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Requoting the previous posts

Karim Brohi karimbrohi at gmail.com
Wed Apr 25 11:20:51 BST 2012


RM
It's because you had subscribed to the 'Digest' version of the list.
I have switched you back to nomal mode.
(I agree it's much better to receive posts individually)
Karim

On Wed, Apr 25, 2012 at 10:28, rm khattar <dr_rm_khattar at yahoo.co.in> wrote:
>
>
> Takes away the pleasure of reading,and becomes difficult and time consuming.If one has to refer to previous posts, he would have saved the same.The older format of presentation was good.
> R.M.khattar
> General And acute Care Surgery
>
> ------------------------------
> On Wed 25 Apr, 2012 1:20 PM IST 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: TXA (Jonathan Morrison)
>>   2. Don't requote entire messages (James Bradley)
>>   3. Re: TXA (Karim Brohi)
>>
>>
>>----------------------------------------------------------------------
>>
>>Message: 1
>>Date: Tue, 24 Apr 2012 23:49:23 +0100
>>From: "Jonathan Morrison" <jonny_morrison at doctors.org.uk>
>>Subject: Re: TXA
>>To: "Trauma-List \[TRAUMA.ORG\]" <trauma-list at trauma.org>,     Ian Seppelt
>>       <seppelt at med.usyd.edu.au>
>>Message-ID: <web-4848836 at be4.doctors.org.uk>
>>Content-Type: text/plain;charset=iso-8859-1
>>
>>
>>MATTERs was a collaborative UK and US study. I agree that it is interesting how people have interpreted the CRASH-2 findings in the context of this military work. Ultimately, if it gets the right drug into the right patients then something positive has come from it all.
>>
>>Jonny
>>
>>
>>----------------------------------------------------------------------
>>Major Jonathan Morrison, MB ChB, MRCS, RAMC (V),
>>Research Fellow &
>>Registrar in General Surgery and Critical Care,
>>
>>US Army Institute of Surgical Research,
>>Fort Sam Houston, Tx, USA
>>&
>>Academic Dept Military Surgery and Trauma,
>>Royal Centre for Defence Medicine,
>>Birmingham, UK
>>
>>
>>On Wed, 25 Apr 2012 08:13:59 +1000
>> Ian Seppelt <seppelt at med.usyd.edu.au> wrote:
>>>But Karim, you know the hierarchy of evidence. A retrospective observational study done by Americans is a much higher level of evidence than a well conducted large RCT done elsewhere in the world. <wicked grin, ducking for cover>
>>>
>>>Ian
>>>
>>>Sent from my iPad
>>>
>>>On 25/04/2012, at 7:33 AM, Karim Brohi <karimbrohi at gmail.com> wrote:
>>>
>>> It's amazing how people won't believe a 20,000 patient RCT but will
>>> believe a small retrospective study.
>>>
>>> Arguably the MATTERS study has done more to improv uptake of TXA use
>>> in the USA than the CRASH2 study.  But of course you could read
>>> MATTERS as any difference between UK and US practice.  In fact, maybe
>>> transplanting UK surgeons to the US would improve survival??
>>>
>>> Karim
>>>
>>> On Sat, Apr 14, 2012 at 11:27, Christian Medby <cmedby at hotmail.com> wrote:
>>>>
>>>> If you don't believe in the CRASH-2 trial, check out the MATTERs study:
>>>>
>>>> TXA was found to reduce mortality from 23.9% to 17.4% and reduce coagulopathy in a retrospective observational military study.
>>>>
>>>> Morrison, J. J., Dubose, J. J., Rasmussen, T. E., & Midwinter, M. J. (2012). Military Application of Tranexamic Acid in Trauma Emergency Resuscitation (MATTERs) Study. Archives of Surgery, 147(2), 113?119. doi:10.1001/archsurg.2011.287
>>>>
>>>> Christian Medby
>>>> Consultant Anesthesiologist
>>>> Norwegian Armed Forces Medical Services
>>>>
>>>>
>>>> From: trauma-list-request at trauma.org
>>>> Subject: trauma-list Digest, Vol 106, Issue 6
>>>> To: trauma-list at trauma.org
>>>> Date: Sat, 14 Apr 2012 01:40:46 +0100
>>>>
>>>> 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: Giving packed red blood cells in the prehospital phase
>>>>       ofcare...a      good idea? (McSwain, Norman E)
>>>>    2. Re: trauma-list Digest, Vol 106, Issue 5 (John Hall)
>>>>    3. crushing case (Caesar Ursic)
>>>>    4. Re: crushing case (Dr and Mrs T Hardcastle)
>>>>    5. Fwd: Free April Webinar: Assessment & Prognosis in Severe TBI
>>>>       (Krin135 at aol.com)
>>>>    6. Fwd: Registration is Now Open for World Trauma Symposium
>>>>       (Gustavo E. Flores)
>>>>    7. RE: ICU to ICU transfers: what is your policy? (Gross, Ronald)
>>>>    8. Emergency Department CT Scanner (Bjorn, Pret)
>>>>    9. Re: Emergency Department CT Scanner (K Mattox)
>>>>   10. Disaster Response (JJ)
>>>>   11. RE: Disaster Response (Dr. Alejandro Cabrera Esquenazi)
>>>>
>>>>
>>>> ----------------------------------------------------------------------
>>>>
>>>> Message: 1
>>>> Date: Mon, 9 Apr 2012 08:47:07 -0500
>>>> From: "McSwain, Norman E" <nmcswai at tulane.edu>
>>>> Subject: RE: Giving packed red blood cells in the prehospital phase
>>>>       ofcare...a      good idea?
>>>> To: "Trauma-List [TRAUMA.ORG]" <trauma-list at trauma.org>
>>>> Message-ID:
>>>>       <2AB2A689A074DB439A79EF89F66CB97DD897A7 at EX05.ad.tulane.edu>
>>>> Content-Type: text/plain;     charset="iso-8859-1"
>>>>
>>>> Karim
>>>>
>>>> I would disagree slightly.
>>>> * a non-trauma hemorrhaging  patient can tolerate HGB to 7 gms. In fact that is the transfusion indication in many patients
>>>> * Plasma has the coagulation factors
>>>> * Several places in Europe have lyophilized plasma available now. It is in the wings for the US in a couple of years
>>>> * Liquid plasma last 30 days and some research that John Holcomb is doing shows maybe it is better than FFP with clotting factors
>>>>
>>>> Perhaps the best approach is to use plasma not PRBCs for field resuscitation. Use only enough to keep the systolic pressure in the range of 90 mmHg  in the prehospital period. This gives volume, coagulation and in a younger person there is enough O2 carrying capacity to profuse the body and perhaps the brain as well.
>>>>
>>>>  The best of both worlds
>>>>
>>>> Norman
>>>> Professor, Tulane  Univ, Surgery
>>>> Trauma Director, Spirit of Charity Trauma Center, ILH
>>>> New Orleans, 504-988-5111
>>>>
>>>>
>>>> -----Original Message-----
>>>> From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] On Behalf Of Karim Brohi
>>>> Sent: Monday, April 09, 2012 6:04 AM
>>>> To: Trauma-List [TRAUMA.ORG]
>>>> Subject: Re: Giving packed red blood cells in the prehospital phase ofcare...a good idea?
>>>>
>>>> E
>>>>
>>>> You're correct - this is for a very small subset of patients.  However clearly if one goal any advance in prehospital care is to reduce mortality, then this is a group of patients to target, as they continue to have a mortality of up to 30%
>>>>
>>>> There are two conflicting goals here - perfusion and coagulation.  At the moment we cannot monitor either and we treat one at the expense of the other.  Permissive hypotension strategies sacrifice perfusion for coagulation.  Prehospital resuscitation strategies in some parts of the world sacrifice coagulation for perfusion.  There is no clear winner.
>>>>
>>>> In London our protocols favour the permissive hypotension strategy (as a part of damage control resuscitation).  However when we say 'in penetrating trauma we would limit fluids' we are usually talking about patients who have SBPs above (say) 70mmHg.  But do you ever let a patient with (say) penetrating chest trauma sit at a blood pressure of 40mmHg till they get into the operating room?  Or if you do, how low would you go before you would give something - anything, to get a bit of perfusion??
>>>>
>>>> Karim
>>>>
>>>>
>>>> On Sat, Apr 7, 2012 at 23:37, Errington Thompson <errington at erringtonthompson.com> wrote:
>>>>> I find this fascinating. Fearing one on the prehospital ambulances...
>>>>> Fascinating. I wonder what percentages of patients who would benefit
>>>>> from prehospital administration of blood? From trauma standpoint, I
>>>>> suspect were only talking about patients were victims of blunt trauma.
>>>>> Of those, probably one or 2%, at most, would require prehospital blood
>>>>> transfusion in order to stabilize their vital signs. Again, I'm just
>>>>> guessing, that we would only be talking about patients who have
>>>>> relatively prolonged prehospital transport times - >30 min.
>>>>>
>>>>> In our trauma center, here in Asheville, North Carolina, we see about
>>>>> 3500 patients a year. About 400 patients with penetrating trauma. For
>>>>> our code traumas, our highest activation, we used to have blood
>>>>> available every time a code traumas activated. We stopped that. We
>>>>> just don't transfuse that many patients. I guess, another way of
>>>>> putting it, is that we just don't transfuse that many patients acutely.
>>>>>
>>>>> For patients with penetrating trauma, it would seem that we would like
>>>>> to limit fluid into it and get the patient to the operating room.
>>>>> Therefore, the vast majority of patients with penetrating trauma would
>>>>> not receive any significant prehospital fluid/blood transfusions.
>>>>>
>>>>> I'm sure there's a way to look into the national trauma databank and
>>>>> figure out which patients would possibly have benefited from
>>>>> prehospital transfusions and what the numbers are. Again, I think this
>>>>> would be fascinating. I look forward to some of the data that comes
>>>>> out of this new protocol.
>>>>>
>>>>> Errington C. Thompson, MD, FACS, FCCM
>>>>> Trauma Surgeon/Surgical Critical Care
>>>>> Radio Talk Show Host - Podcasts
>>>>> Asheville, NC
>>>>>
>>>>>
>>>>> -----Original Message-----
>>>>> From: trauma-list-bounces at trauma.org
>>>>> [mailto:trauma-list-bounces at trauma.org]
>>>>> On Behalf Of Dominik Krzanicki
>>>>> Sent: Saturday, April 07, 2012 4:23 AM
>>>>> To: Trauma-List [TRAUMA.ORG]
>>>>> Subject: Re: Giving packed red blood cells in the prehospital phase of
>>>>> care...a good idea?
>>>>>
>>>>> I can clarify some of the logistics to allow the discussion to become
>>>>> more clinical.
>>>>>
>>>>> London HEMS operate a Doctor-Paramedic model.
>>>>> 4 units of blood are carried on the helicopter and 4 units on the
>>>>> rapid response vehicles.
>>>>>
>>>>> They are stored in 'Golden-Hour' boxes which have a data logger within
>>>>> them to ensure temperature storage compliance. The blood is exchanged
>>>>> every 24 hours when it re-enters hospital circulation (assuming
>>>>> temperature storage conditions are acceptable) and therefore waste is
>>>>> minimal. This also ensures that the HEMS team are equipped with
>>>>> relatively 'fresh' blood. All blood is tracked to ensure 100%
>>>>> traceability regardless of which of the trauma centres in London the patient is admitted to.
>>>>>
>>>>> Administration is governed by SOP and discussed with an on-call
>>>>> consultant prior to administration to ensure robust governance.
>>>>>
>>>>> As Karim said - huge undertaking to get this initiative operational
>>>>> and a testament to those involved - well done.
>>>>>
>>>>>
>>>>> Dom - London HEMS registrar.
>>>>>
>>>>>
>>>>> On 7 Apr 2012, at 09:07, Karim Brohi wrote:
>>>>>
>>>>> Marty
>>>>>
>>>>> My question related to patient care and how we might be able to
>>>>> improve survival. ?If we determine that patients do better with a
>>>>> given intervention, then it is our duty to provide the clinical,
>>>>> logistic and legal frameworks that allow delivery of that care.
>>>>>
>>>>> You are not wrong to bring these issues up - much research is done
>>>>> and never implemented because of blocks at the implementation &
>>>>> policy phase. ?However in this case we don't even know if it's the
>>>>> right thing to do yet - so let's talk about the science before we
>>>>> discuss practicalities.
>>>>>
>>>>> (BTW it took us 2 years to work out the logistics, regulatory issues,
>>>>> training and accountability issues to carry blood on the helicopter.
>>>>> It's not something you'd get foisted with overnight!)
>>>>>
>>>>> Karim
>>>>>
>>>>> On Sat, Apr 7, 2012 at 01:26, Marty Munro <marty_munro at yahoo.ca> wrote:
>>>>>> Mr. McSwain, I apologize for going astray, as it was my post that
>>>>> initiated it. ?It is about the patient. However, EMS is a job for me.
>>>>> I want a paycheque from it. If I only wanted to provide treatment, I
>>>>> would work for free or for room and board. I always provide care to
>>>>> the best of my ability within my scope of practice, but in the end, I
>>>>> want to be paid, with as little risk as possible.
>>>>>>
>>>>>> It would be interesting to read some studies and hear from some
>>>>>> providers
>>>>> that have these directives in place. If anyone wishes to further
>>>>> discuss issues that I have brought up, I welcome you to e-mail me privately.
>>>>>>
>>>>>> Marty
>>>>>>
>>>>>> --- On Fri, 4/6/12, McSwain, Norman E <nmcswai at tulane.edu> wrote:
>>>>>>
>>>>>>
>>>>>> From: McSwain, Norman E <nmcswai at tulane.edu>
>>>>>> Subject: RE: Giving packed red blood cells in the prehospital phase
>>>>>> of
>>>>> care...a good idea?
>>>>>> To: "Trauma-List [TRAUMA.ORG]" <trauma-list at trauma.org>
>>>>>> Received: Friday, April 6, 2012, 7:50 PM
>>>>>>
>>>>>>
>>>>>> I think that we have gone astray
>>>>>> It is not about the providers, the EMS systems or the hospitals It
>>>>>> IS about the patient
>>>>>>
>>>>>> Let's address the science and then we can work out the process
>>>>>> problems
>>>>>>
>>>>>> The question Kiram asked is: "Will RBC given in the field be
>>>>>> beneficial to the patient?"
>>>>>>
>>>>>> Norman
>>>>>>
>>>>>> Professor, Tulane University, Surgery Trauma Director, Spirit of
>>>>>> Charity Trauma Center, ILH/MCLNO New Orleans, Louisiana
>>>>>> 504 988 5111
>>>>>>
>>>>>>
>>>>>> -----Original Message-----
>>>>>> From: trauma-list-bounces at trauma.org
>>>>>> [mailto:trauma-list-bounces at trauma.org] On Behalf Of johnleslie48
>>>>>> Sent: Friday, April 06, 2012 6:36 PM
>>>>>> To: Trauma-List [TRAUMA.ORG]
>>>>>> Subject: Re: Giving packed red blood cells in the prehospital phase
>>>>>> of care...a good idea?
>>>>>>
>>>>>> Well said!
>>>>>>
>>>>>> John Leslie
>>>>>>
>>>>>> 0412 528851
>>>>>>
>>>>>> Sent from my iPhone
>>>>>>
>>>>>> On Apr 7, 2012, at 6:45, Marty Munro <marty_munro at yahoo.ca> wrote:
>>>>>>
>>>>>> Speaking as a paramedic, I would not want this responsibility. It's
>>>>>> just one more thing to go wrong in an often unstable environment,
>>>>>> and
>>>>>> one more reason for me to lose my certification, job, or be sued. We
>>>>>> are always taught to limit our scene times in traumas and provide
>>>>>> required care en route, for obvious reasons. This means that often,
>>>>>> we are unable to establish an I.V. due extreme movement of the
>>>>>> vehicle, accessibility of available veins and the requirement to
>>>>>> maintain a patent airway as a priority. Therefore, arriving at the
>>>>>> emergency department/trauma room in a timely manner is a medic's
>>>>>> priority. There is conflicting evidence as to whether or not a fluid
>>>>>> bolus is even beneficial, and evidence that suggests it is harmful
>>>>>> to the trauma patient. So now, if medics start carrying blood, will
>>>>>> they be expected to always have blood running en route to the hospital?
>>>>>> And when they are unable to, suddenly the topic becomes "the patient
>>>>>> could have survived had the paramedics started an I.V. and given
>>>>>> blood en route". ?The law suit begins, the medics lose their
>>>>>> certifications and become the subject of an investigation and
>>>>>> inquest. ?And if they do start an I.V. and give blood and the
>>>>>> patient dies, the topic becomes "paramedics wasted time by starting
>>>>>> blood en route to the hospital". I am all for progressive medicine
>>>>>> in the pre-hospital care, but I think that those who choose to
>>>>>> implement certain things should try this first. Next time a trauma
>>>>>> comes in to the hospital, instead of going to the nice bright trauam
>>>>>> room, the patient should be taken into a utility closet, with only
>>>>>> one physician and one extra person and all the care should be
>>>>>> provided in a cramped closet by the single person while the extra
>>>>>> person continuously shakes the mattress of the bed. Then think about
>>>>>> how realistic/beneficial adding in extra skills/procedures is to
>>>>>> pre-hospital
>>>>> staff. That's just my opinion.
>>>>>>
>>>>>> Marty Munro
>>>>>> Advanced Care Paramedic
>>>>>> Ontario, Canada
>>>>>>
>>>>>>
>>>>>>
>>>>>> --- On Fri, 4/6/12, Stephen Richey <stephen.richey at gmail.com> wrote:
>>>>>>
>>>>>>
>>>>>> From: Stephen Richey <stephen.richey at gmail.com>
>>>>>> Subject: Re: Giving packed red blood cells in the prehospital phase
>>>>>> of
>>>>>> care... a good idea?
>>>>>> To: "Trauma-List [TRAUMA.ORG]" <trauma-list at trauma.org>
>>>>>> Received: Friday, April 6, 2012, 3:25 PM
>>>>>>
>>>>>>
>>>>>> For the most part, I would say no at least here in the US since the
>>>>>> average level of education for a paramedic leaves much to be
>>>>>> desired (speaking as a former EMS educator myself). ?The issues
>>>>>> with quality control, supply maintenance, the need to determine
>>>>>> clinical need (EMS providers tend to massive over-estimate the severity of patients'
>>>>>> conditions because most of them are taught "cookbook" defensive
>>>>>> medicine) and cost. ?I am not sure how the blood banking situation
>>>>>> is in other countries but here there are often region-wide
>>>>>> shortages of blood products so the sequestration of a significant
>>>>>> amount in the hands of EMS providers would probably only exacerbate the situation.
>>>>>>
>>>>>> Also, the problem is worsened by the fact that the patients who
>>>>>> would probably benefit most from field transfusions are the ones in
>>>>>> the areas least suited to its use because of administration,
>>>>>> training and supply issues. ?Rural EMS tends to be almost all
>>>>>> volunteer and many of
>>>>>>
>>>>>> these folks never even meet their medical director let along
>>>>>> receive any meaningful QA/QI feedback. ?The idea of giving the
>>>>>> blood to the local HEMS operators and using them to deliver a
>>>>>> higher level of care isn't going to work because you're going to
>>>>>> delay the arrival of the patient in the OR in all but the most remote of areas.
>>>>>>
>>>>>> In urban settings, you're not going to have that much need for
>>>>>> transfusion because of the proximity to trauma centers. ?Here for
>>>>>> example, it's abnormal for EMS providers (such as my fiancee) to
>>>>>> take longer than 20 minutes from call to arrival at the hospital.
>>>>>>
>>>>>> On Fri, Apr 6, 2012 at 3:12 PM, Karim Brohi <karim at trauma.org> wrote:
>>>>>>
>>>>>>> So our trauma helicopter emergency medical service recently
>>>>>>> started carrying packed cells:
>>>>>>> http://www.bbc.co.uk/news/health-17232529
>>>>>>>
>>>>>>> We'll obviously be auditing its use closely, but I'm interested in
>>>>>>> garnering the lists opinions on this:
>>>>>>> Who should get PRBCs?
>>>>>>> Should anyone get PRBCs?
>>>>>>> Why aren't we carrying plasma as well?
>>>>>>>
>>>>>>> There are a couple of prehospital services in the US carrying
>>>>>>> blood and plasma to my knowledge, and it is used by MERT teams in
>>>>>>> combat zones.
>>>>>>>
>>>>>>> So??
>>>>>>>
>>>>>>> Karim
>>>>>>> --
>>>>>>> trauma-list : TRAUMA.ORG
>>>>>>> To change your settings or unsubscribe visit:
>>>>>>> hhttp://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2012-April/ttp://www.trauma.org/index.php?/community/
>>>>>>>
>>>>>>
>>>>>>
>>>>>>
>>>>>> --
>>>>>> Stephen Richey
>>>>>> Founder and Chief Researcher/Designer Kolibri Aviation Safety
>>>>>> Research 5174-B Winterberry Circle Indianapolis, IN 46254
>>>>>> 317-985-4740
>>>>>>
>>>>>> "I think the best thing, and the only thing in our infinite
>>>>>> inadequacy
>>>>>>
>>>>>> in making up for the loss of life, is to say something we have been
>>>>>> able to say in a lot of other accidents to grieving families. ?That
>>>>>> is
>>>>>>
>>>>>> 'Those deaths will not be in vain. We will not let them be in vain.
>>>>>> Every one of those lives will be made to count in terms of making
>>>>>> sure
>>>>>>
>>>>>> that three, four, five or ten other people do not die."- John J.
>>>>>> Nance
>>>>>> --
>>>>>> trauma-list : TRAUMA.ORG
>>>>>> To change your settings or unsubscribe visit:
>>>>>> hhttp://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2012-April/ttp://www.trauma.org/index.php?/community/
>>>>>> --
>>>>>> trauma-list : TRAUMA.ORG
>>>>>> To change your settings or unsubscribe visit:
>>>>>> hhttp://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2012-April/ttp://www.trauma.org/index.php?/community/
>>>>>> --
>>>>>> trauma-list : TRAUMA.ORG
>>>>>> To change your settings or unsubscribe visit:
>>>>>> hhttp://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2012-April/ttp://www.trauma.org/index.php?/community/
>>>>>> --
>>>>>> trauma-list : TRAUMA.ORG
>>>>>> To change your settings or unsubscribe visit:
>>>>>> hhttp://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2012-April/ttp://www.trauma.org/index.php?/community/
>>>>>> --
>>>>>> trauma-list : TRAUMA.ORG
>>>>>> To change your settings or unsubscribe visit:
>>>>>> hhttp://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2012-April/ttp://www.trauma.org/index.php?/community/
>>>>> --
>>>>> trauma-list : TRAUMA.ORG
>>>>> To change your settings or unsubscribe visit:
>>>>> hhttp://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2012-April/ttp://www.trauma.org/index.php?/community/
>>>>>
>>>>>
>>>>> --
>>>>> trauma-list : TRAUMA.ORG
>>>>> To change your settings or unsubscribe visit:
>>>>> hhttp://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2012-April/ttp://www.trauma.org/index.php?/community/
>>>>>
>>>>>
>>>>> --
>>>>> trauma-list : TRAUMA.ORG
>>>>> To change your settings or unsubscribe visit:
>>>>> hhttp://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2012-April/ttp://www.trauma.org/index.php?/community/
>>>> --
>>>> trauma-list : TRAUMA.ORG
>>>> To change your settings or unsubscribe visit:
>>>> hhttp://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2012-April/ttp://www.trauma.org/index.php?/community/
>>>>
>>>>
>>>> ------------------------------
>>>>
>>>> Message: 2
>>>> Date: Mon, 9 Apr 2012 10:22:48 -0400
>>>> From: John Hall <jrhmdtraum at aol.com>
>>>> Subject: Re: trauma-list Digest, Vol 106, Issue 5
>>>> To: "trauma-list at trauma.org" <trauma-list at trauma.org>
>>>> Message-ID: <7C6BE5A1-0547-401D-9281-33648EA393C7 at aol.com>
>>>> Content-Type: text/plain;     charset=us-ascii
>>>>
>>>>>
>>>>> Re blood in the field
>>>>
>>>> It is interesting to note that in the Northfield trial of "hemoglobin" in the field, in the data of the paramedics who followed the protocol, there was a significant survival advantage.   Unfortunately, the data was muddled by several groups who broke the protocol (these patients are going to die if we don't use the wonder drug).
>>>>
>>>> John Hall
>>>>
>>>> ------------------------------
>>>>
>>>> Message: 3
>>>> Date: Tue, 10 Apr 2012 09:49:30 -1000
>>>> From: Caesar Ursic <cmursic at gmail.com>
>>>> Subject: crushing case
>>>> To: "Trauma-List [TRAUMA.ORG]" <trauma-list at trauma.org>
>>>> Message-ID:
>>>>       <CAG1MY2DgPq4+svN3MmWVdUeiw39BBXMyurU-vWUSwvB_TFgE7Q at mail.gmail.com>
>>>> Content-Type: text/plain; charset=ISO-8859-1
>>>>
>>>> A case submitted for your consideration:
>>>>
>>>> 43 yo male construction worker suddenly had large amount of gravel, rocks
>>>> and dirt fall on him, burying him up to his neck.  Co-workers dug him out
>>>> with shovels (took them ten minutes) and he remained awake and alert during
>>>> this time.  Finally freed of the rubble he collapsed and lost
>>>> consciousness.
>>>>
>>>> Paramedics arrive  two minutes after his collapse.  No bystander CPR is
>>>> being performed.  He has no palpable pulses or spontaneous respiratory
>>>> efforts.  Pupils reported as 5 mm bilaterally and unresponsive. The medics
>>>> begin closed chest compressions, place him on a spine board and load him
>>>> into the ambulance.  They perform rapid sequence intubation (successful on
>>>> first try) and start two IVs en route to the hospital.  They give two doses
>>>> (1 mg) of IV epinephrine en route to the hospital.  They do not feel return
>>>> of palpable pulses.  Transport time is 16 minutes.
>>>>
>>>> On arrival to ER he is undergoing closed chest compressions.  He still has
>>>> no palpable pulses at the carotid or the femoral arteries bilaterally but
>>>> on ECG monitor his *heart rate is 140/min*.  The endotracheal tube seems to
>>>> be in the correct position on visual inspection with the laryngoscope (i.e.
>>>> it is going through the vocal cords). He has bruising and abrasions of the
>>>> chest wall but no lacerations or external bleeding.  Rib fractures are
>>>> palpable bilaterally. Breath sounds are equal bilaterally and he is easy to
>>>> ventilate using the bag-valve.  There are two 16 gauge antecubital IV
>>>> catheters already in place and one of the medics is squeezing in a bag of
>>>> 0.9 NS (they have given 300 ml so far).  Total pre-hospital CPR is
>>>> estimated at 20 minutes (includes time at scene and transport time to ER).
>>>>
>>>> What would you do at this point?
>>>>
>>>> Would you:
>>>>
>>>> A. pronounce him dead on arrival?
>>>> B. continue closed chest compressions, give more fluid (crystalloid?  blood
>>>> products?) and intravenous epineprhine or other vasopressor?
>>>> C. insert bilateral chest tubes?
>>>> D. perform ER thoracotomy?
>>>> E. a combination of one or more of the above?
>>>> F. something else entirely?
>>>>
>>>> Thank you.
>>>>
>>>> C. Ursic, MD
>>>> Honolulu
>>>>
>>>>
>>>> ------------------------------
>>>>
>>>> Message: 4
>>>> Date: Wed, 11 Apr 2012 13:35:46 +0200 (SAST)
>>>> From: "Dr and Mrs T Hardcastle" <dr.tchardcastle at absamail.co.za>
>>>> Subject: Re: crushing case
>>>> To: "Trauma-List \[TRAUMA.ORG\]" <trauma-list at trauma.org>
>>>> Message-ID:
>>>>       <14337.196.35.102.165.1334144146.squirrel at aiamail.lantic.net>
>>>> Content-Type: text/plain;charset=iso-8859-1
>>>>
>>>> Caesar - my comments between your questions:
>>>> Tim Hardcastle
>>>>> A case submitted for your consideration:
>>>>>
>>>>> 43 yo male construction worker suddenly had large amount of gravel, rocks
>>>>> and dirt fall on him, burying him up to his neck.  Co-workers dug him out
>>>>> with shovels (took them ten minutes) and he remained awake and alert
>>>>> during
>>>>> this time.  Finally freed of the rubble he collapsed and lost
>>>>> consciousness.
>>>>>
>>>>> Paramedics arrive  two minutes after his collapse.  No bystander CPR is
>>>>> being performed.  He has no palpable pulses or spontaneous respiratory
>>>>> efforts.  Pupils reported as 5 mm bilaterally and unresponsive. The medics
>>>>> begin closed chest compressions, place him on a spine board and load him
>>>>> into the ambulance.  They perform rapid sequence intubation (successful on
>>>>> first try) and start two IVs en route to the hospital.  They give two
>>>>> doses
>>>>> (1 mg) of IV epinephrine en route to the hospital.  They do not feel
>>>>> return
>>>>> of palpable pulses.  Transport time is 16 minutes.
>>>>>
>>>>> On arrival to ER he is undergoing closed chest compressions.  He still has
>>>>> no palpable pulses at the carotid or the femoral arteries bilaterally but
>>>>> on ECG monitor his *heart rate is 140/min*.  The endotracheal tube seems
>>>>> to
>>>>> be in the correct position on visual inspection with the laryngoscope
>>>>> (i.e.
>>>>> it is going through the vocal cords). He has bruising and abrasions of the
>>>>> chest wall but no lacerations or external bleeding.  Rib fractures are
>>>>> palpable bilaterally. Breath sounds are equal bilaterally and he is easy
>>>>> to
>>>>> ventilate using the bag-valve.  There are two 16 gauge antecubital IV
>>>>> catheters already in place and one of the medics is squeezing in a bag of
>>>>> 0.9 NS (they have given 300 ml so far).  Total pre-hospital CPR is
>>>>> estimated at 20 minutes (includes time at scene and transport time to ER).
>>>>>
>>>>> What would you do at this point?
>>>>>
>>>>> Would you:
>>>>>
>>>>> A. pronounce him dead on arrival?
>>>> No
>>>>> B. continue closed chest compressions, give more fluid (crystalloid?
>>>>> blood
>>>>> products?) and intravenous epineprhine or other vasopressor?
>>>> Yes and check blood gas POTASSIUM and IONISED CALCIUM: this is an acute
>>>> reperfusion - typically occurs about 10 minutes to one our after release.
>>>> The underlying "tachy" PEA fits with hyperkalemia
>>>>> C. insert bilateral chest tubes?
>>>> Not empirically
>>>>> D. perform ER thoracotomy?
>>>> NO
>>>>> E. a combination of one or more of the above?
>>>>> F. something else entirely?
>>>>>
>>>>> Thank you.
>>>>>
>>>>> C. Ursic, MD
>>>>> Honolulu
>>>>> --
>>>>> trauma-list : TRAUMA.ORG
>>>>> To change your settings or unsubscribe visit:
>>>>> hhttp://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2012-April/ttp://www.trauma.org/index.php?/community/
>>>>>
>>>>
>>>>
>>>>
>>>>
>>>> ------------------------------
>>>>
>>>> Message: 5
>>>> Date: Wed, 11 Apr 2012 08:54:26 -0400 (EDT)
>>>> From: Krin135 at aol.com
>>>> Subject: Fwd: Free April Webinar: Assessment & Prognosis in Severe TBI
>>>> To: trauma-list at trauma.org
>>>> Cc: ccm-l at list.pitt.edu
>>>> Message-ID: <11b78.6faf6ed0.3cb6d902 at aol.com>
>>>> Content-Type: text/plain; charset="ISO-8859-1"
>>>>
>>>>
>>>> for those interested- note that I am saddened to see that the BTF is no
>>>> longer certified for CME- they used to have some very engaging courses which
>>>> provided useful information for folks on the front lines of trauma care.
>>>>
>>>> ck
>>>>
>>>>
>>>> ____________________________________
>>>>  From: education at braintrauma.org
>>>> To: Krin135 at aol.com
>>>> Sent: 04/10/12  18:35:26 Central Daylight Time
>>>> Subj: Free April Webinar: Assessment &  Prognosis in Severe TBI
>>>>
>>>>
>>>> FREE  BTF webinar on Assessment & Prognosis in Severe  TBI
>>>> Is  this email not displaying correctly?
>>>> _View it in your browser_
>>>> (http://us1.campaign-archive2.com/?u=dfb11326be59bc7f155536629&id=2b7d8ba540&e=6a2a1ea4b3) .
>>>>
>>>>
>>>> (http://braintrauma.us1.list-manage2.com/track/click?u=dfb11326be59bc7f155536629&id=6f964d4033&e=6a2a1ea4b3)
>>>> Brain Trauma  Foundation
>>>> Traumatic Brain Injury Webinar  Series
>>>>
>>>>
>>>> _Click here to  Register for the FREE  webinar: Assessment &  Prognosis in
>>>> Severe  TBI_
>>>> (http://braintrauma.us1.list-manage.com/track/click?u=dfb11326be59bc7f155536629&id=593f114c37&e=6a2a1ea4b3)
>>>> Wednesday, April 25,  2012, 12-1 ET (please note that this webinar is
>>>> Eastern Time)
>>>> Presenter for  this webinar is Dr. John Whyte
>>>>
>>>> John  Whyte, MD, PhD Bio
>>>> Dr. John  Whyte is Director of the Moss Rehabilitation  Research Institute
>>>> (MRRI), Director of the  Attention Research Center, and Director of Brain
>>>> Injury Research at Drucker Brain Injury Center,  Moss Rehab. Dr. Whyte is
>>>> board certified in  Physical Medicine and Rehabilitation. In  addition to his
>>>> work in MRRI, Dr. Whyte is a  Staff Physiatrist for Einstein Practice Plan,
>>>> Inc. He has teaching appointments at Jefferson  Medical College and Temple
>>>> University School of  Medicine. Dr. Whyte received his medical degree  and a
>>>> PhD in Psychology from the Unversity of  Pennsylvania. He completed a
>>>> residency in  Physical Medicine and Rehabilitation at  University of Minnesota
>>>> Hospital, and a  fellowship in Neurotrauma at New England Medical  Center
>>>> Hospitals and Greenery Rehabilitation and  Skilled Nursing  Center.
>>>>
>>>> Webinar  Description
>>>> Survivors of severe  traumatic brain injury face a wide range of  possible
>>>> prognoses, from nearly complete  recovery to permanent unconsciousness. The
>>>> ability to predict prognosis at an early point  is limited, but the time
>>>> until return of  consciousness (e.g., command following) and  orientation
>>>> (e.g., duration of post-traumatic  amnesia) are useful predictors in the early
>>>> days  and weeks. More specialized assessment  techniques exist of those with
>>>> persistent  disorders of consciousness, and new assessment  tools and
>>>> promising treatment options are under  development. This presentation will review
>>>> the  range of outcomes that are possible after severe  TBI, suggest ways to
>>>> improve prognostic  prediction and treatment planning, and offer  insight
>>>> into emerging  treatments.
>>>>
>>>> Webinar  Objectives
>>>> By the end of this  webinar the participant will be able to:
>>>> 1.  Describe the range of outcomes and prognosis  that are possible
>>>> following severe TBI.
>>>> 2.  Identify 2 approaches to the assessment of  patients whose level of
>>>> consciousness remains  impaired.
>>>> 3. Use time frame and prognostic  information to guide treatment  planning.
>>>>
>>>> Please note that there is  NO charge for this webinar and  CME credit will
>>>> not be offered. All are welcome  to attend.
>>>>
>>>> To register  for additional upcoming  webinars:
>>>>
>>>> Wednesday,  June 6, 2012, 12-1 p.m. ET-"_Blast  Induced Neurotrauma_
>>>> (http://braintrauma.us1.list-manage1.com/track/click?u=dfb11326be59bc7f155536629&id
>>>> =c927ac20a1&e=6a2a1ea4b3) ", presented by James  Ecklund, MD.
>>>>
>>>> Additional summer  webinars coming  soon!
>>>>
>>>>
>>>>
>>>>
>>>>
>>>> CONNECT  WITH US
>>>>
>>>> ____________________________________
>>>>
>>>>
>>>> _Become  a fan on facebook._
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>>>>
>>>> CME INFORMATION
>>>>
>>>> ____________________________________
>>>> Please note that as of January 1st, 2012 Brain  Trauma Foundation is no
>>>> longer accredited by  ACCME and cannot give out CME or CEU  credit.
>>>>  _follow  on Twitter_
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>>>>
>>>>
>>>> ------------------------------
>>>>
>>>> Message: 6
>>>> Date: Thu, 12 Apr 2012 11:49:12 -0400
>>>> From: "Gustavo E. Flores" <gflores911 at gmail.com>
>>>> Subject: Fwd: Registration is Now Open for World Trauma Symposium
>>>> To: "trauma-list at trauma.org" <trauma-list at trauma.org>
>>>> Message-ID: <810E027E-7F8D-48F8-B6A1-4B1A5DA7CBE8 at gmail.com>
>>>> Content-Type: text/plain;     charset=utf-8
>>>>
>>>>
>>>>
>>>>
>>>>
>>>> Begin forwarded message:
>>>>
>>>>> From: World Trauma Symposium <WTS at events.cygnusb2bmail.com>
>>>>> Date: April 12, 2012 11:03:30 AM GMT-04:00
>>>>> To: <gustavo.flores at uccaribe.edu>
>>>>> Subject: Registration is Now Open for World Trauma Symposium
>>>>> Reply-To: World Trauma Symposium <emsexpo at cygnus.com>
>>>>>
>>>>>
>>>>>
>>>>> A new event from the creators of the world-renowned Prehospital Trauma Life Support Program (PHTLS), presenting the latest information on the care of prehospital trauma patients and global trends in trauma care from internationally recognized experts.
>>>>>
>>>>>
>>>>> The Symposium will bring together internationally recognized experts in prehospital trauma care. Norman McSwain, Jr., MD, FACS, will moderate the morning session, featuring:
>>>>> Ken Mattox, MD, FACS, discussing controversies in EMS
>>>>> Karim Brohi, MBBS, MD, FRCS (Eng), FRCA, discussing prehospital trauma care in the United Kingdom
>>>>> Michael Rotondo, MD, FACS, presenting Advanced Trauma Life Support and the work of the Committee on Trauma
>>>>> Frank Butler, Jr., MD, on Tactical Combat Casualty Care
>>>>> Lt. Col. Robert Mabry, MD, will provide the luncheon address: Military EMS and Disaster Medicine
>>>>>
>>>>> Jeff Guy, MD, MSc, MMHC, will moderate the afternoon session featuring:
>>>>> Steve Greisch, RN, presenting on EMS trauma care in the European Union
>>>>> Osvaldo Rois, MD, discussing EMS trauma care in Latin America
>>>>> Jeffrey Salomone, MD, FACS, NREMT-P, discussing current challenges in prehospital trauma care
>>>>> A panel debate on the hottest issues in prehospital trauma today
>>>>>
>>>>>
>>>>>
>>>>> Special discounts are available for those who register for the World Trauma Symposium and the three-day EMS World Expo core program.
>>>>>
>>>>> For complete details
>>>>> and to register,
>>>>> click here.
>>>>>
>>>>> ?2012 Cygnus Business Media - 801 Cliff Road East, Suite201, Burnsville, MN 55337 - 800.827.8009
>>>>>
>>>>
>>>>
>>>> ------------------------------
>>>>
>>>> Message: 7
>>>> Date: Thu, 12 Apr 2012 14:18:36 -0400
>>>> From: "Gross, Ronald" <Ronald.Gross at baystatehealth.org>
>>>> Subject: RE: ICU to ICU transfers: what is your policy?
>>>> To: "'Trauma-List [TRAUMA.ORG]'" <trauma-list at trauma.org>
>>>> Message-ID:
>>>>       <D3B8664B81FCEF41B9679BF4FE9C723B06776B01F7 at bhsexc11.bhs.org>
>>>> Content-Type: text/plain; charset="us-ascii"
>>>>
>>>> " I've heard trauma is a young man's game. Is there any truth to that?"
>>>> Sadly, I am beginning to believe so!!
>>>> Just back from teaching the TOPIC course in Savannah, and catching up on 2 weeks of service-related unread e-mails.
>>>> I need a vacation BAD!
>>>> R
>>>>
>>>> Ronald I. Gross, MD, FACS
>>>> Associate Professor of Surgery, Tufts University School of Medicine
>>>> Chief, Division of Trauma & Emergency Surgery Services
>>>> Baystate Medical Center
>>>> 759 Chestnut Street, Springfield, MA 01199
>>>> Telephone: 413-794-4022  Fax: 413-794-0142
>>>> ronald.gross at baystatehealth.org
>>>>
>>>>
>>>> -----Original Message-----
>>>> From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] On Behalf Of Robert Smith
>>>> Sent: Saturday, March 31, 2012 3:05 PM
>>>> To: Trauma-List [TRAUMA.ORG]
>>>> Subject: Re: ICU to ICU transfers: what is your policy?
>>>>
>>>> Ron,
>>>>
>>>> The bottom line is the podcast.
>>>>
>>>> You sound totally exhausted. I've heard trauma is a young man's game. Is there any truth to that?
>>>>
>>>>
>>>>
>>>> Thanks for thinking of us,
>>>>
>>>> Rob
>>>>
>>>>
>>>>
>>>> Robert Smith, MD, MPH
>>>> Secretary War Dogs Making It HomeChair, Div Pre-hospital Care and Prevention (ret)
>>>> Department of Trauma John H.Stroger Jr. Hospital of Cook County
>>>> War Dogs - Making it home
>>>> Tiny service dog heals Hampshire Marine - DailyHerald.com
>>>> http://www.whereistheoutrage.net/wordpress/2012/03/20/interview-war-dogs-making-it-home
>>>>
>>>>
>>>>
>>>>
>>>>
>>>>
>>>> On Mar 31, 2012, at 11:44 AM, Gross, Ronald wrote:
>>>>
>>>>> You cannot justify transferring a patient from a higher level of care to a lesser level of care. You just can't.  On the other hand if the patient is on the floor and the level of care is basic then I could see the convenience transfer.....sometimes.
>>>>> Ron
>>>>>
>>>>> Sent from my iPhone
>>>>>
>>>>> On Mar 31, 2012, at 11:12 AM, "Caesar Ursic" <cmursic at gmail.com> wrote:
>>>>>
>>>>> For those of you who work in designated/verified trauma centers:
>>>>>
>>>>> What is your official policy (or your opinion if there is no actual policy
>>>>> where you are) on the transfer of trauma patients from *your* ICU (at a
>>>>> trauma center) to another ICU at an outside hospital that is *not* a trauma
>>>>> center?  Obviously I am speaking of transfers for reasons *other* than
>>>>> provision of higher level of care, i.e. you are transferring for
>>>>> non-medical reasons.  Perhaps the reason is that the family wants the
>>>>> patient to be closer to home, or perhaps the patient belongs to a hospital
>>>>> plan that, for financial reasons, prefers its patients to be treated at
>>>>> specific participating institutions which are NOT designated trauma centers.
>>>>>
>>>>> Is it an acceptable risk to the patient to transfer him/her ICU to ICU when
>>>>> there is no *medical* need to do so? Or should the transfer wait until the
>>>>> patient is downgraded to "floor status," based on improvement of medical
>>>>> condition and acuity?
>>>>>
>>>>> Many thanks,
>>>>>
>>>>> C. Ursic, MD
>>>>> --
>>>>> trauma-list : TRAUMA.ORG
>>>>> To change your settings or unsubscribe visit:
>>>>> hhttp://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2012-April/ttp://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 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 site at http://baystatehealth.org.
>>>>> --
>>>>> trauma-list : TRAUMA.ORG
>>>>> To change your settings or unsubscribe visit:
>>>>> hhttp://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2012-April/ttp://www.trauma.org/index.php?/community/
>>>>
>>>> --
>>>> trauma-list : TRAUMA.ORG
>>>> To change your settings or unsubscribe visit:
>>>> hhttp://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2012-April/ttp://www.trauma.org/index.php?/community/
>>>>
>>>> ----------------------------------------------------------------------
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>>>>
>>>>
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>>>>
>>>>
>>>> ------------------------------
>>>>
>>>> Message: 8
>>>> Date: Fri, 13 Apr 2012 11:56:41 +0000
>>>> From: "Bjorn, Pret" <pbjorn at emh.org>
>>>> Subject: Emergency Department CT Scanner
>>>> To: "'Trauma-List [TRAUMA.ORG]'" <trauma-list at trauma.org>
>>>> Message-ID:
>>>>       <C2A56A3BCB08F9449038815A21E9612E0A91CDCB at MARINA.me.emh.org>
>>>> Content-Type: text/plain; charset="us-ascii"
>>>>
>>>> I think this may have been discussed recently, but I've been on & off the list for a few months, so sorry for any redundancy:
>>>>
>>>> Our ED is looking at some renovations, the most conspicuous of which is the acquisition of its own CT scanner adjacent to the trauma room.  Of course, trauma applications are getting all the attention; but such a machine would get plenty of use for strokes and acute abdomens and so forth.  It's a busy ED.
>>>>
>>>> The List has always been good about finding pros and cons for everything, and I'd appreciate all comments.  Who has brought scanners into their ED's, and what has been the practical upshot -- besides quicker (and perhaps more) scans?
>>>>
>>>> Pret Bjorn, RN
>>>> EMMC Trauma Program
>>>> Bangor, Maine USA
>>>> -----------------------------------------------------------------------------------------------------------
>>>> This email message, including any associated files, is for the sole use of the intended recipient(s)
>>>> and may contain information that is confidential, privileged, or subject to copyright, trade secret
>>>> or other protection. This message also may contain information protected by state and federal privacy
>>>> laws that are enforced through serious civil and criminal sanctions. Any unauthorized review, use,
>>>> disclosure, or distribution is prohibited. If you are not an intended recipient of this message,
>>>> please notify the sender immediately by replying to this e-mail, and delete the original and all
>>>> copies of this message from your computer or other device.
>>>>
>>>>
>>>>
>>>> ------------------------------
>>>>
>>>> Message: 9
>>>> Date: Fri, 13 Apr 2012 07:56:42 -0500
>>>> From: K Mattox <kmattox at aol.com>
>>>> Subject: Re: Emergency Department CT Scanner
>>>> To: "Trauma-List [TRAUMA.ORG]" <trauma-list at trauma.org>
>>>> Cc: "Trauma-List [TRAUMA.ORG]" <trauma-list at trauma.org>
>>>> Message-ID: <BBE75741-1B79-4E9B-9CCD-A969AD5FBA2E at aol.com>
>>>> Content-Type: text/plain;     charset=us-ascii
>>>>
>>>> We actually have 3 ct scanners in the middle of and adjacent to Ed and shock rooms.   We love this arrangement but beware that it will be overly used because of its convenience
>>>>
>>>> k.
>>>>
>>>> Sent from my iPhone
>>>>
>>>> On Apr 13, 2012, at 6:56 AM, "Bjorn, Pret" <pbjorn at emh.org> wrote:
>>>>
>>>>> I think this may have been discussed recently, but I've been on & off the list for a few months, so sorry for any redundancy:
>>>>>
>>>>> Our ED is looking at some renovations, the most conspicuous of which is the acquisition of its own CT scanner adjacent to the trauma room.  Of course, trauma applications are getting all the attention; but such a machine would get plenty of use for strokes and acute abdomens and so forth.  It's a busy ED.
>>>>>
>>>>> The List has always been good about finding pros and cons for everything, and I'd appreciate all comments.  Who has brought scanners into their ED's, and what has been the practical upshot -- besides quicker (and perhaps more) scans?
>>>>>
>>>>> Pret Bjorn, RN
>>>>> EMMC Trauma Program
>>>>> Bangor, Maine USA
>>>>> -----------------------------------------------------------------------------------------------------------
>>>>> This email message, including any associated files, is for the sole use of the intended recipient(s)
>>>>> and may contain information that is confidential, privileged, or subject to copyright, trade secret
>>>>> or other protection. This message also may contain information protected by state and federal privacy
>>>>> laws that are enforced through serious civil and criminal sanctions. Any unauthorized review, use,
>>>>> disclosure, or distribution is prohibited. If you are not an intended recipient of this message,
>>>>> please notify the sender immediately by replying to this e-mail, and delete the original and all
>>>>> copies of this message from your computer or other device.
>>>>>
>>>>> --
>>>>> trauma-list : TRAUMA.ORG
>>>>> To change your settings or unsubscribe visit:
>>>>> hhttp://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2012-April/ttp://www.trauma.org/index.php?/community/
>>>>
>>>>
>>>> ------------------------------
>>>>
>>>> Message: 10
>>>> Date: Fri, 13 Apr 2012 18:02:15 -0400 (EDT)
>>>> From: JJ <jjsurgmd at aol.com>
>>>> Subject: Disaster Response
>>>> To: trauma-list at trauma.org
>>>> Message-ID: <8CEE7D83896038C-1260-15FAC at webmail-d058.sysops.aol.com>
>>>> Content-Type: text/plain; charset="us-ascii"
>>>>
>>>>
>>>> Colleagues,
>>>>  I have been asked to review the clinical aspects of our level II trauma center here in Florida.  I would like to review what others have planned at their facilities if you would be so kind to share so that I can compare and contrast to what our current plans are.
>>>>  thanks ,
>>>>
>>>> Jeffery L. Johnson, MD, FACS
>>>> Bayfront Medical Center
>>>> St Petersburg, Florida
>>>>
>>>>
>>>>
>>>>
>>>>
>>>>
>>>>
>>>>
>>>> -----Original Message-----
>>>> From: Richard Wigle MD FACS <rlwigle at yahoo.com>
>>>> To: Trauma-List [TRAUMA.ORG] <trauma-list at trauma.org>
>>>> Sent: Fri, Mar 16, 2012 10:23 am
>>>> Subject: Re: TXA
>>>>
>>>>
>>>> A US military review has recently shown results consistent with the CRASH2
>>>> rial. I don't know anything about the meathodology
>>>>
>>>>  Wigle MD FACS FCCM
>>>> sst Prof Surgery
>>>> SUS
>>>>
>>>> ________________________________
>>>> From: Ian Seppelt <seppelt at med.usyd.edu.au>
>>>> o: trauma-list at trauma.org
>>>> ent: Friday, March 16, 2012 12:38 AM
>>>> ubject: Re: TXA
>>>>
>>>> lease elaborate, Ken! Are you saying that because a trial does not
>>>> ncludes patients from the USA it is not valid? <grin>
>>>> Need to be careful distinguishing methodological flaws (it was very
>>>> ound methodologically) from questions about generalisability (most
>>>> atients were in low and middle income countries, higher than expected
>>>> verall mortality, many patients were not transfused, etc etc as
>>>> iscussed previously on this list)/
>>>> [Disclosure - I was a site investigator in CRASH2]
>>>> Cheers, Ian
>>>> On 16/03/12 1:52 PM, KMATTOX at aol.com wrote:
>>>>  Be careful.        Many glitches in the  methodology of that trial.   NO
>>>>  ONE from the USA in the  trial.     The drug family has been around for a long
>>>>  long  while in search of an indication.     If this drug should  work, it
>>>>  should work as an antifibrinolytic..
>>>>
>>>>  k
>>>>
>>>>
>>>>  In a message dated 3/15/2012 9:32:13 P.M. Central Daylight Time,
>>>>  bryanboling at gmail.com writes:
>>>>
>>>>  Any have  any experience with using transexamic acid in trauma?  Listened to
>>>>  a  couple of podcasts today and going to look at the crash 2 trial.
>>>>  Thinking
>>>>  about writing a short paper about it for  school.
>>>>  Thanks,
>>>>  Bryan
>>>>
>>>>  Bryan Boling, RN, CCRN, CEN
>>>>  DNP Student,  Acute Care Nurse Practitioner Program
>>>>  University of  Kentucky
>>>>  --
>>>>  trauma-list : TRAUMA.ORG
>>>>  To change your settings or  unsubscribe  visit:
>>>>  hhttp://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2012-April/ttp://www.trauma.org/index.php?/community/
>>>>
>>>>  --
>>>>  trauma-list : TRAUMA.ORG
>>>>  To change your settings or unsubscribe visit:
>>>>  hhttp://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2012-April/ttp://www.trauma.org/index.php?/community/
>>>> --
>>>> r Ian Seppelt FANZCA FCICM
>>>> enior Specialist in Intensive Care Medicine
>>>> epean Hospital, Penrith NSW
>>>> ydney Medical School - Nepean, University of Sydney
>>>> --
>>>> rauma-list : TRAUMA.ORG
>>>> o change your settings or unsubscribe visit:
>>>> http://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2012-April/ttp://www.trauma.org/index.php?/community/
>>>> -
>>>> rauma-list : TRAUMA.ORG
>>>> o change your settings or unsubscribe visit:
>>>> http://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2012-April/ttp://www.trauma.org/index.php?/community/
>>>>
>>>>
>>>>
>>>> ------------------------------
>>>>
>>>> Message: 11
>>>> Date: Fri, 13 Apr 2012 19:39:32 -0500
>>>> From: "Dr. Alejandro Cabrera Esquenazi" <spe at prodigy.net.mx>
>>>> Subject: RE: Disaster Response
>>>> To: "'Trauma-List [TRAUMA.ORG]'" <trauma-list at trauma.org>
>>>> Message-ID: <0EC21C545F454816A8D7F929CECA2357 at INSPIRON6400>
>>>> Content-Type: text/plain; charset="us-ascii"
>>>>
>>>> You may find it interesting.
>>>> Just adequate to your hospital, as we did.
>>>>
>>>> Regards.
>>>>
>>>>
>>>> Alejandro Cabrera, M.D.
>>>> Former ER Medical Director.
>>>> Real San Jose Hospital
>>>>
>>>>
>>>> -----Mensaje original-----
>>>> De: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
>>>> En nombre de JJ
>>>> Enviado el: Viernes, 13 de Abril de 2012 05:02 p.m.
>>>> Para: trauma-list at trauma.org
>>>> Asunto: Disaster Response
>>>>
>>>>
>>>> Colleagues,
>>>>  I have been asked to review the clinical aspects of our level II trauma
>>>> center here in Florida.  I would like to review what others have planned at
>>>> their facilities if you would be so kind to share so that I can compare and
>>>> contrast to what our current plans are.
>>>>  thanks ,
>>>>
>>>> Jeffery L. Johnson, MD, FACS
>>>> Bayfront Medical Center
>>>> St Petersburg, Florida
>>>>
>>>>
>>>>
>>>>
>>>>
>>>>
>>>>
>>>>
>>>> -----Original Message-----
>>>> From: Richard Wigle MD FACS <rlwigle at yahoo.com>
>>>> To: Trauma-List [TRAUMA.ORG] <trauma-list at trauma.org>
>>>> Sent: Fri, Mar 16, 2012 10:23 am
>>>> Subject: Re: TXA
>>>>
>>>>
>>>> A US military review has recently shown results consistent with the CRASH2
>>>> rial. I don't know anything about the meathodology
>>>>
>>>>  Wigle MD FACS FCCM
>>>> sst Prof Surgery
>>>> SUS
>>>>
>>>> ________________________________
>>>> From: Ian Seppelt <seppelt at med.usyd.edu.au>
>>>> o: trauma-list at trauma.org
>>>> ent: Friday, March 16, 2012 12:38 AM
>>>> ubject: Re: TXA
>>>>
>>>> lease elaborate, Ken! Are you saying that because a trial does not
>>>> ncludes patients from the USA it is not valid? <grin>
>>>> Need to be careful distinguishing methodological flaws (it was very
>>>> ound methodologically) from questions about generalisability (most
>>>> atients were in low and middle income countries, higher than expected
>>>> verall mortality, many patients were not transfused, etc etc as
>>>> iscussed previously on this list)/
>>>> [Disclosure - I was a site investigator in CRASH2]
>>>> Cheers, Ian
>>>> On 16/03/12 1:52 PM, KMATTOX at aol.com wrote:
>>>>  Be careful.        Many glitches in the  methodology of that trial.   NO
>>>>  ONE from the USA in the  trial.     The drug family has been around for a
>>>> long
>>>>  long  while in search of an indication.     If this drug should  work, it
>>>>  should work as an antifibrinolytic..
>>>>
>>>>  k
>>>>
>>>>
>>>>  In a message dated 3/15/2012 9:32:13 P.M. Central Daylight Time,
>>>>  bryanboling at gmail.com writes:
>>>>
>>>>  Any have  any experience with using transexamic acid in trauma?  Listened
>>>> to
>>>>  a  couple of podcasts today and going to look at the crash 2 trial.
>>>>  Thinking
>>>>  about writing a short paper about it for  school.
>>>>  Thanks,
>>>>  Bryan
>>>>
>>>>  Bryan Boling, RN, CCRN, CEN
>>>>  DNP Student,  Acute Care Nurse Practitioner Program
>>>>  University of  Kentucky
>>>>  --
>>>>  trauma-list : TRAUMA.ORG
>>>>  To change your settings or  unsubscribe  visit:
>>>>  hhttp://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2012-April/ttp://www.trauma.org/index.php?/community/
>>>>
>>>>  --
>>>>  trauma-list : TRAUMA.ORG
>>>>  To change your settings or unsubscribe visit:
>>>>  hhttp://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2012-April/ttp://www.trauma.org/index.php?/community/
>>>> --
>>>> r Ian Seppelt FANZCA FCICM
>>>> enior Specialist in Intensive Care Medicine
>>>> epean Hospital, Penrith NSW
>>>> ydney Medical School - Nepean, University of Sydney
>>>> --
>>>> rauma-list : TRAUMA.ORG
>>>> o change your settings or unsubscribe visit:
>>>> http://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2012-April/ttp://www.trauma.org/index.php?/community/
>>>> -
>>>> rauma-list : TRAUMA.ORG
>>>> o change your settings or unsubscribe visit:
>>>> http://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2012-April/ttp://www.trauma.org/index.php?/community/
>>>>
>>>> --
>>>> trauma-list : TRAUMA.ORG
>>>> To change your settings or unsubscribe visit:
>>>> hhttp://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2012-April/ttp://www.trauma.org/index.php?/community/
>>>> -------------- next part --------------
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>>>>
>>>> ------------------------------
>>>>
>>>> --
>>>> trauma-list : TRAUMA.ORG
>>>> To change your settings or unsubscribe visit:
>>>> hhttp://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2012-April/ttp://www.trauma.org/index.php?/community/
>>>>
>>>> End of trauma-list Digest, Vol 106, Issue 6
>>>> *******************************************
>>>>
>>>> --
>>>> trauma-list : TRAUMA.ORG
>>>> To change your settings or unsubscribe visit:
>>>> hhttp://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2012-April/ttp://www.trauma.org/index.php?/community/
>>> --
>>> trauma-list : TRAUMA.ORG
>>> To change your settings or unsubscribe visit:
>>> hhttp://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2012-April/ttp://www.trauma.org/index.php?/community/
>>>--
>>>trauma-list : TRAUMA.ORG
>>>To change your settings or unsubscribe visit:
>>>hhttp://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2012-April/ttp://www.trauma.org/index.php?/community/
>>
>>
>>------------------------------
>>
>>Message: 2
>>Date: Wed, 25 Apr 2012 06:41:32 +0200
>>From: James Bradley <jebradley at gmail.com>
>>Subject: Don't requote entire messages
>>To: trauma-list at trauma.org
>>Message-ID: <4F97807C.5070404 at gmail.com>
>>Content-Type: text/plain; charset=ISO-8859-1; format=flowed
>>
>>I receive the trauma-list via a digest, and just received Vol 106, Issue 13.
>>It has a total of 81 lines of message and 2597 lines of requoted
>>messages (2 of the 3 requoted the entire digest). I already get the
>>digest. I don't need to have the digest requoted in its entirety.
>>Everyone on this list is intelligent. Why don't you use it (and show a
>>little internet courtesy), and cut out a snippet of the message you're
>>commenting about, or set you phone or browser to NOT requote the message
>>being replied to. It would make most messages easier to read and follow.
>>Thank you.
>>Jim Bradley -- currently in Zambia and paying for downloads by the byte
>>(and that bites).
>>
>>
>>------------------------------
>>
>>Message: 3
>>Date: Wed, 25 Apr 2012 08:49:59 +0100
>>From: Karim Brohi <karimbrohi at gmail.com>
>>Subject: Re: TXA
>>To: "Trauma-List [TRAUMA.ORG]" <trauma-list at trauma.org>
>>Message-ID:
>>       <CAE-U-g-eUuJWxL0=aBNznrk9vihAoTkD81MaSLhmjmjDbH6e_Q at mail.gmail.com>
>>Content-Type: text/plain; charset=windows-1252
>>
>>Jonny
>>
>>Yes and the two militaries are collaborating increasingly on trauma
>>research which is excellent.  The point here though is why clinicians
>>(not just US clinicians but everywhere) are more likely to utilize
>>results from a small retrospective study than from a large prospective
>>clinical trial.  Is it because these studies are easier for clinicians
>>to understand?
>>
>>This issue of how you disseminate research results into clinical
>>practice is increasingly seen as an important issue for researchers -
>>indeed the UK's National Institute of Health Research is putting out a
>>number of calls for research into this area.  Ultimately there's no
>>point in anyone doing research if it doesn't change practice.
>>
>>Karim
>>
>>On 04/24/2012, Jonathan Morrison <jonny_morrison at doctors.org.uk> wrote:
>>>
>>> MATTERs was a collaborative UK and US study. I agree that it is interesting
>>> how people have interpreted the CRASH-2 findings in the context of this
>>> military work. Ultimately, if it gets the right drug into the right patients
>>> then something positive has come from it all.
>>>
>>> Jonny
>>>
>>>
>>> ----------------------------------------------------------------------
>>> Major Jonathan Morrison, MB ChB, MRCS, RAMC (V),
>>> Research Fellow &
>>> Registrar in General Surgery and Critical Care,
>>>
>>> US Army Institute of Surgical Research,
>>> Fort Sam Houston, Tx, USA
>>> &
>>> Academic Dept Military Surgery and Trauma,
>>> Royal Centre for Defence Medicine,
>>> Birmingham, UK
>>>
>>>
>>> On Wed, 25 Apr 2012 08:13:59 +1000
>>>  Ian Seppelt <seppelt at med.usyd.edu.au> wrote:
>>>But Karim, you know the hierarchy of evidence. A retrospective
>>> observational study done by Americans is a much higher level of evidence
>>> than a well conducted large RCT done elsewhere in the world. <wicked grin,
>>> ducking for cover>
>>>
>>>Ian
>>>
>>>Sent from my iPad
>>>
>>>On 25/04/2012, at 7:33 AM, Karim Brohi <karimbrohi at gmail.com> wrote:
>>>
>>>> It's amazing how people won't believe a 20,000 patient RCT but will
>>>> believe a small retrospective study.
>>>>
>>>> Arguably the MATTERS study has done more to improv uptake of TXA use
>>>> in the USA than the CRASH2 study.  But of course you could read
>>>> MATTERS as any difference between UK and US practice.  In fact, maybe
>>>> transplanting UK surgeons to the US would improve survival??
>>>>
>>>> Karim
>>>>
>>>> On Sat, Apr 14, 2012 at 11:27, Christian Medby <cmedby at hotmail.com>
>>>> wrote:
>>>>
>>>> If you don't believe in the CRASH-2 trial, check out the MATTERs study:
>>>>
>>>> TXA was found to reduce mortality from 23.9% to 17.4% and reduce
>>>> coagulopathy in a retrospective observational military study.
>>>>
>>>> Morrison, J. J., Dubose, J. J., Rasmussen, T. E., & Midwinter, M. J.
>>>> (2012). Military Application of Tranexamic Acid in Trauma Emergency
>>>> Resuscitation (MATTERs) Study. Archives of Surgery, 147(2), 113?119.
>>>> doi:10.1001/archsurg.2011.287
>>>>
>>>> Christian Medby
>>>> Consultant Anesthesiologist
>>>> Norwegian Armed Forces Medical Services
>>>>
>>>>
>>>>> From: trauma-list-request at trauma.org
>>>>> Subject: trauma-list Digest, Vol 106, Issue 6
>>>>> To: trauma-list at trauma.org
>>>>> Date: Sat, 14 Apr 2012 01:40:46 +0100
>>>>>
>>>>> 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: Giving packed red blood cells in the prehospital phase
>>>>>       ofcare...a      good idea? (McSwain, Norman E)
>>>>>    2. Re: trauma-list Digest, Vol 106, Issue 5 (John Hall)
>>>>>    3. crushing case (Caesar Ursic)
>>>>>    4. Re: crushing case (Dr and Mrs T Hardcastle)
>>>>>    5. Fwd: Free April Webinar: Assessment & Prognosis in Severe TBI
>>>>>       (Krin135 at aol.com)
>>>>>    6. Fwd: Registration is Now Open for World Trauma Symposium
>>>>>       (Gustavo E. Flores)
>>>>>    7. RE: ICU to ICU transfers: what is your policy? (Gross, Ronald)
>>>>>    8. Emergency Department CT Scanner (Bjorn, Pret)
>>>>>    9. Re: Emergency Department CT Scanner (K Mattox)
>>>>>   10. Disaster Response (JJ)
>>>>>   11. RE: Disaster Response (Dr. Alejandro Cabrera Esquenazi)
>>>>>
>>>>>
>>>>> ----------------------------------------------------------------------
>>>>>
>>>>> Message: 1
>>>>> Date: Mon, 9 Apr 2012 08:47:07 -0500
>>>>> From: "McSwain, Norman E" <nmcswai at tulane.edu>
>>>>> Subject: RE: Giving packed red blood cells in the prehospital phase
>>>>>       ofcare...a      good idea?
>>>>> To: "Trauma-List [TRAUMA.ORG]" <trauma-list at trauma.org>
>>>>> Message-ID:
>>>>>       <2AB2A689A074DB439A79EF89F66CB97DD897A7 at EX05.ad.tulane.edu>
>>>>> Content-Type: text/plain;     charset="iso-8859-1"
>>>>>
>>>>> Karim
>>>>>
>>>>> I would disagree slightly.
>>>>> * a non-trauma hemorrhaging  patient can tolerate HGB to 7 gms. In fact
>>>>> that is the transfusion indication in many patients
>>>>> * Plasma has the coagulation factors
>>>>> * Several places in Europe have lyophilized plasma available now. It is
>>>>> in the wings for the US in a couple of years
>>>>> * Liquid plasma last 30 days and some research that John Holcomb is
>>>>> doing shows maybe it is better than FFP with clotting factors
>>>>>
>>>>> Perhaps the best approach is to use plasma not PRBCs for field
>>>>> resuscitation. Use only enough to keep the systolic pressure in the
>>>>> range of 90 mmHg  in the prehospital period. This gives volume,
>>>>> coagulation and in a younger person there is enough O2 carrying
>>>>> capacity to profuse the body and perhaps the brain as well.
>>>>>
>>>>>  The best of both worlds
>>>>>
>>>>> Norman
>>>>> Professor, Tulane  Univ, Surgery
>>>>> Trauma Director, Spirit of Charity Trauma Center, ILH
>>>>> New Orleans, 504-988-5111
>>>>>
>>>>>
>>>>> -----Original Message-----
>>>>> From: trauma-list-bounces at trauma.org
>>>>> [mailto:trauma-list-bounces at trauma.org] On Behalf Of Karim Brohi
>>>>> Sent: Monday, April 09, 2012 6:04 AM
>>>>> To: Trauma-List [TRAUMA.ORG]
>>>>> Subject: Re: Giving packed red blood cells in the prehospital phase
>>>>> ofcare...a good idea?
>>>>>
>>>>> E
>>>>>
>>>>> You're correct - this is for a very small subset of patients.  However
>>>>> clearly if one goal any advance in prehospital care is to reduce
>>>>> mortality, then this is a group of patients to target, as they continue
>>>>> to have a mortality of up to 30%
>>>>>
>>>>> There are two conflicting goals here - perfusion and coagulation.  At
>>>>> the moment we cannot monitor either and we treat one at the expense of
>>>>> the other.  Permissive hypotension strategies sacrifice perfusion for
>>>>> coagulation.  Prehospital resuscitation strategies in some parts of the
>>>>> world sacrifice coagulation for perfusion.  There is no clear winner.
>>>>>
>>>>> In London our protocols favour the permissive hypotension strategy (as
>>>>> a part of damage control resuscitation).  However when we say 'in
>>>>> penetrating trauma we would limit fluids' we are usually talking about
>>>>> patients who have SBPs above (say) 70mmHg.  But do you ever let a
>>>>> patient with (say) penetrating chest trauma sit at a blood pressure of
>>>>> 40mmHg till they get into the operating room?  Or if you do, how low
>>>>> would you go before you would give something - anything, to get a bit
>>>>> of perfusion??
>>>>>
>>>>> Karim
>>>>>
>>>>>
>>>>> On Sat, Apr 7, 2012 at 23:37, Errington Thompson
>>>>> <errington at erringtonthompson.com> wrote:
>>>>> I find this fascinating. Fearing one on the prehospital ambulances...
>>>>> Fascinating. I wonder what percentages of patients who would benefit
>>>>> from prehospital administration of blood? From trauma standpoint, I
>>>>> suspect were only talking about patients were victims of blunt trauma.
>>>>> Of those, probably one or 2%, at most, would require prehospital blood
>>>>> transfusion in order to stabilize their vital signs. Again, I'm just
>>>>> guessing, that we would only be talking about patients who have
>>>>> relatively prolonged prehospital transport times - >30 min.
>>>>>
>>>>> In our trauma center, here in Asheville, North Carolina, we see about
>>>>> 3500 patients a year. About 400 patients with penetrating trauma. For
>>>>> our code traumas, our highest activation, we used to have blood
>>>>> available every time a code traumas activated. We stopped that. We
>>>>> just don't transfuse that many patients. I guess, another way of
>>>>> putting it, is that we just don't transfuse that many patients
>>>>> acutely.
>>>>>
>>>>> For patients with penetrating trauma, it would seem that we would like
>>>>> to limit fluid into it and get the patient to the operating room.
>>>>> Therefore, the vast majority of patients with penetrating trauma would
>>>>> not receive any significant prehospital fluid/blood transfusions.
>>>>>
>>>>> I'm sure there's a way to look into the national trauma databank and
>>>>> figure out which patients would possibly have benefited from
>>>>> prehospital transfusions and what the numbers are. Again, I think this
>>>>> would be fascinating. I look forward to some of the data that comes
>>>>> out of this new protocol.
>>>>>
>>>>> Errington C. Thompson, MD, FACS, FCCM
>>>>> Trauma Surgeon/Surgical Critical Care
>>>>> Radio Talk Show Host - Podcasts
>>>>> Asheville, NC
>>>>>
>>>>>
>>>>> -----Original Message-----
>>>>> From: trauma-list-bounces at trauma.org
>>>>> [mailto:trauma-list-bounces at trauma.org]
>>>>> On Behalf Of Dominik Krzanicki
>>>>> Sent: Saturday, April 07, 2012 4:23 AM
>>>>> To: Trauma-List [TRAUMA.ORG]
>>>>> Subject: Re: Giving packed red blood cells in the prehospital phase of
>>>>> care...a good idea?
>>>>>
>>>>> I can clarify some of the logistics to allow the discussion to become
>>>>> more clinical.
>>>>>
>>>>> London HEMS operate a Doctor-Paramedic model.
>>>>> 4 units of blood are carried on the helicopter and 4 units on the
>>>>> rapid response vehicles.
>>>>>
>>>>> They are stored in 'Golden-Hour' boxes which have a data logger within
>>>>> them to ensure temperature storage compliance. The blood is exchanged
>>>>> every 24 hours when it re-enters hospital circulation (assuming
>>>>> temperature storage conditions are acceptable) and therefore waste is
>>>>> minimal. This also ensures that the HEMS team are equipped with
>>>>> relatively 'fresh' blood. All blood is tracked to ensure 100%
>>>>> traceability regardless of which of the trauma centres in London the
>>>>> patient is admitted to.
>>>>>
>>>>> Administration is governed by SOP and discussed with an on-call
>>>>> consultant prior to administration to ensure robust governance.
>>>>>
>>>>> As Karim said - huge undertaking to get this initiative operational
>>>>> and a testament to those involved - well done.
>>>>>
>>>>>
>>>>> Dom - London HEMS registrar.
>>>>>
>>>>>
>>>>> On 7 Apr 2012, at 09:07, Karim Brohi wrote:
>>>>>
>>>>>> Marty
>>>>>>
>>>>>> My question related to patient care and how we might be able to
>>>>>> improve survival. ?If we determine that patients do better with a
>>>>>> given intervention, then it is our duty to provide the clinical,
>>>>>> logistic and legal frameworks that allow delivery of that care.
>>>>>>
>>>>>> You are not wrong to bring these issues up - much research is done
>>>>>> and never implemented because of blocks at the implementation &
>>>>>> policy phase. ?However in this case we don't even know if it's the
>>>>>> right thing to do yet - so let's talk about the science before we
>>>>>> discuss practicalities.
>>>>>>
>>>>>> (BTW it took us 2 years to work out the logistics, regulatory issues,
>>>>>> training and accountability issues to carry blood on the helicopter.
>>>>>> It's not something you'd get foisted with overnight!)
>>>>>>
>>>>>> Karim
>>>>>>
>>>>>> On Sat, Apr 7, 2012 at 01:26, Marty Munro <marty_munro at yahoo.ca>
>>>>>> wrote:
>>>>>> Mr. McSwain, I apologize for going astray, as it was my post that
>>>>> initiated it. ?It is about the patient. However, EMS is a job for me.
>>>>> I want a paycheque from it. If I only wanted to provide treatment, I
>>>>> would work for free or for room and board. I always provide care to
>>>>> the best of my ability within my scope of practice, but in the end, I
>>>>> want to be paid, with as little risk as possible.
>>>>>>
>>>>>> It would be interesting to read some studies and hear from some
>>>>>> providers
>>>>> that have these directives in place. If anyone wishes to further
>>>>> discuss issues that I have brought up, I welcome you to e-mail me
>>>>> privately.
>>>>>>
>>>>>> Marty
>>>>>>
>>>>>> --- On Fri, 4/6/12, McSwain, Norman E <nmcswai at tulane.edu> wrote:
>>>>>>
>>>>>>
>>>>>> From: McSwain, Norman E <nmcswai at tulane.edu>
>>>>>> Subject: RE: Giving packed red blood cells in the prehospital phase
>>>>>> of
>>>>> care...a good idea?
>>>>>> To: "Trauma-List [TRAUMA.ORG]" <trauma-list at trauma.org>
>>>>>> Received: Friday, April 6, 2012, 7:50 PM
>>>>>>
>>>>>>
>>>>>> I think that we have gone astray
>>>>>> It is not about the providers, the EMS systems or the hospitals It
>>>>>> IS about the patient
>>>>>>
>>>>>> Let's address the science and then we can work out the process
>>>>>> problems
>>>>>>
>>>>>> The question Kiram asked is: "Will RBC given in the field be
>>>>>> beneficial to the patient?"
>>>>>>
>>>>>> Norman
>>>>>>
>>>>>> Professor, Tulane University, Surgery Trauma Director, Spirit of
>>>>>> Charity Trauma Center, ILH/MCLNO New Orleans, Louisiana
>>>>>> 504 988 5111
>>>>>>
>>>>>>
>>>>>> -----Original Message-----
>>>>>> From: trauma-list-bounces at trauma.org
>>>>>> [mailto:trauma-list-bounces at trauma.org] On Behalf Of johnleslie48
>>>>>> Sent: Friday, April 06, 2012 6:36 PM
>>>>>> To: Trauma-List [TRAUMA.ORG]
>>>>>> Subject: Re: Giving packed red blood cells in the prehospital phase
>>>>>> of care...a good idea?
>>>>>>
>>>>>> Well said!
>>>>>>
>>>>>> John Leslie
>>>>>>
>>>>>> 0412 528851
>>>>>>
>>>>>> Sent from my iPhone
>>>>>>
>>>>>> On Apr 7, 2012, at 6:45, Marty Munro <marty_munro at yahoo.ca> wrote:
>>>>>>
>>>>>>> Speaking as a paramedic, I would not want this responsibility. It's
>>>>>>> just one more thing to go wrong in an often unstable environment,
>>>>>>> and
>>>>>> one more reason for me to lose my certification, job, or be sued. We
>>>>>> are always taught to limit our scene times in traumas and provide
>>>>>> required care en route, for obvious reasons. This means that often,
>>>>>> we are unable to establish an I.V. due extreme movement of the
>>>>>> vehicle, accessibility of available veins and the requirement to
>>>>>> maintain a patent airway as a priority. Therefore, arriving at the
>>>>>> emergency department/trauma room in a timely manner is a medic's
>>>>>> priority. There is conflicting evidence as to whether or not a fluid
>>>>>> bolus is even beneficial, and evidence that suggests it is harmful
>>>>>> to the trauma patient. So now, if medics start carrying blood, will
>>>>>> they be expected to always have blood running en route to the
>>>>>> hospital?
>>>>>> And when they are unable to, suddenly the topic becomes "the patient
>>>>>> could have survived had the paramedics started an I.V. and given
>>>>>> blood en route". ?The law suit begins, the medics lose their
>>>>>> certifications and become the subject of an investigation and
>>>>>> inquest. ?And if they do start an I.V. and give blood and the
>>>>>> patient dies, the topic becomes "paramedics wasted time by starting
>>>>>> blood en route to the hospital". I am all for progressive medicine
>>>>>> in the pre-hospital care, but I think that those who choose to
>>>>>> implement certain things should try this first. Next time a trauma
>>>>>> comes in to the hospital, instead of going to the nice bright trauam
>>>>>> room, the patient should be taken into a utility closet, with only
>>>>>> one physician and one extra person and all the care should be
>>>>>> provided in a cramped closet by the single person while the extra
>>>>>> person continuously shakes the mattress of the bed. Then think about
>>>>>> how realistic/beneficial adding in extra skills/procedures is to
>>>>>> pre-hospital
>>>>> staff. That's just my opinion.
>>>>>>>
>>>>>>> Marty Munro
>>>>>>> Advanced Care Paramedic
>>>>>>> Ontario, Canada
>>>>>>>
>>>>>>>
>>>>>>>
>>>>>>> --- On Fri, 4/6/12, Stephen Richey <stephen.richey at gmail.com>
>>>>>>> wrote:
>>>>>>>
>>>>>>>
>>>>>>> From: Stephen Richey <stephen.richey at gmail.com>
>>>>>>> Subject: Re: Giving packed red blood cells in the prehospital phase
>>>>>>> of
>>>>>> care... a good idea?
>>>>>>> To: "Trauma-List [TRAUMA.ORG]" <trauma-list at trauma.org>
>>>>>>> Received: Friday, April 6, 2012, 3:25 PM
>>>>>>>
>>>>>>>
>>>>>>> For the most part, I would say no at least here in the US since the
>>>>>>> average level of education for a paramedic leaves much to be
>>>>>>> desired (speaking as a former EMS educator myself). ?The issues
>>>>>>> with quality control, supply maintenance, the need to determine
>>>>>>> clinical need (EMS providers tend to massive over-estimate the
>>>>>>> severity of patients'
>>>>>>> conditions because most of them are taught "cookbook" defensive
>>>>>>> medicine) and cost. ?I am not sure how the blood banking situation
>>>>>>> is in other countries but here there are often region-wide
>>>>>>> shortages of blood products so the sequestration of a significant
>>>>>>> amount in the hands of EMS providers would probably only exacerbate
>>>>>>> the situation.
>>>>>>>
>>>>>>> Also, the problem is worsened by the fact that the patients who
>>>>>>> would probably benefit most from field transfusions are the ones in
>>>>>>> the areas least suited to its use because of administration,
>>>>>>> training and supply issues. ?Rural EMS tends to be almost all
>>>>>>> volunteer and many of
>>>>>>
>>>>>>> these folks never even meet their medical director let along
>>>>>>> receive any meaningful QA/QI feedback. ?The idea of giving the
>>>>>>> blood to the local HEMS operators and using them to deliver a
>>>>>>> higher level of care isn't going to work because you're going to
>>>>>>> delay the arrival of the patient in the OR in all but the most
>>>>>>> remote of areas.
>>>>>>>
>>>>>>> In urban settings, you're not going to have that much need for
>>>>>>> transfusion because of the proximity to trauma centers. ?Here for
>>>>>>> example, it's abnormal for EMS providers (such as my fiancee) to
>>>>>>> take longer than 20 minutes from call to arrival at the hospital.
>>>>>>>
>>>>>>> On Fri, Apr 6, 2012 at 3:12 PM, Karim Brohi <karim at trauma.org>
>>>>>>> wrote:
>>>>>>>
>>>>>>> So our trauma helicopter emergency medical service recently
>>>>>>> started carrying packed cells:
>>>>>>> http://www.bbc.co.uk/news/health-17232529
>>>>>>>
>>>>>>> We'll obviously be auditing its use closely, but I'm interested in
>>>>>>> garnering the lists opinions on this:
>>>>>>> Who should get PRBCs?
>>>>>>> Should anyone get PRBCs?
>>>>>>> Why aren't we carrying plasma as well?
>>>>>>>
>>>>>>> There are a couple of prehospital services in the US carrying
>>>>>>> blood and plasma to my knowledge, and it is used by MERT teams in
>>>>>>> combat zones.
>>>>>>>
>>>>>>> So??
>>>>>>>
>>>>>>> Karim
>>>>>>> --
>>>>>>> trauma-list : TRAUMA.ORG
>>>>>>> To change your settings or unsubscribe visit:
>>>>>>> hhttp://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2012-April/ttp://www.trauma.org/index.php?/community/
>>>>>>>
>>>>>>>
>>>>>>>
>>>>>>>
>>>>>>> --
>>>>>>> Stephen Richey
>>>>>>> Founder and Chief Researcher/Designer Kolibri Aviation Safety
>>>>>>> Research 5174-B Winterberry Circle Indianapolis, IN 46254
>>>>>>> 317-985-4740
>>>>>>>
>>>>>>> "I think the best thing, and the only thing in our infinite
>>>>>>> inadequacy
>>>>>>
>>>>>>> in making up for the loss of life, is to say something we have been
>>>>>>> able to say in a lot of other accidents to grieving families. ?That
>>>>>>> is
>>>>>>
>>>>>>> 'Those deaths will not be in vain. We will not let them be in vain.
>>>>>>> Every one of those lives will be made to count in terms of making
>>>>>>> sure
>>>>>>
>>>>>>> that three, four, five or ten other people do not die."- John J.
>>>>>>> Nance
>>>>>>> --
>>>>>>> trauma-list : TRAUMA.ORG
>>>>>>> To change your settings or unsubscribe visit:
>>>>>>> hhttp://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2012-April/ttp://www.trauma.org/index.php?/community/
>>>>>>> --
>>>>>>> trauma-list : TRAUMA.ORG
>>>>>>> To change your settings or unsubscribe visit:
>>>>>>> hhttp://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2012-April/ttp://www.trauma.org/index.php?/community/
>>>>>> --
>>>>>> trauma-list : TRAUMA.ORG
>>>>>> To change your settings or unsubscribe visit:
>>>>>> hhttp://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2012-April/ttp://www.trauma.org/index.php?/community/
>>>>>> --
>>>>>> trauma-list : TRAUMA.ORG
>>>>>> To change your settings or unsubscribe visit:
>>>>>> hhttp://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2012-April/ttp://www.trauma.org/index.php?/community/
>>>>>> --
>>>>>> trauma-list : TRAUMA.ORG
>>>>>> To change your settings or unsubscribe visit:
>>>>>> hhttp://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2012-April/ttp://www.trauma.org/index.php?/community/
>>>>>> --
>>>>>> trauma-list : TRAUMA.ORG
>>>>>> To change your settings or unsubscribe visit:
>>>>>> hhttp://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2012-April/ttp://www.trauma.org/index.php?/community/
>>>>>>
>>>>>
>>>>> --
>>>>> trauma-list : TRAUMA.ORG
>>>>> To change your settings or unsubscribe visit:
>>>>> hhttp://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2012-April/ttp://www.trauma.org/index.php?/community/
>>>>>
>>>>>
>>>>> --
>>>>> trauma-list : TRAUMA.ORG
>>>>> To change your settings or unsubscribe visit:
>>>>> hhttp://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2012-April/ttp://www.trauma.org/index.php?/community/
>>>>> --
>>>>> trauma-list : TRAUMA.ORG
>>>>> To change your settings or unsubscribe visit:
>>>>> hhttp://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2012-April/ttp://www.trauma.org/index.php?/community/
>>>>>
>>>>>
>>>>> ------------------------------
>>>>>
>>>>> Message: 2
>>>>> Date: Mon, 9 Apr 2012 10:22:48 -0400
>>>>> From: John Hall <jrhmdtraum at aol.com>
>>>>> Subject: Re: trauma-list Digest, Vol 106, Issue 5
>>>>> To: "trauma-list at trauma.org" <trauma-list at trauma.org>
>>>>> Message-ID: <7C6BE5A1-0547-401D-9281-33648EA393C7 at aol.com>
>>>>> Content-Type: text/plain;     charset=us-ascii
>>>>>
>>>>>
>>>>> Re blood in the field
>>>>>
>>>>> It is interesting to note that in the Northfield trial of "hemoglobin"
>>>>> in the field, in the data of the paramedics who followed the protocol,
>>>>> there was a significant survival advantage.   Unfortunately, the data
>>>>> was muddled by several groups who broke the protocol (these patients
>>>>> are going to die if we don't use the wonder drug).
>>>>>
>>>>> John Hall
>>>>>
>>>>> ------------------------------
>>>>>
>>>>> Message: 3
>>>>> Date: Tue, 10 Apr 2012 09:49:30 -1000
>>>>> From: Caesar Ursic <cmursic at gmail.com>
>>>>> Subject: crushing case
>>>>> To: "Trauma-List [TRAUMA.ORG]" <trauma-list at trauma.org>
>>>>> Message-ID:
>>>>>
>>>>> <CAG1MY2DgPq4+svN3MmWVdUeiw39BBXMyurU-vWUSwvB_TFgE7Q at mail.gmail.com>
>>>>> Content-Type: text/plain; charset=ISO-8859-1
>>>>>
>>>>> A case submitted for your consideration:
>>>>>
>>>>> 43 yo male construction worker suddenly had large amount of gravel,
>>>>> rocks
>>>>> and dirt fall on him, burying him up to his neck.  Co-workers dug him
>>>>> out
>>>>> with shovels (took them ten minutes) and he remained awake and alert
>>>>> during
>>>>> this time.  Finally freed of the rubble he collapsed and lost
>>>>> consciousness.
>>>>>
>>>>> Paramedics arrive  two minutes after his collapse.  No bystander CPR is
>>>>> being performed.  He has no palpable pulses or spontaneous respiratory
>>>>> efforts.  Pupils reported as 5 mm bilaterally and unresponsive. The
>>>>> medics
>>>>> begin closed chest compressions, place him on a spine board and load
>>>>> him
>>>>> into the ambulance.  They perform rapid sequence intubation (successful
>>>>> on
>>>>> first try) and start two IVs en route to the hospital.  They give two
>>>>> doses
>>>>> (1 mg) of IV epinephrine en route to the hospital.  They do not feel
>>>>> return
>>>>> of palpable pulses.  Transport time is 16 minutes.
>>>>>
>>>>> On arrival to ER he is undergoing closed chest compressions.  He still
>>>>> has
>>>>> no palpable pulses at the carotid or the femoral arteries bilaterally
>>>>> but
>>>>> on ECG monitor his *heart rate is 140/min*.  The endotracheal tube
>>>>> seems to
>>>>> be in the correct position on visual inspection with the laryngoscope
>>>>> (i.e.
>>>>> it is going through the vocal cords). He has bruising and abrasions of
>>>>> the
>>>>> chest wall but no lacerations or external bleeding.  Rib fractures are
>>>>> palpable bilaterally. Breath sounds are equal bilaterally and he is
>>>>> easy to
>>>>> ventilate using the bag-valve.  There are two 16 gauge antecubital IV
>>>>> catheters already in place and one of the medics is squeezing in a bag
>>>>> of
>>>>> 0.9 NS (they have given 300 ml so far).  Total pre-hospital CPR is
>>>>> estimated at 20 minutes (includes time at scene and transport time to
>>>>> ER).
>>>>>
>>>>> What would you do at this point?
>>>>>
>>>>> Would you:
>>>>>
>>>>> A. pronounce him dead on arrival?
>>>>> B. continue closed chest compressions, give more fluid (crystalloid?
>>>>> blood
>>>>> products?) and intravenous epineprhine or other vasopressor?
>>>>> C. insert bilateral chest tubes?
>>>>> D. perform ER thoracotomy?
>>>>> E. a combination of one or more of the above?
>>>>> F. something else entirely?
>>>>>
>>>>> Thank you.
>>>>>
>>>>> C. Ursic, MD
>>>>> Honolulu
>>>>>
>>>>>
>>>>> ------------------------------
>>>>>
>>>>> Message: 4
>>>>> Date: Wed, 11 Apr 2012 13:35:46 +0200 (SAST)
>>>>> From: "Dr and Mrs T Hardcastle" <dr.tchardcastle at absamail.co.za>
>>>>> Subject: Re: crushing case
>>>>> To: "Trauma-List \[TRAUMA.ORG\]" <trauma-list at trauma.org>
>>>>> Message-ID:
>>>>>       <14337.196.35.102.165.1334144146.squirrel at aiamail.lantic.net>
>>>>> Content-Type: text/plain;charset=iso-8859-1
>>>>>
>>>>> Caesar - my comments between your questions:
>>>>> Tim Hardcastle
>>>>> A case submitted for your consideration:
>>>>>
>>>>> 43 yo male construction worker suddenly had large amount of gravel,
>>>>> rocks
>>>>> and dirt fall on him, burying him up to his neck.  Co-workers dug him
>>>>> out
>>>>> with shovels (took them ten minutes) and he remained awake and alert
>>>>> during
>>>>> this time.  Finally freed of the rubble he collapsed and lost
>>>>> consciousness.
>>>>>
>>>>> Paramedics arrive  two minutes after his collapse.  No bystander CPR
>>>>> is
>>>>> being performed.  He has no palpable pulses or spontaneous respiratory
>>>>> efforts.  Pupils reported as 5 mm bilaterally and unresponsive. The
>>>>> medics
>>>>> begin closed chest compressions, place him on a spine board and load
>>>>> him
>>>>> into the ambulance.  They perform rapid sequence intubation
>>>>> (successful on
>>>>> first try) and start two IVs en route to the hospital.  They give two
>>>>> doses
>>>>> (1 mg) of IV epinephrine en route to the hospital.  They do not feel
>>>>> return
>>>>> of palpable pulses.  Transport time is 16 minutes.
>>>>>
>>>>> On arrival to ER he is undergoing closed chest compressions.  He still
>>>>> has
>>>>> no palpable pulses at the carotid or the femoral arteries bilaterally
>>>>> but
>>>>> on ECG monitor his *heart rate is 140/min*.  The endotracheal tube
>>>>> seems
>>>>> to
>>>>> be in the correct position on visual inspection with the laryngoscope
>>>>> (i.e.
>>>>> it is going through the vocal cords). He has bruising and abrasions of
>>>>> the
>>>>> chest wall but no lacerations or external bleeding.  Rib fractures are
>>>>> palpable bilaterally. Breath sounds are equal bilaterally and he is
>>>>> easy
>>>>> to
>>>>> ventilate using the bag-valve.  There are two 16 gauge antecubital IV
>>>>> catheters already in place and one of the medics is squeezing in a bag
>>>>> of
>>>>> 0.9 NS (they have given 300 ml so far).  Total pre-hospital CPR is
>>>>> estimated at 20 minutes (includes time at scene and transport time to
>>>>> ER).
>>>>>
>>>>> What would you do at this point?
>>>>>
>>>>> Would you:
>>>>>
>>>>> A. pronounce him dead on arrival?
>>>>> No
>>>>> B. continue closed chest compressions, give more fluid (crystalloid?
>>>>> blood
>>>>> products?) and intravenous epineprhine or other vasopressor?
>>>>> Yes and check blood gas POTASSIUM and IONISED CALCIUM: this is an acute
>>>>> reperfusion - typically occurs about 10 minutes to one our after
>>>>> release.
>>>>> The underlying "tachy" PEA fits with hyperkalemia
>>>>> C. insert bilateral chest tubes?
>>>>> Not empirically
>>>>> D. perform ER thoracotomy?
>>>>> NO
>>>>> E. a combination of one or more of the above?
>>>>> F. something else entirely?
>>>>>
>>>>> Thank you.
>>>>>
>>>>> C. Ursic, MD
>>>>> Honolulu
>>>>> --
>>>>> trauma-list : TRAUMA.ORG
>>>>> To change your settings or unsubscribe visit:
>>>>> hhttp://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2012-April/ttp://www.trauma.org/index.php?/community/
>>>>>
>>>>>
>>>>>
>>>>>
>>>>>
>>>>> ------------------------------
>>>>>
>>>>> Message: 5
>>>>> Date: Wed, 11 Apr 2012 08:54:26 -0400 (EDT)
>>>>> From: Krin135 at aol.com
>>>>> Subject: Fwd: Free April Webinar: Assessment & Prognosis in Severe TBI
>>>>> To: trauma-list at trauma.org
>>>>> Cc: ccm-l at list.pitt.edu
>>>>> Message-ID: <11b78.6faf6ed0.3cb6d902 at aol.com>
>>>>> Content-Type: text/plain; charset="ISO-8859-1"
>>>>>
>>>>>
>>>>> for those interested- note that I am saddened to see that the BTF is no
>>>>> longer certified for CME- they used to have some very engaging courses
>>>>> which
>>>>> provided useful information for folks on the front lines of trauma
>>>>> care.
>>>>>
>>>>> ck
>>>>>
>>>>>
>>>>> ____________________________________
>>>>>  From: education at braintrauma.org
>>>>> To: Krin135 at aol.com
>>>>> Sent: 04/10/12  18:35:26 Central Daylight Time
>>>>> Subj: Free April Webinar: Assessment &  Prognosis in Severe TBI
>>>>>
>>>>>
>>>>> FREE  BTF webinar on Assessment & Prognosis in Severe  TBI
>>>>> Is  this email not displaying correctly?
>>>>> _View it in your browser_
>>>>> (http://us1.campaign-archive2.com/?u=dfb11326be59bc7f155536629&id=2b7d8ba540&e=6a2a1ea4b3)
>>>>> .
>>>>>
>>>>>
>>>>> (http://braintrauma.us1.list-manage2.com/track/click?u=dfb11326be59bc7f155536629&id=6f964d4033&e=6a2a1ea4b3)
>>>>> Brain Trauma  Foundation
>>>>> Traumatic Brain Injury Webinar  Series
>>>>>
>>>>>
>>>>> _Click here to  Register for the FREE  webinar: Assessment &  Prognosis
>>>>> in
>>>>> Severe  TBI_
>>>>> (http://braintrauma.us1.list-manage.com/track/click?u=dfb11326be59bc7f155536629&id=593f114c37&e=6a2a1ea4b3)
>>>>> Wednesday, April 25,  2012, 12-1 ET (please note that this webinar is
>>>>> Eastern Time)
>>>>> Presenter for  this webinar is Dr. John Whyte
>>>>>
>>>>> John  Whyte, MD, PhD Bio
>>>>> Dr. John  Whyte is Director of the Moss Rehabilitation  Research
>>>>> Institute
>>>>> (MRRI), Director of the  Attention Research Center, and Director of
>>>>> Brain
>>>>> Injury Research at Drucker Brain Injury Center,  Moss Rehab. Dr. Whyte
>>>>> is
>>>>> board certified in  Physical Medicine and Rehabilitation. In  addition
>>>>> to his
>>>>> work in MRRI, Dr. Whyte is a  Staff Physiatrist for Einstein Practice
>>>>> Plan,
>>>>> Inc. He has teaching appointments at Jefferson  Medical College and
>>>>> Temple
>>>>> University School of  Medicine. Dr. Whyte received his medical degree
>>>>> and a
>>>>> PhD in Psychology from the Unversity of  Pennsylvania. He completed a
>>>>> residency in  Physical Medicine and Rehabilitation at  University of
>>>>> Minnesota
>>>>> Hospital, and a  fellowship in Neurotrauma at New England Medical
>>>>> Center
>>>>> Hospitals and Greenery Rehabilitation and  Skilled Nursing  Center.
>>>>>
>>>>> Webinar  Description
>>>>> Survivors of severe  traumatic brain injury face a wide range of
>>>>> possible
>>>>> prognoses, from nearly complete  recovery to permanent unconsciousness.
>>>>> The
>>>>> ability to predict prognosis at an early point  is limited, but the
>>>>> time
>>>>> until return of  consciousness (e.g., command following) and
>>>>> orientation
>>>>> (e.g., duration of post-traumatic  amnesia) are useful predictors in
>>>>> the early
>>>>> days  and weeks. More specialized assessment  techniques exist of those
>>>>> with
>>>>> persistent  disorders of consciousness, and new assessment  tools and
>>>>> promising treatment options are under  development. This presentation
>>>>> will review
>>>>> the  range of outcomes that are possible after severe  TBI, suggest
>>>>> ways to
>>>>> improve prognostic  prediction and treatment planning, and offer
>>>>> insight
>>>>> into emerging  treatments.
>>>>>
>>>>> Webinar  Objectives
>>>>> By the end of this  webinar the participant will be able to:
>>>>> 1.  Describe the range of outcomes and prognosis  that are possible
>>>>> following severe TBI.
>>>>> 2.  Identify 2 approaches to the assessment of  patients whose level of
>>>>> consciousness remains  impaired.
>>>>> 3. Use time frame and prognostic  information to guide treatment
>>>>> planning.
>>>>>
>>>>> Please note that there is  NO charge for this webinar and  CME credit
>>>>> will
>>>>> not be offered. All are welcome  to attend.
>>>>>
>>>>> To register  for additional upcoming  webinars:
>>>>>
>>>>> Wednesday,  June 6, 2012, 12-1 p.m. ET-"_Blast  Induced Neurotrauma_
>>>>> (http://braintrauma.us1.list-manage1.com/track/click?u=dfb11326be59bc7f155536629&id
>>>>> =c927ac20a1&e=6a2a1ea4b3) ", presented by James  Ecklund, MD.
>>>>>
>>>>> Additional summer  webinars coming  soon!
>>>>>
>>>>>
>>>>>
>>>>>
>>>>>
>>>>> CONNECT  WITH US
>>>>>
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>>>>> (http://www.facebook.com/share.php?u=hhttp://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2012-April/ttp://us1.campaign-archive1.com/?u=dfb11326be59bc7f155536629&id=2b7d8ba540&t=Free%20Apri
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>>>>> ebinar:%20Assessment%20&%20Prognosis%20in%20Severe%20TBI)
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>>>>> Free%20April%20Webinar:%20Assessment%20&%20Prognosis%20in%20Severe%20TBI)
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>>>>> Webinar:%20Assessment%20&%20Prognosis%20in%20Severe%20TBI&popup=no)
>>>>> (http://www.newsvine.com/_tools/seed?u=http://us1.campaign-archive1.com/?u=dfb1132
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>>>>> http://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2012-April/ttp://us1.campaign-archive1.com/?u=dfb11326be59bc7f155536629&id=2b7d8ba540)
>>>>>
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>>>>> (http://myweb2.search.yahoo.com/myresults/bookmarklet?u=http://us1.campaign-archive1.com/?u=dfb11326be59bc7f155536
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>>>>> n%20Severe%20TBI)
>>>>> (http://www.blinklist.com/index.php?Action=Blink/addblink.php&Url=http://us1.campaign-archive1.com/?u=dfb11326be59bc7f155536629&id=2
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>>>>> Severe%20TBI)
>>>>> (http://www.designfloat.com/submit.php?url=hhttp://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2012-April/ttp://us1.campaign-archive1.com/?u=dfb11326be59bc7f155536629&id=2b7d8ba540&title=Free%20Apri
>>>>> l%20Webinar:%20Assessment%20&%20Prognosis%20in%20Severe%20TBI)
>>>>> (http://www.webnews.de/einstellen?url=http://us1.campaign-archive1.com/?u=dfb11326be59b
>>>>> c7f155536629&id=2b7d8ba540&title=Free%20April%20Webinar:%20Assessment%20&%20
>>>>> Prognosis%20in%20Severe%20TBI)
>>>>>
>>>>> CME INFORMATION
>>>>>
>>>>> ____________________________________
>>>>> Please note that as of January 1st, 2012 Brain  Trauma Foundation is no
>>>>> longer accredited by  ACCME and cannot give out CME or CEU  credit.
>>>>>  _follow  on Twitter_
>>>>> (http://braintrauma.us1.list-manage1.com/track/click?u=dfb11326be59bc7f155536629&id=99e5738277&e=6a2a1ea4b3)
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>>>>> Copyright  ? 2012 The Brain Trauma Foundation, All rights  reserved.
>>>>> You have received this email  because you singed up to receive
>>>>> notifications from  The Brain Trauma Foundation at our site, an event,
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>>>>> directly and requested to be added.
>>>>> Our mailing address is:
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>>>>>
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>>>>>
>>>>>
>>>>>
>>>>> ------------------------------
>>>>>
>>>>> Message: 6
>>>>> Date: Thu, 12 Apr 2012 11:49:12 -0400
>>>>> From: "Gustavo E. Flores" <gflores911 at gmail.com>
>>>>> Subject: Fwd: Registration is Now Open for World Trauma Symposium
>>>>> To: "trauma-list at trauma.org" <trauma-list at trauma.org>
>>>>> Message-ID: <810E027E-7F8D-48F8-B6A1-4B1A5DA7CBE8 at gmail.com>
>>>>> Content-Type: text/plain;     charset=utf-8
>>>>>
>>>>>
>>>>>
>>>>>
>>>>>
>>>>> Begin forwarded message:
>>>>>
>>>>> From: World Trauma Symposium <WTS at events.cygnusb2bmail.com>
>>>>> Date: April 12, 2012 11:03:30 AM GMT-04:00
>>>>> To: <gustavo.flores at uccaribe.edu>
>>>>> Subject: Registration is Now Open for World Trauma Symposium
>>>>> Reply-To: World Trauma Symposium <emsexpo at cygnus.com>
>>>>>
>>>>>
>>>>>
>>>>> A new event from the creators of the world-renowned Prehospital Trauma
>>>>> Life Support Program (PHTLS), presenting the latest information on the
>>>>> care of prehospital trauma patients and global trends in trauma care
>>>>> from internationally recognized experts.
>>>>>
>>>>>
>>>>> The Symposium will bring together internationally recognized experts
>>>>> in prehospital trauma care. Norman McSwain, Jr., MD, FACS, will
>>>>> moderate the morning session, featuring:
>>>>> Ken Mattox, MD, FACS, discussing controversies in EMS
>>>>> Karim Brohi, MBBS, MD, FRCS (Eng), FRCA, discussing prehospital trauma
>>>>> care in the United Kingdom
>>>>> Michael Rotondo, MD, FACS, presenting Advanced Trauma Life Support and
>>>>> the work of the Committee on Trauma
>>>>> Frank Butler, Jr., MD, on Tactical Combat Casualty Care
>>>>> Lt. Col. Robert Mabry, MD, will provide the luncheon address: Military
>>>>> EMS and Disaster Medicine
>>>>>
>>>>> Jeff Guy, MD, MSc, MMHC, will moderate the afternoon session
>>>>> featuring:
>>>>> Steve Greisch, RN, presenting on EMS trauma care in the European Union
>>>>> Osvaldo Rois, MD, discussing EMS trauma care in Latin America
>>>>> Jeffrey Salomone, MD, FACS, NREMT-P, discussing current challenges in
>>>>> prehospital trauma care
>>>>> A panel debate on the hottest issues in prehospital trauma today
>>>>>
>>>>>
>>>>>
>>>>> Special discounts are available for those who register for the World
>>>>> Trauma Symposium and the three-day EMS World Expo core program.
>>>>>
>>>>> For complete details
>>>>> and to register,
>>>>> click here.
>>>>>
>>>>> ?2012 Cygnus Business Media - 801 Cliff Road East, Suite201,
>>>>> Burnsville, MN 55337 - 800.827.8009
>>>>>
>>>>>
>>>>>
>>>>> ------------------------------
>>>>>
>>>>> Message: 7
>>>>> Date: Thu, 12 Apr 2012 14:18:36 -0400
>>>>> From: "Gross, Ronald" <Ronald.Gross at baystatehealth.org>
>>>>> Subject: RE: ICU to ICU transfers: what is your policy?
>>>>> To: "'Trauma-List [TRAUMA.ORG]'" <trauma-list at trauma.org>
>>>>> Message-ID:
>>>>>       <D3B8664B81FCEF41B9679BF4FE9C723B06776B01F7 at bhsexc11.bhs.org>
>>>>> Content-Type: text/plain; charset="us-ascii"
>>>>>
>>>>> " I've heard trauma is a young man's game. Is there any truth to that?"
>>>>> Sadly, I am beginning to believe so!!
>>>>> Just back from teaching the TOPIC course in Savannah, and catching up
>>>>> on 2 weeks of service-related unread e-mails.
>>>>> I need a vacation BAD!
>>>>> R
>>>>>
>>>>> Ronald I. Gross, MD, FACS
>>>>> Associate Professor of Surgery, Tufts University School of Medicine
>>>>> Chief, Division of Trauma & Emergency Surgery Services
>>>>> Baystate Medical Center
>>>>> 759 Chestnut Street, Springfield, MA 01199
>>>>> Telephone: 413-794-4022  Fax: 413-794-0142
>>>>> ronald.gross at baystatehealth.org
>>>>>
>>>>>
>>>>> -----Original Message-----
>>>>> From: trauma-list-bounces at trauma.org
>>>>> [mailto:trauma-list-bounces at trauma.org] On Behalf Of Robert Smith
>>>>> Sent: Saturday, March 31, 2012 3:05 PM
>>>>> To: Trauma-List [TRAUMA.ORG]
>>>>> Subject: Re: ICU to ICU transfers: what is your policy?
>>>>>
>>>>> Ron,
>>>>>
>>>>> The bottom line is the podcast.
>>>>>
>>>>> You sound totally exhausted. I've heard trauma is a young man's game.
>>>>> Is there any truth to that?
>>>>>
>>>>>
>>>>>
>>>>> Thanks for thinking of us,
>>>>>
>>>>> Rob
>>>>>
>>>>>
>>>>>
>>>>> Robert Smith, MD, MPH
>>>>> Secretary War Dogs Making It HomeChair, Div Pre-hospital Care and
>>>>> Prevention (ret)
>>>>> Department of Trauma John H.Stroger Jr. Hospital of Cook County
>>>>> War Dogs - Making it home
>>>>> Tiny service dog heals Hampshire Marine - DailyHerald.com
>>>>> http://www.whereistheoutrage.net/wordpress/2012/03/20/interview-war-dogs-making-it-home
>>>>>
>>>>>
>>>>>
>>>>>
>>>>>
>>>>>
>>>>> On Mar 31, 2012, at 11:44 AM, Gross, Ronald wrote:
>>>>>
>>>>> You cannot justify transferring a patient from a higher level of care
>>>>> to a lesser level of care. You just can't.  On the other hand if the
>>>>> patient is on the floor and the level of care is basic then I could
>>>>> see the convenience transfer.....sometimes.
>>>>> Ron
>>>>>
>>>>> Sent from my iPhone
>>>>>
>>>>> On Mar 31, 2012, at 11:12 AM, "Caesar Ursic" <cmursic at gmail.com>
>>>>> wrote:
>>>>>
>>>>>> For those of you who work in designated/verified trauma centers:
>>>>>>
>>>>>> What is your official policy (or your opinion if there is no actual
>>>>>> policy
>>>>>> where you are) on the transfer of trauma patients from *your* ICU (at
>>>>>> a
>>>>>> trauma center) to another ICU at an outside hospital that is *not* a
>>>>>> trauma
>>>>>> center?  Obviously I am speaking of transfers for reasons *other*
>>>>>> than
>>>>>> provision of higher level of care, i.e. you are transferring for
>>>>>> non-medical reasons.  Perhaps the reason is that the family wants the
>>>>>> patient to be closer to home, or perhaps the patient belongs to a
>>>>>> hospital
>>>>>> plan that, for financial reasons, prefers its patients to be treated
>>>>>> at
>>>>>> specific participating institutions which are NOT designated trauma
>>>>>> centers.
>>>>>>
>>>>>> Is it an acceptable risk to the patient to transfer him/her ICU to
>>>>>> ICU when
>>>>>> there is no *medical* need to do so? Or should the transfer wait
>>>>>> until the
>>>>>> patient is downgraded to "floor status," based on improvement of
>>>>>> medical
>>>>>> condition and acuity?
>>>>>>
>>>>>> Many thanks,
>>>>>>
>>>>>> C. Ursic, MD
>>>>>> --
>>>>>> trauma-list : TRAUMA.ORG
>>>>>> To change your settings or unsubscribe visit:
>>>>>> hhttp://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2012-April/ttp://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
>>>>> communication in error and that any review, disclosure, dissemination,
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>>>>> site at http://baystatehealth.org.
>>>>> --
>>>>> trauma-list : TRAUMA.ORG
>>>>> To change your settings or unsubscribe visit:
>>>>> hhttp://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2012-April/ttp://www.trauma.org/index.php?/community/
>>>>>
>>>>> --
>>>>> trauma-list : TRAUMA.ORG
>>>>> To change your settings or unsubscribe visit:
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>>>>>
>>>>> ----------------------------------------------------------------------
>>>>> 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
>>>>> communication in error and that any review, disclosure, dissemination,
>>>>> distribution or copying of it or its contents is prohibited. If you
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>>>>> immediately or by telephone at 413-794-0000 and destroy all copies of
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>>>>> regarding Baystate Health's privacy policy, please visit our Internet
>>>>> site at http://baystatehealth.org.
>>>>>
>>>>>
>>>>> ------------------------------
>>>>>
>>>>> Message: 8
>>>>> Date: Fri, 13 Apr 2012 11:56:41 +0000
>>>>> From: "Bjorn, Pret" <pbjorn at emh.org>
>>>>> Subject: Emergency Department CT Scanner
>>>>> To: "'Trauma-List [TRAUMA.ORG]'" <trauma-list at trauma.org>
>>>>> Message-ID:
>>>>>       <C2A56A3BCB08F9449038815A21E9612E0A91CDCB at MARINA.me.emh.org>
>>>>> Content-Type: text/plain; charset="us-ascii"
>>>>>
>>>>> I think this may have been discussed recently, but I've been on & off
>>>>> the list for a few months, so sorry for any redundancy:
>>>>>
>>>>> Our ED is looking at some renovations, the most conspicuous of which is
>>>>> the acquisition of its own CT scanner adjacent to the trauma room.  Of
>>>>> course, trauma applications are getting all the attention; but such a
>>>>> machine would get plenty of use for strokes and acute abdomens and so
>>>>> forth.  It's a busy ED.
>>>>>
>>>>> The List has always been good about finding pros and cons for
>>>>> everything, and I'd appreciate all comments.  Who has brought scanners
>>>>> into their ED's, and what has been the practical upshot -- besides
>>>>> quicker (and perhaps more) scans?
>>>>>
>>>>> Pret Bjorn, RN
>>>>> EMMC Trauma Program
>>>>> Bangor, Maine USA
>>>>> -----------------------------------------------------------------------------------------------------------
>>>>> This email message, including any associated files, is for the sole use
>>>>> of the intended recipient(s)
>>>>> and may contain information that is confidential, privileged, or
>>>>> subject to copyright, trade secret
>>>>> or other protection. This message also may contain information
>>>>> protected by state and federal privacy
>>>>> laws that are enforced through serious civil and criminal sanctions.
>>>>> Any unauthorized review, use,
>>>>> disclosure, or distribution is prohibited. If you are not an intended
>>>>> recipient of this message,
>>>>> please notify the sender immediately by replying to this e-mail, and
>>>>> delete the original and all
>>>>> copies of this message from your computer or other device.
>>>>>
>>>>>
>>>>>
>>>>> ------------------------------
>>>>>
>>>>> Message: 9
>>>>> Date: Fri, 13 Apr 2012 07:56:42 -0500
>>>>> From: K Mattox <kmattox at aol.com>
>>>>> Subject: Re: Emergency Department CT Scanner
>>>>> To: "Trauma-List [TRAUMA.ORG]" <trauma-list at trauma.org>
>>>>> Cc: "Trauma-List [TRAUMA.ORG]" <trauma-list at trauma.org>
>>>>> Message-ID: <BBE75741-1B79-4E9B-9CCD-A969AD5FBA2E at aol.com>
>>>>> Content-Type: text/plain;     charset=us-ascii
>>>>>
>>>>> We actually have 3 ct scanners in the middle of and adjacent to Ed and
>>>>> shock rooms.   We love this arrangement but beware that it will be
>>>>> overly used because of its convenience
>>>>>
>>>>> k.
>>>>>
>>>>> Sent from my iPhone
>>>>>
>>>>> On Apr 13, 2012, at 6:56 AM, "Bjorn, Pret" <pbjorn at emh.org> wrote:
>>>>>
>>>>> I think this may have been discussed recently, but I've been on & off
>>>>> the list for a few months, so sorry for any redundancy:
>>>>>
>>>>> Our ED is looking at some renovations, the most conspicuous of which
>>>>> is the acquisition of its own CT scanner adjacent to the trauma room.
>>>>> Of course, trauma applications are getting all the attention; but such
>>>>> a machine would get plenty of use for strokes and acute abdomens and
>>>>> so forth.  It's a busy ED.
>>>>>
>>>>> The List has always been good about finding pros and cons for
>>>>> everything, and I'd appreciate all comments.  Who has brought scanners
>>>>> into their ED's, and what has been the practical upshot -- besides
>>>>> quicker (and perhaps more) scans?
>>>>>
>>>>> Pret Bjorn, RN
>>>>> EMMC Trauma Program
>>>>> Bangor, Maine USA
>>>>> -----------------------------------------------------------------------------------------------------------
>>>>> This email message, including any associated files, is for the sole
>>>>> use of the intended recipient(s)
>>>>> and may contain information that is confidential, privileged, or
>>>>> subject to copyright, trade secret
>>>>> or other protection. This message also may contain information
>>>>> protected by state and federal privacy
>>>>> laws that are enforced through serious civil and criminal sanctions.
>>>>> Any unauthorized review, use,
>>>>> disclosure, or distribution is prohibited. If you are not an intended
>>>>> recipient of this message,
>>>>> please notify the sender immediately by replying to this e-mail, and
>>>>> delete the original and all
>>>>> copies of this message from your computer or other device.
>>>>>
>>>>> --
>>>>> trauma-list : TRAUMA.ORG
>>>>> To change your settings or unsubscribe visit:
>>>>> hhttp://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2012-April/ttp://www.trauma.org/index.php?/community/
>>>>>
>>>>>
>>>>> ------------------------------
>>>>>
>>>>> Message: 10
>>>>> Date: Fri, 13 Apr 2012 18:02:15 -0400 (EDT)
>>>>> From: JJ <jjsurgmd at aol.com>
>>>>> Subject: Disaster Response
>>>>> To: trauma-list at trauma.org
>>>>> Message-ID: <8CEE7D83896038C-1260-15FAC at webmail-d058.sysops.aol.com>
>>>>> Content-Type: text/plain; charset="us-ascii"
>>>>>
>>>>>
>>>>> Colleagues,
>>>>>  I have been asked to review the clinical aspects of our level II
>>>>> trauma center here in Florida.  I would like to review what others have
>>>>> planned at their facilities if you would be so kind to share so that I
>>>>> can compare and contrast to what our current plans are.
>>>>>  thanks ,
>>>>>
>>>>> Jeffery L. Johnson, MD, FACS
>>>>> Bayfront Medical Center
>>>>> St Petersburg, Florida
>>>>>
>>>>>
>>>>>
>>>>>
>>>>>
>>>>>
>>>>>
>>>>>
>>>>> -----Original Message-----
>>>>> From: Richard Wigle MD FACS <rlwigle at yahoo.com>
>>>>> To: Trauma-List [TRAUMA.ORG] <trauma-list at trauma.org>
>>>>> Sent: Fri, Mar 16, 2012 10:23 am
>>>>> Subject: Re: TXA
>>>>>
>>>>>
>>>>> A US military review has recently shown results consistent with the
>>>>> CRASH2
>>>>> rial. I don't know anything about the meathodology
>>>>>
>>>>>  Wigle MD FACS FCCM
>>>>> sst Prof Surgery
>>>>> SUS
>>>>>
>>>>> ________________________________
>>>>> From: Ian Seppelt <seppelt at med.usyd.edu.au>
>>>>> o: trauma-list at trauma.org
>>>>> ent: Friday, March 16, 2012 12:38 AM
>>>>> ubject: Re: TXA
>>>>>
>>>>> lease elaborate, Ken! Are you saying that because a trial does not
>>>>> ncludes patients from the USA it is not valid? <grin>
>>>>> Need to be careful distinguishing methodological flaws (it was very
>>>>> ound methodologically) from questions about generalisability (most
>>>>> atients were in low and middle income countries, higher than expected
>>>>> verall mortality, many patients were not transfused, etc etc as
>>>>> iscussed previously on this list)/
>>>>> [Disclosure - I was a site investigator in CRASH2]
>>>>> Cheers, Ian
>>>>> On 16/03/12 1:52 PM, KMATTOX at aol.com wrote:
>>>>>  Be careful.        Many glitches in the  methodology of that trial.
>>>>> NO
>>>>>  ONE from the USA in the  trial.     The drug family has been around
>>>>> for a long
>>>>>  long  while in search of an indication.     If this drug should  work,
>>>>> it
>>>>>  should work as an antifibrinolytic..
>>>>>
>>>>>  k
>>>>>
>>>>>
>>>>>  In a message dated 3/15/2012 9:32:13 P.M. Central Daylight Time,
>>>>>  bryanboling at gmail.com writes:
>>>>>
>>>>>  Any have  any experience with using transexamic acid in trauma?
>>>>> Listened to
>>>>>  a  couple of podcasts today and going to look at the crash 2 trial.
>>>>>  Thinking
>>>>>  about writing a short paper about it for  school.
>>>>>  Thanks,
>>>>>  Bryan
>>>>>
>>>>>  Bryan Boling, RN, CCRN, CEN
>>>>>  DNP Student,  Acute Care Nurse Practitioner Program
>>>>>  University of  Kentucky
>>>>>  --
>>>>>  trauma-list : TRAUMA.ORG
>>>>>  To change your settings or  unsubscribe  visit:
>>>>>  hhttp://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2012-April/ttp://www.trauma.org/index.php?/community/
>>>>>
>>>>>  --
>>>>>  trauma-list : TRAUMA.ORG
>>>>>  To change your settings or unsubscribe visit:
>>>>>  hhttp://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2012-April/ttp://www.trauma.org/index.php?/community/
>>>>> --
>>>>> r Ian Seppelt FANZCA FCICM
>>>>> enior Specialist in Intensive Care Medicine
>>>>> epean Hospital, Penrith NSW
>>>>> ydney Medical School - Nepean, University of Sydney
>>>>> --
>>>>> rauma-list : TRAUMA.ORG
>>>>> o change your settings or unsubscribe visit:
>>>>> http://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2012-April/ttp://www.trauma.org/index.php?/community/
>>>>> -
>>>>> rauma-list : TRAUMA.ORG
>>>>> o change your settings or unsubscribe visit:
>>>>> http://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2012-April/ttp://www.trauma.org/index.php?/community/
>>>>>
>>>>>
>>>>>
>>>>> ------------------------------
>>>>>
>>>>> Message: 11
>>>>> Date: Fri, 13 Apr 2012 19:39:32 -0500
>>>>> From: "Dr. Alejandro Cabrera Esquenazi" <spe at prodigy.net.mx>
>>>>> Subject: RE: Disaster Response
>>>>> To: "'Trauma-List [TRAUMA.ORG]'" <trauma-list at trauma.org>
>>>>> Message-ID: <0EC21C545F454816A8D7F929CECA2357 at INSPIRON6400>
>>>>> Content-Type: text/plain; charset="us-ascii"
>>>>>
>>>>> You may find it interesting.
>>>>> Just adequate to your hospital, as we did.
>>>>>
>>>>> Regards.
>>>>>
>>>>>
>>>>> Alejandro Cabrera, M.D.
>>>>> Former ER Medical Director.
>>>>> Real San Jose Hospital
>>>>>
>>>>>
>>>>> -----Mensaje original-----
>>>>> De: trauma-list-bounces at trauma.org
>>>>> [mailto:trauma-list-bounces at trauma.org]
>>>>> En nombre de JJ
>>>>> Enviado el: Viernes, 13 de Abril de 2012 05:02 p.m.
>>>>> Para: trauma-list at trauma.org
>>>>> Asunto: Disaster Response
>>>>>
>>>>>
>>>>> Colleagues,
>>>>>  I have been asked to review the clinical aspects of our level II
>>>>> trauma
>>>>> center here in Florida.  I would like to review what others have
>>>>> planned at
>>>>> their facilities if you would be so kind to share so that I can compare
>>>>> and
>>>>> contrast to what our current plans are.
>>>>>  thanks ,
>>>>>
>>>>> Jeffery L. Johnson, MD, FACS
>>>>> Bayfront Medical Center
>>>>> St Petersburg, Florida
>>>>>
>>>>>
>>>>>
>>>>>
>>>>>
>>>>>
>>>>>
>>>>>
>>>>> -----Original Message-----
>>>>> From: Richard Wigle MD FACS <rlwigle at yahoo.com>
>>>>> To: Trauma-List [TRAUMA.ORG] <trauma-list at trauma.org>
>>>>> Sent: Fri, Mar 16, 2012 10:23 am
>>>>> Subject: Re: TXA
>>>>>
>>>>>
>>>>> A US military review has recently shown results consistent with the
>>>>> CRASH2
>>>>> rial. I don't know anything about the meathodology
>>>>>
>>>>>  Wigle MD FACS FCCM
>>>>> sst Prof Surgery
>>>>> SUS
>>>>>
>>>>> ________________________________
>>>>> From: Ian Seppelt <seppelt at med.usyd.edu.au>
>>>>> o: trauma-list at trauma.org
>>>>> ent: Friday, March 16, 2012 12:38 AM
>>>>> ubject: Re: TXA
>>>>>
>>>>> lease elaborate, Ken! Are you saying that because a trial does not
>>>>> ncludes patients from the USA it is not valid? <grin>
>>>>> Need to be careful distinguishing methodological flaws (it was very
>>>>> ound methodologically) from questions about generalisability (most
>>>>> atients were in low and middle income countries, higher than expected
>>>>> verall mortality, many patients were not transfused, etc etc as
>>>>> iscussed previously on this list)/
>>>>> [Disclosure - I was a site investigator in CRASH2]
>>>>> Cheers, Ian
>>>>> On 16/03/12 1:52 PM, KMATTOX at aol.com wrote:
>>>>>  Be careful.        Many glitches in the  methodology of that trial.
>>>>> NO
>>>>>  ONE from the USA in the  trial.     The drug family has been around
>>>>> for a
>>>>> long
>>>>>  long  while in search of an indication.     If this drug should  work,
>>>>> it
>>>>>  should work as an antifibrinolytic..
>>>>>
>>>>>  k
>>>>>
>>>>>
>>>>>  In a message dated 3/15/2012 9:32:13 P.M. Central Daylight Time,
>>>>>  bryanboling at gmail.com writes:
>>>>>
>>>>>  Any have  any experience with using transexamic acid in trauma?
>>>>> Listened
>>>>> to
>>>>>  a  couple of podcasts today and going to look at the crash 2 trial.
>>>>>  Thinking
>>>>>  about writing a short paper about it for  school.
>>>>>  Thanks,
>>>>>  Bryan
>>>>>
>>>>>  Bryan Boling, RN, CCRN, CEN
>>>>>  DNP Student,  Acute Care Nurse Practitioner Program
>>>>>  University of  Kentucky
>>>>>  --
>>>>>  trauma-list : TRAUMA.ORG
>>>>>  To change your settings or  unsubscribe  visit:
>>>>>  hhttp://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2012-April/ttp://www.trauma.org/index.php?/community/
>>>>>
>>>>>  --
>>>>>  trauma-list : TRAUMA.ORG
>>>>>  To change your settings or unsubscribe visit:
>>>>>  hhttp://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2012-April/ttp://www.trauma.org/index.php?/community/
>>>>> --
>>>>> r Ian Seppelt FANZCA FCICM
>>>>> enior Specialist in Intensive Care Medicine
>>>>> epean Hospital, Penrith NSW
>>>>> ydney Medical School - Nepean, University of Sydney
>>>>> --
>>>>> rauma-list : TRAUMA.ORG
>>>>> o change your settings or unsubscribe visit:
>>>>> http://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2012-April/ttp://www.trauma.org/index.php?/community/
>>>>> -
>>>>> rauma-list : TRAUMA.ORG
>>>>> o change your settings or unsubscribe visit:
>>>>> http://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2012-April/ttp://www.trauma.org/index.php?/community/
>>>>>
>>>>> --
>>>>> trauma-list : TRAUMA.ORG
>>>>> To change your settings or unsubscribe visit:
>>>>> hhttp://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2012-April/ttp://www.trauma.org/index.php?/community/
>>>>> -------------- next part --------------
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>>>>> Desc: not available
>>>>> URL:
>>>>> <http://list.mistral.net/pipermail/trauma-list/attachments/20120413/d8953a25/attachment.pdf>
>>>>> -------------- next part --------------
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>>>>> URL:
>>>>> <http://list.mistral.net/pipermail/trauma-list/attachments/20120413/d8953a25/attachment-0001.pdf>
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>>>>> URL:
>>>>> <http://list.mistral.net/pipermail/trauma-list/attachments/20120413/d8953a25/attachment-0002.pdf>
>>>>>
>>>>> ------------------------------
>>>>>
>>>>> --
>>>>> trauma-list : TRAUMA.ORG
>>>>> To change your settings or unsubscribe visit:
>>>>> hhttp://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2012-April/ttp://www.trauma.org/index.php?/community/
>>>>>
>>>>> End of trauma-list Digest, Vol 106, Issue 6
>>>>> *******************************************
>>>>
>>>> --
>>>> trauma-list : TRAUMA.ORG
>>>> To change your settings or unsubscribe visit:
>>>> hhttp://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2012-April/ttp://www.trauma.org/index.php?/community/
>>>> --
>>>> trauma-list : TRAUMA.ORG
>>>> To change your settings or unsubscribe visit:
>>>> hhttp://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2012-April/ttp://www.trauma.org/index.php?/community/
>>>--
>>>trauma-list : TRAUMA.ORG
>>>To change your settings or unsubscribe visit:
>>>hhttp://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2012-April/ttp://www.trauma.org/index.php?/community/
>>> --
>>> trauma-list : TRAUMA.ORG
>>> To change your settings or unsubscribe visit:
>>> hhttp://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2012-April/ttp://www.trauma.org/index.php?/community/
>>>
>>
>>
>>------------------------------
>>
>>--
>>trauma-list : TRAUMA.ORG
>>To change your settings or unsubscribe visit:
>>hhttp://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2012-April/ttp://www.trauma.org/index.php?/community/
>>
>>End of trauma-list Digest, Vol 106, Issue 14
>>********************************************
>
> --
> trauma-list : TRAUMA.ORG
> To change your settings or unsubscribe visit:
> hhttp://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2012-April/ttp://www.trauma.org/index.php?/community/


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