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Home > Case Presentation

Initial chest x-ray

Intraoperative injury site control

Comments

On 08/09/2010, Doggie Schnauzer commented:

I have an idea for a piece of medical equipment.

This has no bearing on this case.

When you have a severe trauma patient in a resus room or O.R, he is losing blood fast, and you have to send blood off for cross match and typing. During this time the patient is losing blood, while Type O negative blood is efficient—in about fifty percent of patients. The other fifty percent, it will have a negative effect on the patient. If you could take a drain and insert an I.V. and have the drain tube inserted into the drain. The blood would then be filtered and be put back into the patient.

While this would not replace O negative blood as an intervention measure, it would be safer then O negative blood, because if you place a patient’s own blood back into him, there is little to no chance of rejection.

If this has already been done, please tell me and give me your thoughts.

—Thanks!

On 08/16/2010, Doggie Schnauzer commented:

I would like to make a correction on a typo I made when i typed this, i meant to put ‘insert the drain tube in to the I.V’. I got distracted and typed the wrong thing sorry.

             

-thanks

On 08/25/2010, Dr Chughtai commented:

i think there are devices which filters off ones own blood and then re transfuse it , even in trauma setting .... this has been done before.U can donate ur own blood and re use it on an elective case too !

On 08/26/2010, Doggie Schnauzer commented:

ok thanks.

where did you go to medical school?


where do you practice?

On 08/27/2010, Dr Chughtai commented:

army medical college pakistan
college of physian and surgeons , pakistan
doing my fellow ship in general surgery

Here is a good study

Stowell CP, Giordano GF, Kiss J, Renner SW,
Weiskopf RB, Thurer R. Guidelines for blood recovery
and reinfusion in surgery and trauma. American
Association of Blood Banks Autologous Transfusion
Committee. 1997

On 08/27/2010, Dr Chughtai commented:

Davies JM, Aston DLA. Evaluation to assess the Donor
pre-evacuated postoperative autologous blood reinfusion
system. Trans Med 2002 ; 12 : 38-39.

On 08/31/2010, Lori Medic commented:

If I may interject I hope you find this useful: When I worked on the trauma team we set up an autotransfuser with every chest tube. It was essentially an IV bag that attached to the chest tube drain in the case of a hemothorax. If we collected enough blood from the chest we could turn the bag over and it would connect directly to the IV drip set. In the 2 years I worked with the device, we set it up on every chest tube, but never collected enough blood to use it. Hope this helps.

On 09/03/2010, Doggie Schnauzer commented:

I am doing a study of trauma care for a thesis and am having trouble getting data, so any interesting cases you have would be most welcome.


thanks

On 09/03/2010, Dr Chughtai commented:

yesterday , had a case in Emergency

24yrs male , h/o gun shot abdomen 15 mins ago

(2 bullets,  one entererd posteriorly from back ,  at lvl umblicus 3 cm lt of mid line , exit anteriorly to the left of root of penis , other 3 cm lt of umblicus anteriorly , exiting in lt mid buttock posteriorly),

Px in apnic state , unconsious , GCS 3/15 , no pulses palpable , no BP recordable , Pupils fixed and dilated but on auscultation had cardiac activity !!Abdomen was distended and as i pressed it , blood was oozing out of it.

Passed ETT , Started ventilation with 100 % O2 , took 16 G double iv access rushed in fluids , got ecg showing normal cardiac rhythum with 100 b/m tachycardia !

I opened the abdomen , packed with a big sheet i could find , shifted him to Emergency OT.Pt went in cardiac arrest , i started CPR and he was resuscitated with sinus rhythum and some respiratory effort.It took 4 o -ve blood 2 lts r/l ans 1 ltr heamaceal and took 20 miniutes.

Then my consultant and anasthetist took over from here.Ionotropics started , CVP and foleys passed.Abdomen explored via mid line.Right colon mobilized and duodenum kockerized , IVC exposed , rent found in infrarenal IVC 3x3 cm , rent in internal illiac 2x2 cm , perforation in sigmoid and 2 perf in terminal illeum.

On table he while manipulations went into arrest again.We tried to resuscitated but were unable to.The body wass then shifted to mortuary.

I would like to have critical analysis of the managemant done .Thanks

On 09/03/2010, Doggie Schnauzer commented:

It sounds like you did everything you could, but he was to far gone when you got to him.

What was the time from when he arrived in the er to when he died?.

On 09/04/2010, Dr Chughtai commented:

arrived at 1 11 pm death at 2 30 pm

On 09/12/2010, Doggie Schnauzer commented:

okay thanks.

do you know if there was a history of alcohol or drugs?

On 09/12/2010, Dr Chughtai commented:

no

On 09/21/2010, Doggie Schnauzer commented:

I have never heard of a gcs of 3 no pulses palpable but with cardiac activity

On 09/21/2010, Dr Chughtai commented:

I cant make u believe but i have seen it my self ...... from my own eyes .!

On 09/22/2010, Doggie Schnauzer commented:

I believe you i was just saying its unusual.

On 11/10/2010, crashlann commented:

Actually pulseless arrest trauma pts with Cardiac activity on US is not that uncommon. Often found with our Tension Ptx. and Cardiac Tamponade pts.

On 12/10/2010, GladyNealious commented:

Yes, this is really very unusual.

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