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Home > List Archives

trauma-list Digest, Vol 143, Issue 7

John Hall jrhmdtraum at aol.com
Tue May 26 17:44:28 BST 2015


Errington

The government should have that data somewhere as it is reportable

Sent from my iPad
John R. Hall, M.D., F.A.C.S., F.C.C.M.
Professor of Surgery

> On May 26, 2015, at 9:03 AM, trauma-list-request at trauma.org wrote:
> 
> Send trauma-list mailing list submissions to
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> 
> Today's Topics:
> 
>   1. Re: Prehospital phase (Mike McEvoy)
>   2. Texas bikers in deadly shootout at Waco restaurant (Doc Holiday)
>   3. RE: Texas bikers in deadly shootout at Waco restaurant
>      (Errington C Thompson, MD)
>   4. Re: Prehospital phase (daniel.gerard at comcast.net)
>   5. RE: In the words of Queen... (Blueflightmedic)
>   6. RE: In the words of Queen... (Doc Holiday)
>   7. Seat Belts (Errington Thompson )
>   8. Re: Seat Belts (Charles Krin)
>   9. RE: Seat Belts (Errington Thompson )
>  10. RE: Seat Belts (Kate Warren)
>  11. Re: (listasmsd)
> 
> 
> ----------------------------------------------------------------------
> 
> Message: 1
> Date: Mon, 18 May 2015 00:01:28 -0400
> From: Mike McEvoy <mike.mcevoy at gmail.com>
> Subject: Re: Prehospital phase
> To: "Trauma-List [TRAUMA.ORG]" <trauma-list at trauma.org>
> Message-ID:
>    <CAMpxhKkPA7LhaVVCw5DdcckXrrOio3U_qWf+QfrM=aDCgHw7Sw at mail.gmail.com>
> Content-Type: text/plain; charset=UTF-8
> 
> I have seen several cases where Cyanokit has been helpful to patients in
> extremis. I fail to see the recent interest is adding the thiosulfate to
> this regimen.
> 
> Mike:)
> 
> On Monday, May 11, 2015, ??????? ??? - Rivkind Avi <AviR at hadassah.org.il>
> wrote:
> 
>> Could people please share their opinions or any data on giving sodium
>> thiosulphate 10%, 100 cc through IV, and Cyanokit (made by Merck) 5g also
>> via IV in the prehospital phase when distance from hospital is maximum half
>> hour? Many thanks.
>> 
>> 
>> Avraham Rivkind, M.D.,
>> Head, Division of Emergency Medicine
>> & Shock Trauma Unit
>> Hadassah Medical Center
>> P.O.B. 12000
>> Jerusalem, Israel, 91120
>> Phone: 972-2-6778800
>> Fax: 972-2-6449412
>> 
>> Email: avir at hadassah.org.il <javascript:;><
>> https://uk-mg42.mail.yahoo.com/compose?to=avir@hadassah.org.il>?
>> 
>> This Message confirms that this email message has been scanned by
>> Hadassah for the presence of malicious code, vandals & computer viruses.
>> --
>> trauma-list : TRAUMA.ORG
>> To change your settings or unsubscribe visit:
>> http://www.trauma.org/index.php?/community/
> 
> 
> -- 
> Mike McEvoy, PhD, RN, CCRN, NRP
> Cardiothoracic Surgery
> Albany Medical Center
> Albany, New York, USA
> 
> 
> ------------------------------
> 
> Message: 2
> Date: Mon, 18 May 2015 11:57:09 +0000
> From: Doc Holiday <drydok at hotmail.com>
> Subject: Texas bikers in deadly shootout at Waco restaurant
> To: ".Trauma List" <trauma-list at trauma.org>
> Message-ID: <DUB121-W4304C0467F68AD344D3199C0C40 at phx.gbl>
> Content-Type: text/plain; charset="iso-8859-1"
> 
> http://www.bbc.co.uk/news/world-us-canada-32776280
> 
> I know that there are quite a few Texans on this List... Hoping none of y'all are gang members...
> 
> But WOW!
> 
> 
> 
>                         
> 
> ------------------------------
> 
> Message: 3
> Date: Mon, 18 May 2015 08:05:18 -0400
> From: "Errington C Thompson, MD" <errington at erringtonthompson.com>
> Subject: RE: Texas bikers in deadly shootout at Waco restaurant
> To: "Trauma-List [TRAUMA.ORG]" <trauma-list at trauma.org>
> Message-ID: <l62mhu3g2e3clh8tw56lrmkg.1431950718998 at email.android.com>
> Content-Type: text/plain; charset=utf-8
> 
> Crazy violence.?
> 
> Errington C Thompson, MD?Director of Trauma Services?Marshall University?Sent from my cool DROID ?-------- Original message --------
> From: Doc Holiday <drydok at hotmail.com> 
> Date: 05/18/2015  07:57  (GMT-05:00) 
> To: ".Trauma List" <trauma-list at trauma.org> 
> Subject: Texas bikers in deadly shootout at Waco restaurant 
> 
> http://www.bbc.co.uk/news/world-us-canada-32776280
> 
> I know that there are quite a few Texans on this List... Hoping none of y'all are gang members...
> 
> But WOW!
> 
> 
> 
>            ??        ? 
> --
> trauma-list : TRAUMA.ORG
> To change your settings or unsubscribe visit:
> http://www.trauma.org/index.php?/community/
> 
> ------------------------------
> 
> Message: 4
> Date: Mon, 18 May 2015 17:56:22 +0000 (UTC)
> From: daniel.gerard at comcast.net
> Subject: Re: Prehospital phase
> To: "" <mike.mcevoy at gmail.com>, "" <trauma-list at trauma.org>
> Message-ID:
>    <381470519.10671450.1431971782959.JavaMail.zimbra at comcast.net>
> Content-Type: text/plain; charset="us-ascii"
> 
> An HTML attachment was scrubbed...
> URL: <http://list.mistral.net/pipermail/trauma-list/attachments/20150518/4853b8a5/attachment-0001.html>
> 
> ------------------------------
> 
> Message: 5
> Date: Mon, 18 May 2015 21:34:27 +0100
> From: "Blueflightmedic" <trauma at emergencyunit.com>
> Subject: RE: In the words of Queen...
> To: "'Trauma-List [TRAUMA.ORG]'" <trauma-list at trauma.org>
> Message-ID: <4908B269D430419DBA722B1FC35A7663 at RowleyTOSH>
> Content-Type: text/plain;    charset="us-ascii"
> 
> Paragraph, which says it all, has presumably been added at the end at the
> insistence of referees:
> 
> "The major limitation to this study is that it is a retrospective,
> nonrandomized study in which the administration of
> TXA is based on an attending trauma surgeon's belief that a
> patient is bleeding. This introduces selection bias into the results,
> as was seen in the fact that the TXA group was more
> severely injured. This leads to higher unadjusted morbidity
> and mortality rates. We attempted to mitigate this bias with a
> multivariate logistic regression analysis to adjust for anatomic
> and physiologic markers of injury severity. A second limitation
> is the small number of patients who received TXA (98 or
> 9.4%), which may increase our odds at failing to find a significant
> difference. Repeat r-TEG values within the first 6 hours
> were only available on 23% because of noncritical status or
> death at that time point. In addition, this is a single-center study
> in which a significant difference could be masked by other local
> institutional biases or standard treatments. Finally, the work
> currently being done on fibrinolysis shutdown suggests that
> organ dysfunction may be the sequelae of a thrombotic complication.
> 16 We have no data on the incidence of organ dysfunction
> in this cohort of patients."
> 
> Tantamount to admitting that they failed to create a controlled, randomised
> study, and that they failed to power the study adequately to make a Type 2
> error unlikely. I'm not sure this has added constructively to the debate.
> 
> -----Original Message-----
> From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
> On Behalf Of Gross, Ronald
> Sent: 15 May 2015 18:01
> To: Trauma-List [TRAUMA.ORG]
> Subject: RE: In the words of Queen...
> 
> Now you have it to read.........
> 
> Ronald I. Gross, MD, FACS
> Chief, Division of Trauma, Acute Care Surgery & Surgical Critical Care
> Baystate Medical Center
> Associate Professor of Surgery
> Tufts School of Medicine
> 759 Chestnut Street
> Springfield, MA 01199
> 413-794-4022
> ronald.gross at baystatehealth.org
> 
> 
> -----Original Message-----
> From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
> On Behalf Of Doc Holiday
> Sent: Friday, May 15, 2015 12:29 PM
> To: .Trauma List
> Subject: RE: In the words of Queen...
> 
> From: rfsmithmd at comcast.net> Much smarter people than me...
> 
> --> Ahh... I am from the OTHER group...
> 
>> ...why use unadjusted mortality when the two groups have a massive
> difference in ISS? It sounds like the sicker patients were the ones given
> TXA and the sicker patients died more often. Am I missing something?
> 
> --> I believe we are missing the article...
> 
> Abstracts tell us what the authors think about what they did... They are
> usually not completely wrong, but sometimes also not completely right. It
> would be better, as I have previously suggested to some editors, if
> abstracts were written by a team of experts who have read the study, but who
> have not participated in it, THEN the decision to publish or not...
> 
> I'll get some time and read this article... UNLESS someone else reads it
> before and finds out that it does, actually, do what you here have indicated
> it does... Which would be as much of a surprise as working out that people
> who punch brick walls get hurt more often than those who punch down
> pillows...
> 
> It APPEARS (again, pending reading the whole thing) that the use of a drug
> (TXA) when it's too late to use it (LY-30 >3% and hyperfibrinolysis) does
> not show a benefit among the worst off 10% of a cohort of patients and these
> sicker ones survive just as often as those who were not as sick... And
> thromboembolic complications are also not more prevalent with TXA...
> 
> I really think we should resist saying "duh!" until after reading the whole
> thing...
> 
> 
>                         
> --
> trauma-list : TRAUMA.ORG
> To change your settings or unsubscribe visit:
> http://www.trauma.org/index.php?/community/
> 
> ----------------------------------------------------------------------
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> 
> 
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> 
> 
> 
> ------------------------------
> 
> Message: 6
> Date: Tue, 19 May 2015 16:37:38 +0000
> From: Doc Holiday <drydok at hotmail.com>
> Subject: RE: In the words of Queen...
> To: ".Trauma List" <trauma-list at trauma.org>
> Message-ID: <DUB121-W18C5A632C28CA4827BDFB3C0C30 at phx.gbl>
> Content-Type: text/plain; charset="iso-8859-1"
> 
> Have not had time to read it all...
> Just skimmed...
> Beginning to wonder whether I should read it at all... Seems that at least the writers did have some insight into what they did and/or did not accomplish in terms of methodology...
> The number who received TXA did strike me as surprisingly small when I first scanned.
> I'll just keep an eye for now and perhaps, by the time I do have some free time this weekend, enough people will have sent messages similar to the one below to give the impression that I should not spend the time and, instead, do a BBQ or something...
> 
> 
> 
> 
>> From: trauma at emergencyunit.com
>> To: trauma-list at trauma.org
>> Subject: RE: In the words of Queen...
>> Date: Mon, 18 May 2015 21:34:27 +0100
>> 
>> Paragraph, which says it all, has presumably been added at the end at the
>> insistence of referees:
>> 
>> "The major limitation to this study is that it is a retrospective,
>> nonrandomized study in which the administration of
>> TXA is based on an attending trauma surgeon's belief that a
>> patient is bleeding. This introduces selection bias into the results,
>> as was seen in the fact that the TXA group was more
>> severely injured. This leads to higher unadjusted morbidity
>> and mortality rates. We attempted to mitigate this bias with a
>> multivariate logistic regression analysis to adjust for anatomic
>> and physiologic markers of injury severity. A second limitation
>> is the small number of patients who received TXA (98 or
>> 9.4%), which may increase our odds at failing to find a significant
>> difference. Repeat r-TEG values within the first 6 hours
>> were only available on 23% because of noncritical status or
>> death at that time point. In addition, this is a single-center study
>> in which a significant difference could be masked by other local
>> institutional biases or standard treatments. Finally, the work
>> currently being done on fibrinolysis shutdown suggests that
>> organ dysfunction may be the sequelae of a thrombotic complication.
>> 16 We have no data on the incidence of organ dysfunction
>> in this cohort of patients."
>> 
>> Tantamount to admitting that they failed to create a controlled, randomised
>> study, and that they failed to power the study adequately to make a Type 2
>> error unlikely. I'm not sure this has added constructively to the debate.
>                         
> 
> ------------------------------
> 
> Message: 7
> Date: Mon, 25 May 2015 13:15:32 -0400
> From: "Errington Thompson " <errington at erringtonthompson.com>
> Subject: Seat Belts
> To: "'Trauma-List [TRAUMA.ORG]'" <trauma-list at trauma.org>
> Cc: Critical Care <ccm-l at list.pitt.edu>
> Message-ID: <02cb01d0970e$685435f0$38fca1d0$@erringtonthompson.com>
> Content-Type: text/plain;    charset="UTF-8"
> 
> Happy Memorial Day. 
> 
> 
> 
> Does anyone have any data on seat belt failure rates? It is my impression that seat belts almost never fail but I really haven?t found any data to back up my impression. 
> 
> 
> 
> Thanks, 
> 
> 
> 
> Errington C. Thompson, MD, FACS, FCCM
> 
> Chief of Trauma Services
> 
> Marshall University
> 
> Website <http://www.erringtonthompson.com/> 
> 
> 
> 
> 
> 
> ------------------------------
> 
> Message: 8
> Date: Mon, 25 May 2015 13:54:18 -0500
> From: Charles Krin <cskrin2 at hughes.net>
> Subject: Re: Seat Belts
> To: "Trauma-List [TRAUMA.ORG]" <trauma-list at trauma.org>
> Message-ID: <55636FDA.3050603 at hughes.net>
> Content-Type: text/plain; charset=utf-8
> 
> Errington:
> 
> While I recall a (?60 Minutes) expose` on seat-belt latch failures back
> in the 1980s, the more common problem seems to be with rollover and
> other 3 dimensional crashes, and the failure of the inertial retractors
> to latch properly:
> 
> https://scholar.google.com/scholar?q=related:Ml4HV7VtLt4J:scholar.google.com/&hl=en&as_sdt=1,26
> 
> Chuck
> 
>> On 5/25/2015 12:15, Errington Thompson wrote:
>> Happy Memorial Day. 
>> 
>> 
>> 
>> Does anyone have any data on seat belt failure rates? It is my impression that seat belts almost never fail but I really haven?t found any data to back up my impression. 
>> 
>> 
>> 
>> Thanks, 
>> 
>> 
>> 
>> Errington C. Thompson, MD, FACS, FCCM
>> 
>> Chief of Trauma Services
>> 
>> Marshall University
>> 
>> Website <http://www.erringtonthompson.com/> 
>> 
>> 
>> 
>> --
>> trauma-list : TRAUMA.ORG
>> To change your settings or unsubscribe visit:
>> http://www.trauma.org/index.php?/community/
> 
> 
> 
> ------------------------------
> 
> Message: 9
> Date: Mon, 25 May 2015 15:33:44 -0400
> From: "Errington Thompson " <errington at erringtonthompson.com>
> Subject: RE: Seat Belts
> To: "'Trauma-List [TRAUMA.ORG]'" <trauma-list at trauma.org>
> Message-ID: <041c01d09721$b6a843a0$23f8cae0$@erringtonthompson.com>
> Content-Type: text/plain;    charset="UTF-8"
> 
> Did the Google Scholar search and really didn't find anything worth while. (Oops.) I did find an article that has some good numbers. 
> 
> Thanks!!!!
> 
> Errington C. Thompson, MD, FACS, FCCM
> Chief of Trauma Services
> Marshall University
> Website
> 
> -----Original Message-----
> From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] On Behalf Of Charles Krin
> Sent: Monday, May 25, 2015 2:54 PM
> To: Trauma-List [TRAUMA.ORG]
> Subject: Re: Seat Belts
> 
> Errington:
> 
> While I recall a (?60 Minutes) expose` on seat-belt latch failures back in the 1980s, the more common problem seems to be with rollover and other 3 dimensional crashes, and the failure of the inertial retractors to latch properly:
> 
> https://scholar.google.com/scholar?q=related:Ml4HV7VtLt4J:scholar.google.com/&hl=en&as_sdt=1,26
> 
> Chuck
> 
>> On 5/25/2015 12:15, Errington Thompson wrote:
>> Happy Memorial Day. 
>> 
>> 
>> 
>> Does anyone have any data on seat belt failure rates? It is my impression that seat belts almost never fail but I really haven?t found any data to back up my impression. 
>> 
>> 
>> 
>> Thanks,
>> 
>> 
>> 
>> Errington C. Thompson, MD, FACS, FCCM
>> 
>> Chief of Trauma Services
>> 
>> Marshall University
>> 
>> Website <http://www.erringtonthompson.com/>
>> 
>> 
>> 
>> --
>> trauma-list : TRAUMA.ORG
>> To change your settings or unsubscribe visit:
>> http://www.trauma.org/index.php?/community/
> 
> --
> trauma-list : TRAUMA.ORG
> To change your settings or unsubscribe visit:
> http://www.trauma.org/index.php?/community/
> 
> 
> 
> ------------------------------
> 
> Message: 10
> Date: Mon, 25 May 2015 13:39:17 -0700
> From: "Kate Warren" <traumadocs at cox.net>
> Subject: RE: Seat Belts
> To: "'Trauma-List [TRAUMA.ORG]'" <trauma-list at trauma.org>
> Message-ID: <003601d0972a$df1a7ca0$9d4f75e0$@net>
> Content-Type: text/plain;    charset="utf-8"
> 
> http://www.hkllp.com/seatbelt-failure/
> 
> While this is from a PI firm and doesn't have any hard stats it does explain some very faulty belts and latches. Might be worth checking out your POV to see what type of device it has installed. With 4 small kids I am especially interested as our laws in CA (California)are pretty strict for kids.
> 
> -----Original Message-----
> From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] On Behalf Of Errington Thompson 
> Sent: Monday, May 25, 2015 10:16 AM
> To: 'Trauma-List [TRAUMA.ORG]'
> Cc: Critical Care
> Subject: Seat Belts
> 
> Happy Memorial Day. 
> 
> 
> 
> Does anyone have any data on seat belt failure rates? It is my impression that seat belts almost never fail but I really haven?t found any data to back up my impression. 
> 
> 
> 
> Thanks, 
> 
> 
> 
> Errington C. Thompson, MD, FACS, FCCM
> 
> Chief of Trauma Services
> 
> Marshall University
> 
> Website <http://www.erringtonthompson.com/> 
> 
> 
> 
> --
> trauma-list : TRAUMA.ORG
> To change your settings or unsubscribe visit:
> http://www.trauma.org/index.php?/community/
> 
> 
> 
> ------------------------------
> 
> Message: 11
> Date: Tue, 26 May 2015 08:18:24 -0430
> From: "listasmsd" <listasmsd at gmail.com>
> Subject: Re:
> To: "Trauma-List [TRAUMA.ORG]" <trauma-list at trauma.org>
> Message-ID: <463C0AEB8EC74C179ED28379EA04544B at HP>
> Content-Type: text/plain; charset="utf-8"
> 
> What a Memorial Day stands for: ....in USA had their people fought wars to 
> preserve their Nations Rights written in the Constitution. The Commemoration 
> started after the American Civil war (a war to stop slavery). From then on 
> is used to commemorate the American soldiers deaths in any event. To 
> families that lost their love ones is a moment of remembrance. These are 
> more or less the words of my professor of American Culture Course way back 
> when I went to college and a classmate saluted him with a happy Memorial 
> day. Most Nations that have fought in wars have their memorial day too.
> Best regards
> Manuel Sotelo
> Caracas, Venezuela
> In modern days is when summer time starts in the USA and also it the time of 
> "saving specials" in the stores.
> 
> 
> 
> 
> Why You Should Never Wish Anyone a 'Happy Memorial Day'
> 
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> 
> ------------------------------
> 
> --
> trauma-list : TRAUMA.ORG
> To change your settings or unsubscribe visit:
> http://www.trauma.org/index.php?/community/
> 
> End of trauma-list Digest, Vol 143, Issue 7
> *******************************************


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