Trendelenburg (was RE: IVC Filters, Coumadin, Plavix, ASA, Fragmin)

[MARK FORREST]

Dear Rangraj,
The plastic, ENT and head & neck surgeons are generally asking for 'reverse trendelenburg' to reduce venous congestion, whereas shock and resuscitation remain something of a grey area for them!!
Regards
Mark


----- Original Message ----
From: Rangraj Setlur <rangraj at gmail.com>
To: "Trauma &, Critical Care mailing list" <trauma-list at trauma.org>
Sent: Friday, 19 January, 2007 1:36:19 AM
Subject: Re: Trendelenburg (was RE: IVC Filters, Coumadin, Plavix, ASA, Fragmin)


Dear Dr Middleton,
could you send me a copy as well? Just finished telling a plastic surgeon
the trndelenburg position was completely useless, he wanted references.
thanks.
rangraj

On 1/18/07, Paul Middleton <paul.middleton at usa.net> wrote:
>
> Ian
>
> Not sure if I can attach things to Trauma list emails so I have sent it to
> your work email.
>
> Regards
>
> Paul
>
>
> ------ Original Message ------
> *Received: *Thu, 18 Jan 2007 12:23:05 PM EST
> *From: *"Ian Seppelt" <SeppelI at wahs.nsw.gov.au>
> *To: *<trauma-list at trauma.org>
> *Subject: *Trendelenburg (was RE: IVC Filters, Coumadin, Plavix,ASA,
> Fragmin)
>
>
> Does anyone have access to Am J Crit Care who can send a pdf of this
> paper? [Still frustratingly common to see this done in general wards]
> Thanks, Ian
>
> Ian Seppelt FANZCA FJFICM
> Senior Staff Specialist
> Dept of Intensive Care Medicine
> The Nepean Hospital, PO Box 63 Penrith NSW 2751
> Clinical Lecturer, University of Sydney
>
> >>> pbjorn at emh.org 18/01/2007 6:10am >>>
> I PubMedded ["Trendelenburg Position" AND Shock] for the past ten
> years,
> yielding five references -- three of which were irrelevant and one of
> which was a survey. The last is abstracted below.
>
> The data seems to suggest that there's no data.
>
> Pret Bjorn, RN
> Bangor, ME USA
>
>
> Am J Crit Care. 2005 Sep;14(5):364-8. Links
> Use of the Trendelenburg position as the resuscitation position: to T
> or
> not to T?Bridges N, Jarquin-Valdivia AA.
> The Neurointensive Care Unit, Vanderbilt University Medical Center,
> Nashville, TN, USA.
>
> OBJECTIVE: To review the literature on use of the Trendelenburg
> position
> as a position for resuscitation of patients who are hypotensive.
> METHODS: PubMed online, cited bibliographies, critical care textbooks,
> and Advanced Cardiac Life Support guidelines were searched for
> information on the position used for resuscitation. Because of the
> heterogeneity of the data, only pertinent articles and chapters were
> summarized. RESULTS: Eight peer-reviewed publications on the position
> used for resuscitation were found. Pertinent information from 2
> critical
> care textbooks and from the Advanced Cardiac Life Support guidelines
> was
> included in the review. Literature on the position was scarce, lacked
> strength, and seemed to be guided by "expert opinion." CONCLUSION: The
> general "slant" of the available data seems to indicate that the
> Trendelenburg position is probably not a good position for
> resuscitation
> of patients who are hypotensive. Further clinical studies are needed
> to
> determine the optimal position for resuscitation.
>
>
> -----Original Message-----
> From: trauma-list-bounces at trauma.org
> [mailto:trauma-list-bounces at trauma.org] On Behalf Of Nappio at aol.com
> Sent: Wednesday, January 17, 2007 10:33 AM
> To: trauma-list at trauma.org
> Subject: Re: IVC Filters, Coumadin, Plavix,ASA, Fragmin
>
> Just yesterday, unrelated to this list, an orthopedic doc approached
> me
> with
> this very complaint that his pt said his primary had to stay on the
> drug
>
> forever with an IVC. In yet another example of antiquated
> interventions, I
> also arrived in my ICU to find my nurses had put my pt in
> Trendelenberg
> position
> which I thought was written out of text books. can someone please
> tell
> me
> the best reference for avoiding Trendelenberg, and for my ortho
> friend, can
> someone send the bundle of threads on the coumadin discussion to
> either
> my
> e-mail personally or repeat to the list,,thanks,,,Dave Nap,,,MD, FACS
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>
>
> Dr Paul Middleton RGN MBBS FRCS(Eng) DipIMCRCS(Ed) FCEM FACEM, Staff
> Specialist / Conjoint Senior Lecturer in Emergency Medicine, Public Health
> and Community Medicine POWH / UNSW Sydney NSW
>
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-- 
Lt Col Rangraj Setlur
Associate Professor
Department of Anaesthesiology and Critical Care
Armed Forces Medical College
Pune
India
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