikes me (if am using rightly the  phrase)
is
> that his works is in a Cochrane review.
>> May  be I should have asked someone in the Cochrane board to
> explain/answer  why they think that steroids have a benefit... if this
> benefit is a  Evidence-based medicine fact.
>> Kindly regards
>> Manuel  Sotelo MD
>> Caracas
>>
>>
>> Kind of  you to invite Dr. Bracken to the conversation; but in the
> interests of  transparency, the list should be aware that Dr. Bracken's
> methods and  behavior have been central to the NASCIS controversy.
>>
>> The following is from Geisler, Fred H. (2008-03-22).  "Excessively
> closed science hurts". BMJ 336 (7645): 629-a.
>>
>> <Snip.>
>>
>> Excessively closed science  hurts
>>
>> I would like to add to Lenzer and Brownlee's  reporting of my comments
> on how excessively closed science can hurt  physicians and patients.[1]
>>
>> Statistician Michael  Bracken led the NASCIS 2 and 3 studies of high
> dose steroids in acute  spinal cord injury.[2] The National Institute
of
> Neurological  Disorders and Stroke conducted a public campaign in
advance
> of the  scientific publication of NASCIS 2 on 17 May 1990. The
institute
>  sent a fax on 13 April 1990 to some 19 000 emergency room  physicians
and
> hospitals, after a press release had resulted in  coverage by the New
> York Times and the Chicago Tribune on 31 March  1990, by Science News
on
> 7 April 1990, by Newsweek on 9 April  1990.
>>
>> This led to widespread use of steroids, off  label. No application for
> regulatory approval for this indication was  completed, and no agency
> ever approved it. Surgeons report that  methylprednisolone is
> administered from fear of litigation, not belief  in efficacy.[3]
Bracken
> reinforced this fear by testifying against  physicians; he was deposed
on
> 9 June 1998 in Civil Action File No  96A-7768-6, Superior Court of
Fulton
> County, GA.
>>
>> We have criticised NASCIS science.4 The later guidelines for  the
> management of acute cervical spine and spinal cord injuries from  the
> American Association of Neurological Surgeons and the Congress  of
> Neurological Surgeons (AANS/CNS)[5] rated the NASCIS publications  as
> evidence class III, citing flaws in study design, data  presentation,
> interpretation, and analysis. They listed steroid  treatment only as an
> "option."
>>
>> The lack of  demonstrated benefit must be weighed against documented
> risks. The  CRASH trial showed a 3% greater mortality when
> corticosteroids were  given to a multitrauma group with head injury.[6]
> If this increased  death rate held in SCI, then 5000 extra patients may
> have died in the  US since 1990.
>>
>> Yet it's difficult to stop the  momentum-especially when primary data
> are unavailable for independent  review.
>>
>> Fred H. Geisler, Director, Illinois  Neuro-Spine Center
>>
>> References
>> Lenzer J,  Brownlee S. Antidepressants. An untold story? BMJ
> 2008;336:532. (8  March.)[Free Full Text]
>> Bracken MB, Shepard MJ, Collins WF Jr,  Holford TR, Baskin DS,
> Eisenberg HM, et al. A randomized, controlled  trial of
> methylprednisolone or naloxone in the treatment of acute  spinal-cord
> injury. Results of the second national acute spinal cord  injury study.
N
> Engl J Med 1990;322:1405-11.
>> Eck JC,  Nachtigall D, Humphreys SC, Hodges SD. Questionnaire survey
of
>  spine surgeons on the use of methylprednisolone for acute spinal cord
>  injury. Spine 2006;31:E250-253.
>> Coleman WP, Benzel E, Cahill DW,  Ducker T, Geisler F, Green B, et al.
> A Critical appraisal of the  reporting of the NASCIS II and III studies
> of MPSS in acute spinal  cord injury. J Spinal Disord 2000;13:185-99.
>> Hadley MN, Walters  BC. Pharmacological therapy after acute cervical
> spinal cord injury.  In: Guidelines for the management of acute
cervical
> spine and  spinal cord injuries. Neurosurgery 2002;50:S63-S72.
>> Edwards P,  Arango M, Balica L, Cottingham R, El-Sayed H, Farrell B.
> Final results  of MRC CRASH, a randomised placebo-controlled trial of
> intravenous  corticosteroid in adults with head injury-outcomes at 6
> months. Lancet  2005;365:1957-9.
>>
>>
>>
>>
>>
>> -----Original Message-----
>> From:  trauma-list-bounces at trauma.org
> [mailto:trauma-list-bounces at trauma.org]  On Behalf Of listasmsd
>> Sent: Sunday, November 07, 2010 8:12  AM
>> To: michael.bracken at yale.edu
>> Cc: *TRAUMA  LIST
>> Subject: Role of Steroids in Spinal Cord Inj
>>
>> Dear Dr. Bracken
>> There is been a discussion going on  in the www.trauma.org list about
> the role of Role of Steroids in  Spinal Cord Injuries. This list is
free
> to sign in and it will be  interesting that you share a word about your
> papers in this subject.  The main stream of the list members believed
> that steroids have no  place in in Spinal Cord injury. I have not taken
a
> stand yet,  mainly because all studies don?t show a clear and clean cut
> of  statistics. Initially in your papers (Cochrane Plus in Spanish ) in
>  the ?80 you conclude there is no benefit but after the late ?80,  ?90
and
> 2001 you change your conclusions.Why?  The CRASH trial  protocol on the
> other hand from 2001 concludes the opposite from a  placebo-controlled
> trial.
>> Could you share your opinion in  this list?
>>
>> Sincerely
>> Manuel Sotelo  MD
>> Caracas
>> Venezuela
>>
>>
>>
>>
>> ----- Original Message -----
>> From: Robert Smith
>> To: Trauma-List [TRAUMA.ORG]
>> Sent: S?bado, 06 de Noviembre de 2010 09:33 a.m.
>>  Subject: Re: Role of Steroids in Spinal Cord Inj
>>
>>
>> Meta-analysis is the definition of Garbage In/Garbage  Out
>>
>>
>> On Nov 6, 2010, at 9:57 AM, Pret  Bjorn wrote:
>>
>>> Meta-analysis is overrated, and  highly conditional.
>>>
>>> Pret
>>>
>>>
>>> Clumsily sent from my cell  phone.
>>>
>>> -----Original  Message-----
>>> From: listasmsd  <listasmsd at gmail.com>
>>> Sent: Friday, November 05, 2010  23:00
>>> To: Trauma-List [TRAUMA.ORG]  <trauma-list at trauma.org>
>>> Subject: Re: Role of Steroids  in Spinal Cord Inj
>>>
>>> If it did not say  "Cochrane" I would not take it so seriously
>>>
>>>  Regards
>>> Manuel Sotelo MD
>>>  Caracas
>>>
>>>
>>>
>>>
>
------------------------------------------------------------------------
>  --------
>>> Cochrane Database Syst Rev.  2002;(3):CD001046.
>>>
>>> Steroids for acute spinal  cord injury.
>>> Bracken MB.
>>>
>>>  Department of Epidemiology and Public Health, Yale School of
> Medicine,  60 College street, Box 20834, New Haven, Connecticut,
> 06520-8034, USA.  >
>>> Comment in:
>>>
>>> a.. Ann  Emerg Med. 2003 Mar;41(3):410-3.
>>>
>>> Update of:
>>>
>>> a.. Cochrane Database Syst Rev.  2000;(2):CD001046.
>>>
>>> Abstract
>>>  BACKGROUND: Acute spinal cord injury is a devastating condition
>  typically affecting young people with a preponderance being male.
>  Steroid treatment in the early hours of the injury is aimed  at
reducing
> the extent of permanent paralysis during the rest of  the patient's
life.
>>>
>>> OBJECTIVES: To review  randomized trials of steroids for acute spinal
> cord  injury.
>>>
>>> SEARCH STRATEGY: The review draws on  the search strategy developed
by
> the Cochrane Injuries Group. In  addition, files of the National Acute
> Spinal Cord Injury Study have  been reviewed and a Medline search
> conducted.
>>>
>>> SELECTION CRITERIA: All published or unpublished  randomized
> controlled trials of steroid treatment for acute spinal  cord injury in
> any language.
>>>
>>> DATA  COLLECTION AND ANALYSIS: Data have been abstracted from
original
>  trial reports. For the NASCIS, Japanese and French trials, additional
>  data (e.g. SDs) have been obtained from the original authors.
>>>
>>> MAIN RESULTS: There are few trials in this area of medical  care.
Only
> one steroid has been extensively studied,  methylprednisolone sodium
> succinate, which has been shown to improve  neurologic outcome up to
one
> year post injury if administered  within eight hours of injury and in a
> dose regimen of: bolus 30mg/kg  administered over 15 minutes with a
> maintenance infusion of 5.4 mg/kg  per hour infused for 23 hours. The
> initial North American trial was  replicated in a Japanese trial but
not
> in the one from France. Data  has been obtained from the latter studies
> to permit appropriate  meta-analysis of all three trials. This analysis
> indicates significant  recovery in motor function after
> methylprednisolone therapy when  administration commences within eight
> hours of injury. A more recent  trial indicates that if
> methylprednisolone therapy is given for an  additional 24 hours (for a
> total of 48 hours), additional improvement  in motor neurologic
function
> and functional status is  observed.
>
>> Th
>>> is is particularly observed  if treatment cannot be started until
> between three to eight hours  after injury. The same methylprednisolone
> therapy has been found  effective in whiplash injuries and a modified
> regimen found to improve  recovery after surgery for lumbar disc
disease.
>>>
>>> REVIEWER'S CONCLUSIONS: High dose methylprednisolone steroid  therapy
> is the only pharmacological therapy shown to have efficacy in  a Phase
> Three randomized trial when it can be administered within  eight hours
of
> injury. A recent trial indicates additional benefit  by extending the
> maintenance dose from 24 to 48 hours if start of  treatment must be
> delayed to between three and eight hours after  injury. There is an
> urgent need for more randomized trials of  pharmacological therapy for
> acute spinal cord injury.
>>>
>>>
>>>
>
------------------------------------------------------------------------
>  --------
>>>
>>>
>>>    Do not  believe in anything simply because you've heard it.
>>>
>>>    Do not believe in traditions because they have  been handed down
> for many generations.
>>>
>>>    Do not believe in anything because it is spoken  and rumored by
> many.
>>>
>>>    Do  not believe in anything simply because it is found written in
> your  religious books.
>>>
>>>    Do not believe  in anything merely on the authority of your
> teachers and elders.
>>>
>>>    But after observation and  analysis, when you find anything agrees
> with reason and is conducive  to the good and benefit of one and all
then
> accept it and live up  to it.
>>>
>>>
>>>   Lord  Gautam Buddha
>>>
>>>    2600 BC
>>>
>>>    Anguttara Nikaya III, 65,
>>>
>>>    Quoted in: British Medical  Journal,
>>>
>>>    BMJ 2003;326:737 ( 5  April )
>>>
>>>
>>>
>>>  --
>>> 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/
>>
>>
>> --
>> trauma-list : TRAUMA.ORG
>> To change  your settings or unsubscribe visit:
>>  http://www.trauma.org/index.php?/community/
>>
>>  ------------------------------
>>
>> Message: 4
>>  Date: Tue, 9 Nov 2010 07:39:15 -0500
>> From: "Bjorn, Pret"  <pbjorn at emh.org>
>> Subject: RE: Role of Steroids in Spinal  Cord Inj
>> To: "Trauma-List [TRAUMA.ORG]"  <trauma-list at trauma.org>
>> Message-ID:
>>    <9CCE32ECAAFDEB4DA01EC771B6AD951B0D2F224B at VALIER.me.emh.org>
>>  Content-Type: text/plain;   charset="iso-8859-1"
>>
>> Most clinicians (Dr. Bracken is not a medical doctor) regard  this
work
> with enormous skepticism.  NASCIS is debatable  science to begin with,
> and Dr. Bracken has been reluctant to allow  external review of his
data
> -- especially the early studies, on  which most of his assertions
> reflect.
>>
>> I've  never been a big fan of Cochrane reviews.  Allowing a principle
>  investigator to meta-analyze his own research is one big reason.
>>
>> Pret
>>
>>
>> -----Original  Message-----
>> From: trauma-list-bounces at trauma.org
>  [mailto:trauma-list-bounces at trauma.org] On Behalf Of listasmsd
>>  Sent: Tuesday, November 09, 2010 6:25 AM
>> To: Trauma-List  [TRAUMA.ORG]
>> Subject: Re: Role of Steroids in Spinal Cord  Inj
>>
>> Pret,
>> I ?m just curious. If you go to  his Yale site, Dr. Bracken is into
> gynecology research. What strikes  me (if am using rightly the phrase)
is
> that his works is in a  Cochrane review.
>> May be I should have asked someone in the  Cochrane board to
> explain/answer why they think that steroids have a  benefit... if this
> benefit is a Evidence-based medicine  fact.
>> Kindly regards
>> Manuel Sotelo MD
>>  Caracas
>>
>>
>> Kind of you to invite Dr.  Bracken to the conversation; but in the
> interests of transparency, the  list should be aware that Dr. Bracken's
> methods and behavior have been  central to the NASCIS controversy.
>>
>> The  following is from Geisler, Fred H. (2008-03-22). "Excessively
> closed  science hurts". BMJ 336 (7645): 629-a.
>>
>>  <Snip.>
>>
>> Excessively closed science  hurts
>>
>> I would like to add to Lenzer and Brownlee's  reporting of my comments
> on how excessively closed science can hurt  physicians and patients.[1]
>>
>> Statistician Michael  Bracken led the NASCIS 2 and 3 studies of high
> dose steroids in acute  spinal cord injury.[2] The National Institute
of
> Neurological  Disorders and Stroke conducted a public campaign in
advance
> of the  scientific publication of NASCIS 2 on 17 May 1990. The
institute
>  sent a fax on 13 April 1990 to some 19 000 emergency room  physicians
and
> hospitals, after a press release had resulted in  coverage by the New
> York Times and the Chicago Tribune on 31 March  1990, by Science News
on
> 7 April 1990, by Newsweek on 9 April  1990.
>>
>> This led to widespread use of steroids, off  label. No application for
> regulatory approval for this indication was  completed, and no agency
> ever approved it. Surgeons report that  methylprednisolone is
> administered from fear of litigation, not belief  in efficacy.[3]
Bracken
> reinforced this fear by testifying against  physicians; he was deposed
on
> 9 June 1998 in Civil Action File No  96A-7768-6, Superior Court of
Fulton
> County, GA.
>>
>> We have criticised NASCIS science.4 The later guidelines for  the
> management of acute cervical spine and spinal cord injuries from  the
> American Association of Neurological Surgeons and the Congress  of
> Neurological Surgeons (AANS/CNS)[5] rated the NASCIS publications  as
> evidence class III, citing flaws in study design, data  presentation,
> interpretation, and analysis. They listed steroid  treatment only as an
> "option."
>>
>> The lack of  demonstrated benefit must be weighed against documented
> risks. The  CRASH trial showed a 3% greater mortality when
> corticosteroids were  given to a multitrauma group with head injury.[6]
> If this increased  death rate held in SCI, then 5000 extra patients may
> have died in the  US since 1990.
>>
>> Yet it's difficult to stop the  momentum-especially when primary data
> are unavailable for independent  review.
>>
>> Fred H. Geisler, Director, Illinois  Neuro-Spine Center
>>
>> References
>> Lenzer J,  Brownlee S. Antidepressants. An untold story? BMJ
> 2008;336:532. (8  March.)[Free Full Text]
>> Bracken MB, Shepard MJ, Collins WF Jr,  Holford TR, Baskin DS,
> Eisenberg HM, et al. A randomized, controlled  trial of
> methylprednisolone or naloxone in the treatment of acute  spinal-cord
> injury. Results of the second national acute spinal cord  injury study.
N
> Engl J Med 1990;322:1405-11.
>> Eck JC,  Nachtigall D, Humphreys SC, Hodges SD. Questionnaire survey
of
>  spine surgeons on the use of methylprednisolone for acute spinal cord
>  injury. Spine 2006;31:E250-253.
>> Coleman WP, Benzel E, Cahill DW,  Ducker T, Geisler F, Green B, et al.
> A Critical appraisal of the  reporting of the NASCIS II and III studies
> of MPSS in acute spinal  cord injury. J Spinal Disord 2000;13:185-99.
>> Hadley MN, Walters  BC. Pharmacological therapy after acute cervical
> spinal cord injury.  In: Guidelines for the management of acute
cervical
> spine and  spinal cord injuries. Neurosurgery 2002;50:S63-S72.
>> Edwards P,  Arango M, Balica L, Cottingham R, El-Sayed H, Farrell B.
> Final results  of MRC CRASH, a randomised placebo-controlled trial of
> intravenous  corticosteroid in adults with head injury-outcomes at 6
> months. Lancet  2005;365:1957-9.
>>
>>
>>
>>
>>
>> -----Original Message-----
>> From:  trauma-list-bounces at trauma.org
> [mailto:trauma-list-bounces at trauma.org]  On Behalf Of listasmsd
>> Sent: Sunday, November 07, 2010 8:12  AM
>> To: michael.bracken at yale.edu
>> Cc: *TRAUMA  LIST
>> Subject: Role of Steroids in Spinal Cord Inj
>>
>> Dear Dr. Bracken
>> There is been a discussion going on  in the www.trauma.org list about
> the role of Role of Steroids in  Spinal Cord Injuries. This list is
free
> to sign in and it will be  interesting that you share a word about your
> papers in this subject.  The main stream of the list members believed
> that steroids have no  place in in Spinal Cord injury. I have not taken
a
> stand yet,  mainly because all studies don?t show a clear and clean cut
> of  statistics. Initially in your papers (Cochrane Plus in Spanish ) in
>  the ?80 you conclude there is no benefit but after the late ?80,  ?90
and
> 2001 you change your conclusions.Why?  The CRASH trial  protocol on the
> other hand from 2001 concludes the opposite from a  placebo-controlled
> trial.
>> Could you share your opinion in  this list?
>>
>> Sincerely
>> Manuel Sotelo  MD
>> Caracas
>> Venezuela
>>
>>
>>
>>
>> ----- Original Message -----
>> From: Robert Smith
>> To: Trauma-List [TRAUMA.ORG]
>> Sent: S?bado, 06 de Noviembre de 2010 09:33 a.m.
>>  Subject: Re: Role of Steroids in Spinal Cord Inj
>>
>>
>> Meta-analysis is the definition of Garbage In/Garbage  Out
>>
>>
>> On Nov 6, 2010, at 9:57 AM, Pret  Bjorn wrote:
>>
>>> Meta-analysis is overrated, and  highly conditional.
>>>
>>> Pret
>>>
>>>
>>> Clumsily sent from my cell  phone.
>>>
>>> -----Original  Message-----
>>> From: listasmsd  <listasmsd at gmail.com>
>>> Sent: Friday, November 05, 2010  23:00
>>> To: Trauma-List [TRAUMA.ORG]  <trauma-list at trauma.org>
>>> Subject: Re: Role of Steroids  in Spinal Cord Inj
>>>
>>> If it did not say  "Cochrane" I would not take it so seriously
>>>
>>>  Regards
>>> Manuel Sotelo MD
>>>  Caracas
>>>
>>>
>>>
>>>
>
------------------------------------------------------------------------
>  --------
>>> Cochrane Database Syst Rev.  2002;(3):CD001046.
>>>
>>> Steroids for acute spinal  cord injury.
>>> Bracken MB.
>>>
>>>  Department of Epidemiology and Public Health, Yale School of
> Medicine,  60 College street, Box 20834, New Haven, Connecticut,
> 06520-8034, USA.  >
>>> Comment in:
>>>
>>> a.. Ann  Emerg Med. 2003 Mar;41(3):410-3.
>>>
>>> Update of:
>>>
>>> a.. Cochrane Database Syst Rev.  2000;(2):CD001046.
>>>
>>> Abstract
>>>  BACKGROUND: Acute spinal cord injury is a devastating condition
>  typically affecting young people with a preponderance being male.
>  Steroid treatment in the early hours of the injury is aimed  at
reducing
> the extent of permanent paralysis during the rest of  the patient's
life.
>>>
>>> OBJECTIVES: To review  randomized trials of steroids for acute spinal
> cord  injury.
>>>
>>> SEARCH STRATEGY: The review draws on  the search strategy developed
by
> the Cochrane Injuries Group. In  addition, files of the National Acute
> Spinal Cord Injury Study have  been reviewed and a Medline search
> conducted.
>>>
>>> SELECTION CRITERIA: All published or unpublished  randomized
> controlled trials of steroid treatment for acute spinal  cord injury in
> any language.
>>>
>>> DATA  COLLECTION AND ANALYSIS: Data have been abstracted from
original
>  trial reports. For the NASCIS, Japanese and French trials, additional
>  data (e.g. SDs) have been obtained from the original authors.
>>>
>>> MAIN RESULTS: There are few trials in this area of medical  care.
Only
> one steroid has been extensively studied,  methylprednisolone sodium
> succinate, which has been shown to improve  neurologic outcome up to
one
> year post injury if administered  within eight hours of injury and in a
> dose regimen of: bolus 30mg/kg  administered over 15 minutes with a
> maintenance infusion of 5.4 mg/kg  per hour infused for 23 hours. The
> initial North American trial was  replicated in a Japanese trial but
not
> in the one from France. Data  has been obtained from the latter studies
> to permit appropriate  meta-analysis of all three trials. This analysis
> indicates significant  recovery in motor function after
> methylprednisolone therapy when  administration commences within eight
> hours of injury. A more recent  trial indicates that if
> methylprednisolone therapy is given for an  additional 24 hours (for a
> total of 48 hours), additional improvement  in motor neurologic
function
> and functional status is  observed.
>
>> Th
>>> is is particularly observed  if treatment cannot be started until
> between three to eight hours  after injury. The same methylprednisolone
> therapy has been found  effective in whiplash injuries and a modified
> regimen found to improve  recovery after surgery for lumbar disc
disease.
>>>
>>> REVIEWER'S CONCLUSIONS: High dose methylprednisolone steroid  therapy
> is the only pharmacological therapy shown to have efficacy in  a Phase
> Three randomized trial when it can be administered within  eight hours
of
> injury. A recent trial indicates additional benefit  by extending the
> maintenance dose from 24 to 48 hours if start of  treatment must be
> delayed to between three and eight hours after  injury. There is an
> urgent need for more randomized trials of  pharmacological therapy for
> acute spinal cord injury.
>>>
>>>
>>>
>
------------------------------------------------------------------------
>  --------
>>>
>>>
>>>    Do not  believe in anything simply because you've heard it.
>>>
>>>    Do not believe in traditions because they have  been handed down
> for many generations.
>>>
>>>    Do not believe in anything because it is spoken  and rumored by
> many.
>>>
>>>    Do  not believe in anything simply because it is found written in
> your  religious books.
>>>
>>>    Do not believe  in anything merely on the authority of your
> teachers and elders.
>>>
>>>    But after observation and  analysis, when you find anything agrees
> with reason and is conducive  to the good and benefit of one and all
then
> accept it and live up  to it.
>>>
>>>
>>>   Lord  Gautam Buddha
>>>
>>>    2600 BC
>>>
>>>    Anguttara Nikaya III, 65,
>>>
>>>    Quoted in: British Medical  Journal,
>>>
>>>    BMJ 2003;326:737 ( 5  April )
>>>
>>>
>>>
>>>  --
>>> 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/
>>
>>
>> --
>> 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: 5
>>  Date: Tue, 9 Nov 2010 20:54:29 -0500
>> From: Stephen Richey  <stephen.richey at gmail.com>
>> Subject: Tendon  strength
>> To: "Trauma &amp, Critical Care mailing  list"
<trauma-list at trauma.org>
>>  Message-ID:
>>    <AANLkTindtb6wf-xkWDDsCgQM4nWGOp+-P7Q3W-L=jKEp at mail.gmail.com>
>>  Content-Type: text/plain; charset=ISO-8859-1
>>
>> Does  anyone know an average tensile strength for an "average" tendon?
>>
>> --
>> Stephen Richey
>>
>> "A man's  moral worth is established only at the point where he is
>> ready to  give up his life in defense of his convictions."- Henning
von
>>  Tresckow
>>
>>
>>  ------------------------------
>>
>> Message: 6
>>  Date: Wed, 10 Nov 2010 06:03:01 -0430
>> From: "listasmsd"  <listasmsd at gmail.com>
>> Subject: Re: Tendon  strength
>> To: "Trauma-List [TRAUMA.ORG]"  <trauma-list at trauma.org>
>> Message-ID:  <DF9F5D3EA1FA40F5918D766C8F55DC6D at sceptre>
>> Content-Type:  text/plain;   charset="iso-8859-1"
>>
>>  http://www.scipub.org/fulltext/ajas/ajas65816-819.pdf
>>  http://linkinghub.elsevier.com/retrieve/pii/0021929068900389
>>  http://en.wikipedia.org/wiki/Tendon
>>  http://jhs-euro.com/content/26/3/217.full.pdf
>>
>>
>> It depends on witch tendon. The Aquilles tendons is the  stronger.
>> Just google your question and you will find another  42000 hits.
>> Regards
>> Manuel Sotelo MD
>>  Caracas
>>
>>
>>
>> Does anyone know an  average tensile strength for an "average" tendon?
>>
>> --
>> Stephen Richey
>>
>> "A man's moral worth is  established only at the point where he is
>> ready to give up his  life in defense of his convictions."- Henning
von
>>  Tresckow
>> --
>> trauma-list : TRAUMA.ORG
>> To  change your settings or unsubscribe visit:
>>  http://www.trauma.org/index.php?/community/
>>
>>  ------------------------------
>>
>> Message: 7
>>  Date: Sat, 13 Nov 2010 10:37:02 -0430
>> From: "listasmsd"  <listasmsd at gmail.com>
>> Subject: Homemade ultrasound training  model
>> To: "*TRAUMA LIST"  <trauma-list at trauma.org>
>> Message-ID:  <44AC96A031004E5AB79976D47A74B333 at sceptre>
>> Content-Type:  text/plain; charset="utf-8"
>>
>> The polony phantom: a  cost-effective aid for teaching emergency
> ultrasound  procedures
>> -------------- next part --------------
>> A  non-text attachment was scrubbed...
>> Name: polony  phantom.pdf
>> Type: application/pdf
>> Size: 319826  bytes
>> Desc: not available
>>  URL:
>
<http://list.mistral.net/pipermail/trauma-list/attachments/20101113/fc28
>  ae18/attachment.pdf>
>>
>>  ------------------------------
>>
>> --
>>  trauma-list : TRAUMA.ORG
>> To change your settings or unsubscribe  visit:
>> http://www.trauma.org/index.php?/community/
>>
>> End of trauma-list Digest, Vol 89, Issue 9
>>  ******************************************
> --
> 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:  2
> Date: Tue, 16 Nov 2010 19:50:42 -0800 (PST)
> From: shafiq  chughtai via LinkedIn <member at linkedin.com>
> Subject: Invitation  to connect on LinkedIn
> To: Claudia Kenworthy  <trauma-list at trauma.org>
> Message-ID:
>     <1986568698.11163455.1289965842836.JavaMail.app at ech3-cdn07.prod>
>  Content-Type: text/plain; charset=UTF-8
>
> LinkedIn
>  ------------shafiq chughtai requested to add you as a connection  on
LinkedIn:
> ------------------------------------------
>
> Claudia,
>
> I'd like to add you to my professional  network on LinkedIn.
>
> - shafiq
>
> Accept  invitation from shafiq  chughtai
>
http://www.linkedin.com/e/-paw7s9-gglocuj5-53/VtcKv-9J1ZBYJL8ayhJKsi9J1Z
BYJ7Kbkk-/blk/I2464668294_2/1BpC5vrmRLoRZcjkkZt5YCpnlOt3RApnhMpmdzgmhxrS
NBszYOnPgVczwSdzgSd399bR1eoB1Rh7xBbPcVdP8Rd3gNej4LrCBxbOYWrSlI/EML_comm_
afe/
>
> View invitation from shafiq  chughtai
>
http://www.linkedin.com/e/-paw7s9-gglocuj5-53/VtcKv-9J1ZBYJL8ayhJKsi9J1Z
BYJ7Kbkk-/blk/I2464668294_2/39vd3AOe3oSd3oQcAALqnpPbOYWrSlI/svi/
>  ------------------------------------------
>
> DID YOU KNOW you  can be the first to know when a trusted member of
your network changes  jobs? With Network Updates on your LinkedIn home
page, you'll be notified  as members of your network change their current
position. Be the first to  know and reach out!
> http://www.linkedin.com/
>
>
>  --
> (c) 2010, LinkedIn Corporation
>
>  ------------------------------
>
> Message: 3
> Date: Wed,  17 Nov 2010 04:48:49 -0500
> From: Dave Napoliello  <nappio at aol.com>
> Subject: Re: Invitation to connect on  LinkedIn
> To: "Trauma-List [TRAUMA.ORG]"  <trauma-list at trauma.org>
> Message-ID:  <8bie2s4tsrn844l6f94gc16d.1289987329560 at email.android.com>
>  Content-Type: text/plain; charset=utf-8
>
> im not  claudia
>
> Sent from my Verizon Wireless Phone
>
>  shafiq chughtai via LinkedIn <member at linkedin.com> wrote:
>
>> LinkedIn
>> ------------shafiq chughtai requested to add  you as a connection on
LinkedIn:
>>  ------------------------------------------
>>
>>  Claudia,
>>
>> I'd like to add you to my professional  network on LinkedIn.
>>
>> - shafiq
>>
>> Accept invitation from shafiq  chughtai
>>
http://www.linkedin.com/e/-paw7s9-gglocuj5-53/VtcKv-9J1ZBYJL8ayhJKsi9J1Z
BYJ7Kbkk-/blk/I2464668294_2/1BpC5vrmRLoRZcjkkZt5YCpnlOt3RApnhMpmdzgmhxrS
NBszYOnPgVczwSdzgSd399bR1eoB1Rh7xBbPcVdP8Rd3gNej4LrCBxbOYWrSlI/EML_comm_
afe/
>>
>> View invitation from shafiq  chughtai
>>
http://www.linkedin.com/e/-paw7s9-gglocuj5-53/VtcKv-9J1ZBYJL8ayhJKsi9J1Z
BYJ7Kbkk-/blk/I2464668294_2/39vd3AOe3oSd3oQcAALqnpPbOYWrSlI/svi/
>>  ------------------------------------------
>>
>> DID YOU  KNOW you can be the first to know when a trusted member of
your network  changes jobs? With Network Updates on your LinkedIn home
page, you'll be  notified as members of your network change their current
position. Be the  first to know and reach out!
>> http://www.linkedin.com/
>>
>>
>> --
>> (c) 2010, LinkedIn  Corporation
>> --
>> trauma-list : TRAUMA.ORG
>> To  change your settings or unsubscribe visit:
>>  http://www.trauma.org/index.php?/community/
>
>  ------------------------------
>
> Message: 4
> Date: Thu,  18 Nov 2010 17:42:59 -0800 (PST)
> From: Bobby Smith via LinkedIn  <member at linkedin.com>
> Subject: Bobby Smith wants to stay in  touch on LinkedIn
> To: Claudia Kenworthy  <trauma-list at trauma.org>
> Message-ID:
>     <1581758883.141736.1290130979122.JavaMail.app at ech3-cdn11.prod>
>  Content-Type: text/plain; charset=UTF-8
>
> LinkedIn
>  ------------Bobby Smith requested to add you as a connection  on
LinkedIn:
> ------------------------------------------
>
> Claudia,
>
> I'd like to add you to my professional  network on LinkedIn.
>
> - Bobby Smith
>
> Accept  invitation from Bobby  Smith
>
http://www.linkedin.com/e/-paw7s9-ggoeoai6-6j/VtcKv-9J1ZBYJL8ayhJKsi9J1Z
BYJ7Kbkk-/blk/I2468826493_2/1BpC5vrmRLoRZcjkkZt5YCpnlOt3RApnhMpmdzgmhxrS
NBszYOnPcVd3oOe3wSd399bRBgij8Os4BpbP0OejgOcPgOej4LrCBxbOYWrSlI/EML_comm_
afe/
>
> View invitation from Bobby  Smith
>
http://www.linkedin.com/e/-paw7s9-ggoeoai6-6j/VtcKv-9J1ZBYJL8ayhJKsi9J1Z
BYJ7Kbkk-/blk/I2468826493_2/39vcPAQdz8Ue3oQcAALqnpPbOYWrSlI/svi/
>
> ------------------------------------------
>
> Why might  connecting with Bobby Smith be a good idea?
>
> Bobby Smith's  connections could be useful to you:
> After accepting Bobby Smith's  invitation, check Bobby Smith's
connections to see who else you may know  and who you might want an
introduction to. Building these connections can  create opportunities in
the future.
>
>
> --
>  (c) 2010, LinkedIn Corporation
>
>  ------------------------------
>
> Message: 5
> Date: Fri,  19 Nov 2010 13:42:15 +0100
> From: Farid Pouralikhan  <faridp at gmx.de>
> Subject: Re: Invitation to connect on  LinkedIn
> To: "Trauma-List [TRAUMA.ORG]"  <trauma-list at trauma.org>
> Cc: "Trauma-List [TRAUMA.ORG]"  <trauma-list at trauma.org>
> Message-ID:  <1F812EF6-AB2A-4CF4-A47A-9FF9C33E60E3 at gmx.de>
> Content-Type:  text/plain;   charset=us-ascii
>
> I am Not  claudia
> Check for virus
>
>
> Von meinem iPhone  gesendet
>
> Am 17.11.2010 um 10:48 schrieb Dave Napoliello  <nappio at aol.com>:
>
>> im not claudia
>>
>> Sent from my Verizon Wireless Phone
>>
>>  shafiq chughtai via LinkedIn <member at linkedin.com> wrote:
>>
>>> LinkedIn
>>> ------------shafiq chughtai  requested to add you as a connection on
LinkedIn:
>>>  ------------------------------------------
>>>
>>>  Claudia,
>>>
>>> I'd like to add you to my  professional network on LinkedIn.
>>>
>>> -  shafiq
>>>
>>> Accept invitation from shafiq  chughtai
>>>
http://www.linkedin.com/e/-paw7s9-gglocuj5-53/VtcKv-9J1ZBYJL8ayhJKsi9J1Z
BYJ7Kbkk-/blk/I2464668294_2/1BpC5vrmRLoRZcjkkZt5YCpnlOt3RApnhMpmdzgmhxrS
NBszYOnPgVczwSdzgSd399bR1eoB1Rh7xBbPcVdP8Rd3gNej4LrCBxbOYWrSlI/EML_comm_
afe/
>>>
>>> View invitation from shafiq  chughtai
>>>
http://www.linkedin.com/e/-paw7s9-gglocuj5-53/VtcKv-9J1ZBYJL8ayhJKsi9J1Z
BYJ7Kbkk-/blk/I2464668294_2/39vd3AOe3oSd3oQcAALqnpPbOYWrSlI/svi/
>>>  ------------------------------------------
>>>
>>>  DID YOU KNOW you can be the first to know when a trusted member of
your  network changes jobs? With Network Updates on your LinkedIn home
page,  you'll be notified as members of your network change their  current
position. Be the first to know and reach out!
>>>  http://www.linkedin.com/
>>>
>>>
>>> --
>>> (c) 2010, LinkedIn Corporation
>>>  --
>>> 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, 19 Nov 2010 09:37:02 -0700
> From: Raul Medina  Mireles MD <mylkas at prodigy.net.mx>
> Subject: Re: Invitation to  connect on LinkedIn
> To: "Trauma-List [TRAUMA.ORG]"  <trauma-list at trauma.org>
> Message-ID:
>     <AANLkTikO-QUwPEnS2XATjoUyiTCW5aWvBxoy=OaXhHfh at mail.gmail.com>
>  Content-Type: text/plain; charset=ISO-8859-1
>
> I'm not  shafiq
>
> 2010/11/17 Dave Napoliello  <nappio at aol.com>
>
>> im not claudia
>>
>> Sent from my Verizon Wireless Phone
>>
>>  shafiq chughtai via LinkedIn <member at linkedin.com> wrote:
>>
>>> LinkedIn
>>> ------------shafiq chughtai  requested to add you as a connection on
>> LinkedIn:
>>>  ------------------------------------------
>>>
>>>  Claudia,
>>>
>>> I'd like to add you to my  professional network on LinkedIn.
>>>
>>> -  shafiq
>>>
>>> Accept invitation from shafiq  chughtai
>>>
>>
http://www.linkedin.com/e/-paw7s9-gglocuj5-53/VtcKv-9J1ZBYJL8ayhJKsi9J1Z
BYJ7Kbkk-/blk/I2464668294_2/1BpC5vrmRLoRZcjkkZt5YCpnlOt3RApnhMpmdzgmhxrS
NBszYOnPgVczwSdzgSd399bR1eoB1Rh7xBbPcVdP8Rd3gNej4LrCBxbOYWrSlI/EML_comm_
afe/
>>>
>>> View invitation from shafiq chughtai
>>>
>>
http://www.linkedin.com/e/-paw7s9-gglocuj5-53/VtcKv-9J1ZBYJL8ayhJKsi9J1Z
BYJ7Kbkk-/blk/I2464668294_2/39vd3AOe3oSd3oQcAALqnpPbOYWrSlI/svi/
>>>  ------------------------------------------
>>>
>>>  DID YOU KNOW you can be the first to know when a trusted member  of
your
>> network changes jobs? With Network Updates on your  LinkedIn home
page,
>> you'll be notified as members of your  network change their current
position.
>> Be the first to know and  reach out!
>>> http://www.linkedin.com/
>>>
>>>
>>> --
>>> (c) 2010, LinkedIn  Corporation
>>> --
>>> trauma-list : TRAUMA.ORG  <http://trauma.org/>
>>> To change your settings or  unsubscribe visit:
>>>  http://www.trauma.org/index.php?/community/
>> --
>>  trauma-list : TRAUMA.ORG <http://trauma.org/>
>> To change your  settings or unsubscribe visit:
>>  http://www.trauma.org/index.php?/community/
>>
>
>
> ------------------------------
>
> Message: 7
>  Date: Sat, 20 Nov 2010 16:55:47 +0000
> From: Doc Holiday  <drydok at hotmail.com>
> Subject: RE: Invitation to connect on  LinkedIn
> To: ".Trauma List" <trauma-list at trauma.org>
>  Message-ID: <SNT104-W11096B14B79C8F71D7B78CC03B0 at phx.gbl>
>  Content-Type: text/plain; charset="iso-8859-1"
>
>
> From:  Dave Napoliello nappio at aol.com
>> im not claudia
>
>  From: mylkas at prodigy.net.mx
>> I'm not shafiq
>
> -->  Ahhm...
> There seems to be a trend developing here...
> Maybe we  should save time and have a quick vote: Anyone else on this
List who's NOT  Claudia or Shafiq, please put your hands up... ;-)

>
>  ------------------------------
>
> Message: 8
> Date: Sun,  21 Nov 2010 08:16:07 +0000
> From: Hector Gullen  <hectorgullen at hotmail.com>
> Subject: RE: Invitation to connect on  LinkedIn
> To: <trauma-list at trauma.org>
> Message-ID:  <COL118-W82538FCFA377D0BCE4A23D13C0 at phx.gbl>
> Content-Type:  text/plain; charset="iso-8859-1"
>
>
> 'Im  Spartacus'
>
>>
>> From: Dave Napoliello  nappio at aol.com
>>> im not claudia
>>
>> From:  mylkas at prodigy.net.mx
>>> I'm not shafiq
>>
>>  --> Ahhm...
>> There seems to be a trend developing  here...
>> Maybe we should save time and have a quick vote: Anyone  else on this
List who's NOT Claudia or Shafiq, please put your hands up...  ;-)

>> --
>> trauma-list : TRAUMA.ORG
>> To  change your settings or unsubscribe visit:
>>  http://www.trauma.org/index.php?/community/
>
>
>  ------------------------------
>
> Message: 9
> Date: Sun,  21 Nov 2010 08:17:06 -0430
> From: "listasmsd"  <listasmsd at gmail.com>
> Subject: Re: Invitation to connect on  LinkedIn
> To: "Trauma-List [TRAUMA.ORG]"  <trauma-list at trauma.org>
> Message-ID:  <41A7BBB6F3BF4E43B4924CAA337E6E9D at sceptre>
> Content-Type:  text/plain;   charset="iso-8859-1"
>
> At list he did't  say:  "I'm God"........... ;-))
> Regards
> Manuel Sotelo  MD
> Caracas
>
>
>
>
> 'Im  Spartacus'
>
>>
>> From: Dave Napoliello  nappio at aol.com
>>> im not claudia
>>
>> From:  mylkas at prodigy.net.mx
>>> I'm not shafiq
>>
>>  --> Ahhm...
>> There seems to be a trend developing  here...
>> Maybe we should save time and have a quick vote: Anyone  else on this
List who's NOT Claudia or Shafiq, please put your hands up...  ;-)
>> --
>> 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: 10
> Date: Mon,  22 Nov 2010 21:51:56 -0500
> From: Stephen Richey  <stephen.richey at gmail.com>
> Subject: Instrument sets
> To:  "Trauma &amp, Critical Care mailing list"  <trauma-list at trauma.org>
> Message-ID:
>     <AANLkTi=RZAYkNOW321364p3aeLtnQFmfd+2XM6BBsX=M at mail.gmail.com>
>  Content-Type: text/plain; charset=ISO-8859-1
>
> Does anyone  happen to have a basic list of what is on their hospital's
> thoracotomy  and laparotomy trays for trauma cases?  I did a search
> online but  did not find anything sufficiently detailed for the
> purposes I need  the information for.
>
> --
> Stephen Richey
>
> "A man's moral worth is established only at the point where he  is
> ready to give up his life in defense of his convictions."- Henning  von
> Tresckow
>
>
>  ------------------------------
>
> Message: 11
> Date: Mon,  22 Nov 2010 19:18:17 -0800
> From: "Scott  Bricker"<scottbricker at verizon.net>
> Subject: Re: Instrument  sets
> To: "Trauma-List  \\[TRAUMA.ORG\\]"<trauma-list at trauma.org>
> Message-ID:  <10fae961-2944-46a2-895c-9fd07149c98a at blur>
> Content-Type:  text/plain; Format="Flowed"; DelSp="Yes";
>     charset="US-ASCII"
>
> #10 scalpel
> Curved mayo  scissors
> Finochietto retractor (1 adult/1 pediatric)
> Lebsche  knife and mallet
> Debakey aortic clamp
> Cooley-Satinsky  clamp
> Tonsil clamps
> Hemostats
> Forceps
> Needle  drivers
> Prolene sutures
> A bunch of other stuff I never use and  can't imagine needing.
>
> Interested to see what other people  would add?
>
>
> Scott D.  Bricker, M.D.
>  Torrance, CA
>
> Sent via DROID on Verizon Wireless
>
> -----Original message-----
> From: Stephen Richey  <stephen.richey at gmail.com>
> To: "Trauma &amp, Critical Care  mailing list" <trauma-list at trauma.org>
> Sent: Tue, Nov 23, 2010  02:51:56 GMT+00:00
> Subject: Instrument sets
>
> Does  anyone happen to have a basic list of what is on their hospital's
>  thoracotomy and laparotomy trays for trauma cases?  I did a  search
> online but did not find anything sufficiently detailed for  the
> purposes I need the information for.
>
> --
>  Stephen Richey
>
> "A man's moral worth is established only at  the point where he is
> ready to give up his life in defense of his  convictions."- Henning von
> Tresckow
> --
> trauma-list :  TRAUMA.ORG
> To change your settings or unsubscribe visit:
>  http://www.trauma.org/index.php?/community/
>
>
>
>  ------------------------------
>
> Message: 12
> Date: Mon,  22 Nov 2010 22:27:45 -0500
> From: Stephen Richey  <stephen.richey at gmail.com>
> Subject: Re: Instrument sets
>  To: "Trauma-List [TRAUMA.ORG]" <trauma-list at trauma.org>
>  Message-ID:
>     <AANLkTimd_+3xj36kMVyg9j_L0QTiSTYHWv9NB7Hee7GF at mail.gmail.com>
>  Content-Type: text/plain; charset=ISO-8859-1
>
> Excellent.   I am interested in both the emergency room side of things
> as well as  the OR variants.
>
> On a related note, does anyone know when the  Debakey and Satinsky
> clamps were introduced?
>
> On Mon,  Nov 22, 2010 at 10:18 PM, Scott Bricker
>  <scottbricker at verizon.net> wrote:
>> #10 scalpel
>>  Curved mayo scissors
>> Finochietto retractor (1 adult/1  pediatric)
>> Lebsche knife and mallet
>> Debakey aortic  clamp
>> Cooley-Satinsky clamp
>> Tonsil clamps
>>  Hemostats
>> Forceps
>> Needle drivers
>> Prolene  sutures
>> A bunch of other stuff I never use and can't imagine  needing.
>>
>> Interested to see what other people would  add?
>>
>>
>> Scott D. ?Bricker, M.D.
>>  Torrance, CA
>>
>> Sent via DROID on Verizon  Wireless
>>
>> -----Original message-----
>> From:  Stephen Richey <stephen.richey at gmail.com>
>> To: "Trauma  &amp, Critical Care mailing  list"
<trauma-list at trauma.org>
>> Sent: Tue, Nov 23, 2010  02:51:56 GMT+00:00
>> Subject: Instrument sets
>>
>> Does anyone happen to have a basic list of what is on  their
hospital's
>> thoracotomy and laparotomy trays for trauma  cases? ?I did a search
>> online but did not find anything  sufficiently detailed for the
>> purposes I need the information  for.
>>
>> --
>> Stephen Richey
>>
>> "A man's moral worth is established only at the point where he  is
>> ready to give up his life in defense of his convictions."-  Henning
von
>> Tresckow
>> --
>> 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/
>>
>
>
>
> --
> Stephen Richey
>
> "A man's moral  worth is established only at the point where he is
> ready to give up  his life in defense of his convictions."- Henning von
> Tresckow
>
>
> ------------------------------
>
> Message:  13
> Date: Mon, 22 Nov 2010 22:46:04 EST
> From:  KMATTOX at aol.com
> Subject: Re: Instrument sets
> To:  trauma-list at trauma.org
> Message-ID:  <f4fc.88835bf.3a1c92fc at aol.com>
> Content-Type: text/plain;  charset="US-ASCII"
>
> Yes.     How much detail do  you  want.      There are more than 300
> different  DeBakey  Clamps and there are of course many other pioneers
in  vascular
> surgery that have  their names on clamps.   I even have a few, but
those
> were  specifically  for conditions described during the 1970s.
>
> When  he came to Houston in 1948/49, Dr. DeBakey developed a Machine
Shop as
> part of the Animal Surgery Laboratories.    He employed a  man,  almost
off
> the street, by the name of Lew Feldman who  was a natural  engineer.
The
> first DeBakey Clamps that I  could find were  developed by DeBakey with
the
> help of Lew  Feldman in the 1952-1954 time  frame.    I still have  a
couple of
> these original clamps in my  office.  Lew  Feldman is still alive.   I
have
> a photo of him  and  Dr. DeBakey taken about 3 years ago.
>
>  During ALL the years that I knew him, Dr. DeBakey was continually
modifying
> his instruments, both on the metal, the curve of the blades, the  size
of
> the  finger holes, the spring of the metal, the  country of the metal,
the
> groving on  the inside of the  clamps, the length or smallness of the
> instruments, the color   of the handle, the color of the tip, the
narrowness of the tip
> and  the blades,  the width of the blades, the covering of the blades.
He
> worked  with at least 10 different instrument companies on  instruments
and
> devices.
>
> His very first device was a hand turned crank to give blood from  one
donor
> directly to a patient, arm to arm when he was a  MEDICAL STUDENT at
Tulane.
>   I have some of the  photographs of that  device.    His invention was
the
> ribbing on the side of the  tubing to keep it from "walking"  during
the
> twists of the crank.
>
> k
>  k
>
>
> In a message dated 11/22/2010 9:28:04 P.M. Central  Standard Time,
> stephen.richey at gmail.com writes:
>
> On a  related note, does anyone know when the Debakey and  Satinsky
> clamps were  introduced?
>
>
>
> ------------------------------
>
> Message: 14
>  Date: Mon, 22 Nov 2010 22:49:32 EST
> From: KMATTOX at aol.com
>  Subject: Re: Instrument sets
> To: trauma-list at trauma.org
>  Message-ID: <f729.38270a20.3a1c93cc at aol.com>
> Content-Type:  text/plain; charset="US-ASCII"
>
> I could be very crast and say  we have a knife fork and spoon.
Really
> KEEP IT SIMPLE.   I will try to compose a  list.    Most OR  sets
have about
> 80% of the junk on the sets  which are not  needed or are detrimental
for
> rapid effective  surgery.
>
> k
>
>
> In a message  dated 11/22/2010 8:52:15 P.M. Central Standard Time,
>  stephen.richey at gmail.com writes:
>
> Does  anyone happen to  have a basic list of what is on their
hospital's
> thoracotomy and  laparotomy trays for trauma cases?  I did a  search
> online  but did not find anything sufficiently detailed for  the
> purposes  I need the information for.
>
> --
> Stephen   Richey
>
> "A man's moral worth is established only at the point  where he  is
> ready to give up his life in defense of his  convictions."- Henning
von
> Tresckow
> --
> trauma-list  : TRAUMA.ORG
> To change your settings  or unsubscribe   visit:
> http://www.trauma.org/index.php?/community/
>
>
>
> ------------------------------
>
> Message:  15
> Date: Mon, 22 Nov 2010 22:55:55 EST
> From:  Krin135 at aol.com
> Subject: Re: Instrument sets
> To:  trauma-list at trauma.org
> Message-ID:  <dd081.3ff9f043.3a1c954b at aol.com>
> Content-Type: text/plain;  charset="US-ASCII"
>
> the widespread use of the Bovie and other  'hot knives' also reduced
the
> instrument count in many  sets.
>
> When I first started doing instrument cleaning and pack  set up in
1979,
> there were several chest and abdominal sets  that were particular to
certain
> surgeons that had about  twice as many mosquito forceps as the rest,
because
> these  surgeons still preferred to tie, rather than spot cauterize,
bleeders
> in  the subcutaneous fat.
>
> ck
>
>
> In a message dated 11/22/10 21:50:01 Central Standard  Time,
KMATTOX at aol.com
> writes:
>
> I could  be  very crast and say we have a knife fork and spoon.
Really
>  KEEP IT SIMPLE.     I will try to compose a    list.    Most OR sets
have
> about
> 80% of the  junk on the  sets  which are not needed or are detrimental
for
> rapid  effective  surgery.
>
> k
>
>
> In a  message dated  11/22/2010 8:52:15 P.M. Central Standard Time,
>  stephen.richey at gmail.com writes:
>
> Does  anyone happen to  have a  basic list of what is on their
hospital's
> thoracotomy  and laparotomy  trays for trauma cases?  I did a   search
> online but did not find  anything sufficiently detailed  for  the
> purposes I need the  information for.
>
> --
> Stephen  Richey
>
> "A man's  moral  worth is established only at the point where he  is
>  ready to give up  his life in defense of his convictions."-  Henning
von
> Tresckow
> --
> 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/
>
>
>
>  ------------------------------
>
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> trauma-list :  TRAUMA.ORG
> To change your settings or unsubscribe visit:
>  http://www.trauma.org/index.php?/community/
>
> End of  trauma-list Digest, Vol 89, Issue 11
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------------------------------

Message:  4
Date: Wed, 24 Nov 2010 21:56:31 +0530
From: Nikahat Jahan  <nikahat at gmail.com>
Subject: Re: splenectomy and vaccination
To:  "Trauma-List [TRAUMA.ORG]"  <trauma-list at trauma.org>
Message-ID:
<AANLkTi=K4prvZNRs5boksUtTsN4X3L7+mnaRrhv_PsAQ at mail.gmail.com>
Content-Type:  text/plain; charset=ISO-8859-1

Thanks a lot Dr Matthew for a detailed  answer to my query. Yes there seems
to be a lot of variation in practice  across the world and even within a
nation. Your inputs are invaluable.  thanks  again
regards
nikahat


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