adrenal insufficiency
Hardcastle, Tim, Dr <tch at sun.ac.za>
tch at sun.ac.za
Wed May 23 14:53:35 BST 2007
MLS
As a fellow SA provider and one with both pre- and in-hospital experience: Adrenalin is for use in CARDIAC ARREST, not trauma! If you start an adrenalin infusion for a trauma with a trunkal injury and don't restrict the fluids, most EMS providers here will tell you you are not practising good quality EMS!
Having said that, I suspect you've missed the point of the discussion: Adrenal insufficiency is a problem in the ICU post major trauma where the adrenal gland does not respond to the ACTH stimulus from the brain. Many factors are associated with this phenomenon: severe shock (prolonged), certain drugs - notably Etomidate in SEPTIC shoxck patients and possibly in head injury (not conclusive). It has nothing to do with giving adrenalin bolus or infusion.
Hope this helps; feel free to mail me off-list if you need more local info.
Tim
Dr T C Hardcastle
M.B.,Ch.B.(Stell); M.Med(Chir); FCS(SA)
Senior Surgeon / Senior Lecturer: Surgery (Trauma and ICU)
ATLS instructor and DSTC Cape Town Course Director
Intern program Coordinator: Surgery
M.Med (Emergency Medicine) Executive Committee member
Clinical Head (Director): Diana Princess of Wales Trauma Unit
Division of Surgery (General) Room 4064
Department of Surgical Sciences
Tygerberg Hospital / University of Stellenbosch
PO Box 19063
Tygerberg 7505
Western Cape
South Africa
e-mail: tch at sun.ac.za
Cell: +27824681615
Office: +27219389281 or 4911 pager 0302
-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org]On Behalf Of mls at webmail.co.za
Sent: Wednesday, May 23, 2007 10:30 AM
To: trauma-list at trauma.org
Subject: adrenal insufficiency
I happen to be paramedic in South Africa, we use adrenalin in the
prehospital setting, however some poeple say we over use to it,they say we
use it to do the hand over with a patient still having a pulse.
What I will like to know is(from any one who has expirience in the field)
when would you say we shouldnt use adrenalin and when do think we should,
incase when a patient is in cardaic arrest, we should test whether it is
sufficient in the BC,what do you think.
>
> ----------------------------------------------------------------------
>
> Message: 1
> Date: Tue, 22 May 2007 10:24:47 -0400
> From: "Hall, John R" <John_R_Hall at Wellmont.org>
> Subject: RE: adrenal insufficiency
> To: "Trauma & Critical Care mailing list" <trauma-list at trauma.org>
> Message-ID:
> <79561B43C52DBC4C9C74FEF221B12331017E8660 at whsnt15.wmdomain1.wellmont.org>
>
> Content-Type: text/plain; charset="iso-8859-1"
>
> An easy way to "check" for adrenal insufficiency is to look at the eos on
> your WBC. If the person is "normal", they should be suppressed due to
> adrenal steroids (usually elevated post shock, icu, etc). If they are
> elevated, it is almost diagnostic for adrenal insufficiency in the ICU
> (barring a few zebras)
> j
>
> ________________________________
>
> From: trauma-list-bounces at trauma.org on behalf of Rangraj Setlur
> Sent: Tue 5/15/2007 9:15 AM
> To: Trauma &, Critical Care mailing list
> Subject: Re: adrenal insufficiency
>
>
>
> I'm sure it exists, but theres also the possibility that what being seen
> is
> vasopressin deficiency.
> rangraj
> On 5/13/07, Roy Danks <roydanks at hotmail.com> wrote:
>>
>> Absolutely...low flow state. Without a doubt. well described in the
>> acute burn patient as well.
>>
>> RD
>>
>>
>>
>> > Date: Sun, 13 May 2007 14:12:31 +0100> From: kazakosgm at yahoo.gr> To:
>> trauma-list at trauma.org> Subject: adrenal insufficiency> > Dear all,> I'd
>> like to ask if any of you have ever suspected relative adrenal
>> insufficiency
>> after profound hemorrhagic shock (even if you didn't administered
>> steroids).
>> Thank you in advance, > George M. Kazakos DVM, PhD.> > > George M.
>> Kazakos
>> DVM, PhD, > Anesthesia and Intensive Care Unit, > Companion Animal
>> Clinic, >
>> Dept. Clinical Sciences, > Faculty of Veterinary Medicine, > Aristotle
>> University of Thessaloniki, > 11 St. Voutyra str., > 54627 Thessaloniki,
>> >
>> Greece> > ---------------------------------> ?????????????? Yahoo!>
>> ?????????? ?? ?????????? ???? ???? (spam); ?? Yahoo! Mail ???????? ???
>> ???????? ?????? ????????? ???? ??? ??????????? ????????? >
>> http://login.yahoo.com/config/mail?.intl=gr > --> trauma-list :
>> TRAUMA.ORG>
>> To change your settings or unsubscribe visit:>
>> http://www.trauma.org/index.php?/community/
>> _________________________________________________________________
>> Create the ultimate e-mail address book. Import your contacts to Windows
>> Live Hotmail.
>>
>> www.windowslive-hotmail.com/learnmore/managemail2.html?locale=en-us&ocid=TXT_TAGLM_HMWL_reten_impcont_0507--
>> trauma-list : TRAUMA.ORG
>> To change your settings or unsubscribe visit:
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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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> ------------------------------
>
> Message: 2
> Date: Tue, 22 May 2007 20:35:16 +0530
> From: "Rangraj Setlur" <rangraj at gmail.com>
> Subject: Re: adrenal insufficiency
> To: "Trauma &, Critical Care mailing list" <trauma-list at trauma.org>
> Message-ID:
> <60fef5240705220805x23306704yee62a583fdfbff27 at mail.gmail.com>
> Content-Type: text/plain; charset=ISO-8859-1; format=flowed
>
> Dr Hall, thats a fascinating statement. Do you have any references which
> back that up? what level of eosinophils would you consider as elevated in
> a
> setting of sepsis? we do differentials for eosinophilia in india because
> of
> tropical eosinophilia, but i'd never thought of looking specifically at
> eosinophils in this setting.
> thanks,
> rangraj
>
> On 5/22/07, Hall, John R <John_R_Hall at wellmont.org> wrote:
>>
>> An easy way to "check" for adrenal insufficiency is to look at the eos
>> on
>> your WBC. If the person is "normal", they should be suppressed due to
>> adrenal steroids (usually elevated post shock, icu, etc). If they are
>> elevated, it is almost diagnostic for adrenal insufficiency in the ICU
>> (barring a few zebras)
>> j
>>
>> ________________________________
>>
>> From: trauma-list-bounces at trauma.org on behalf of Rangraj Setlur
>> Sent: Tue 5/15/2007 9:15 AM
>> To: Trauma &, Critical Care mailing list
>> Subject: Re: adrenal insufficiency
>>
>>
>>
>> I'm sure it exists, but theres also the possibility that what being seen
>> is
>> vasopressin deficiency.
>> rangraj
>> On 5/13/07, Roy Danks <roydanks at hotmail.com> wrote:
>> >
>> > Absolutely...low flow state. Without a doubt. well described in the
>> > acute burn patient as well.
>> >
>> > RD
>> >
>> >
>> >
>> > > Date: Sun, 13 May 2007 14:12:31 +0100> From: kazakosgm at yahoo.gr> To:
>> > trauma-list at trauma.org> Subject: adrenal insufficiency> > Dear all,>
>> I'd
>> > like to ask if any of you have ever suspected relative adrenal
>> insufficiency
>> > after profound hemorrhagic shock (even if you didn't administered
>> steroids).
>> > Thank you in advance, > George M. Kazakos DVM, PhD.> > > George M.
>> Kazakos
>> > DVM, PhD, > Anesthesia and Intensive Care Unit, > Companion Animal
>> Clinic, >
>> > Dept. Clinical Sciences, > Faculty of Veterinary Medicine, > Aristotle
>> > University of Thessaloniki, > 11 St. Voutyra str., > 54627
>> Thessaloniki,
>> >
>> > Greece> > ---------------------------------> ?????????????? Yahoo!>
>> > ?????????? ?? ?????????? ???? ???? (spam); ?? Yahoo! Mail ???????? ???
>> > ???????? ?????? ????????? ???? ??? ??????????? ????????? >
>> > http://login.yahoo.com/config/mail?.intl=gr > --> trauma-list :
>> TRAUMA.ORG>
>> > To change your settings or unsubscribe visit:>
>> > http://www.trauma.org/index.php?/community/
>> > _________________________________________________________________
>> > Create the ultimate e-mail address book. Import your contacts to
>> Windows
>> > Live Hotmail.
>> >
>> >
>> www.windowslive-hotmail.com/learnmore/managemail2.html?locale=en-us&ocid=TXT_TAGLM_HMWL_reten_impcont_0507--
>> > trauma-list : TRAUMA.ORG
>> > To change your settings or unsubscribe visit:
>> > http://www.trauma.org/index.php?/community/
>> >
>>
>>
>>
>> --
>> Lt Col Rangraj Setlur
>> Associate Professor
>> Department of Anaesthesiology and Critical Care
>> Armed Forces Medical College
>> Pune
>> India
>>
>>
>>
>> --
>> trauma-list : TRAUMA.ORG
>> To change your settings or unsubscribe visit:
>> http://www.trauma.org/index.php?/community/
>>
>>
>
>
> --
> Lt Col Rangraj Setlur
> Associate Professor
> Department of Anaesthesiology and Critical Care
> Armed Forces Medical College
> Pune
> India
>
>
> ------------------------------
>
> Message: 3
> Date: Tue, 22 May 2007 12:47:36 -0400
> From: "William Bromberg" <brombwi1 at memorialhealth.com>
> Subject: RE: [ccm-l] "Sicko" premise
> To: "Trauma & Critical Care mailing list" <trauma-list at trauma.org>
> Message-ID: <4652E6680200003A00002BB2 at memorialhealth.com>
> Content-Type: text/plain; charset=US-ASCII
>
> Seriously, how many times do you have to sniff dog dirt to make a fairly
> solid prediction that the next pile STILL won't smell like roses.
>
> William J. Bromberg, MD, FACS
> Chair, EAST Practice Management Guidelines Committee
> Savannah Surgical Group
> 912 350-7412
>
>>>> "Thomas Anthony Horan" <thoran at sarah.br> 05/21/07 6:12 PM >>>
> Charles,
>
> What a treat this topic has been, a forcefull K diatriabe against a movie
> he has not seen, supported by someone who never will.
>
> Such arrogance leaves me in awe.
>
> Tom
>
>> ----------
>> From:
>> trauma-list-bounces at trauma.org[SMTP:trauma-list-bounces at trauma.org] on
>> behalf of KMATTOX at aol.com[SMTP:KMATTOX at aol.com]
>> Reply To: Trauma & Critical Care mailing list
>> Sent: segunda-feira, 21 de maio de 2007 16:48
>> To: trauma-list at trauma.org
>> Subject: Re: [ccm-l] "Sicko" premise
>>
>>
>> In a message dated 5/21/2007 12:03:09 P.M. Central Daylight Time,
>> c_brault at yahoo.com writes:
>>
>>
>> Especialyinthe sensethatthe USAas a disproportionate
>> problem with:
>> drinking while driving, drug misuse, availability of guns and other
>> weapons
>> especially when there is a mxture of ETOH, drugs, and excitement,
>> driving
>> fast, etc.
>>
>>
>>
>> We can all learn a valuable lesson from Australia.
>>
>> k
>>
>>
>>
>> ************************************** See what's free at
>> http://www.aol.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: 4
> Date: Tue, 22 May 2007 18:49:18 +0200 (SAST)
> From: mls at webmail.co.za
> Subject: Re: trauma-list Digest, Vol 47, Issue 26
> To: trauma-list at trauma.org
> Message-ID:
> <43460.196.21.60.122.1179852558.squirrel at mail.webmail.co.za>
> Content-Type: text/plain;charset=iso-8859-1
>
> Do you think it possible to get these (fluid warmers) in all the ESV
> (emergency service vehicle)? If hypothermia can be prevented by having
> them, why not have them.
>
>
>
>
>
>
>
>
>>
>> Today's Topics:
>>
>> 1. Re: Level I Fluid Warmer (Ronald Gross)
>> 2. RE: Level I Fluid Warmer (trauma at emergencyunit.com)
>> 3. Re: Level 1 Fluid Infusor (KMATTOX at aol.com)
>> 4. Level I Fluid Warmer (bensonblues at comcast.net)
>> 5. RE: Level I Fluid Warmer (Hardcastle, Tim, Dr <tch at sun.ac.za>)
>> 6. Re: Herniaion of Lung (Ronald Gross)
>>
>>
>> ----------------------------------------------------------------------
>>
>> Message: 1
>> Date: Fri, 18 May 2007 11:47:15 -0400
>> From: "Ronald Gross" <Rgross at harthosp.org>
>> Subject: Re: Level I Fluid Warmer
>> To: "Trauma & Critical Care mailing list" <trauma-list at trauma.org>
>> Message-ID: <464D9243.7FF1.00B9.0 at harthosp.org>
>> Content-Type: text/plain; charset=US-ASCII
>>
>> Truth be told, not only have both modes of therapy (high volume infusion
>> and permissive hypotension) been questioned, but depending on who you
>> read, they have actually been felt to be detrimental to the patient.
>> Hmmmmm........................
>>
>>>>> MARK FORREST <atacc.doc at btinternet.com> 5/17/2007 2:15 PM >>>
>> Ron....remember that high volume crystalloid is still not scientifically
>> proven either!!!!
>> Mark F
>> UK
>>
>>
>> ----- Original Message ----
>> From: Ronald Gross <Rgross at harthosp.org>
>> To: trauma-list at trauma.org
>> Sent: Thursday, 17 May, 2007 2:38:00 PM
>> Subject: Re: Level I Fluid Warmer
>>
>>
>> Larry,
>> Remember that talk is cheap - and with "all the talk of permissive
>> hypotention" that practice is still not universally accepted nor
>> scientifically proven......(sorry, Ken).
>> Ron
>>
>>>>> <ofiara at comcast.net> 5/16/2007 12:22 PM >>>
>> Yes, a Level One Fluid warmer or any type of fluid warmer has it's
>> place.
>> The question is, does a RAPID INFUSER have a place in the trauma
>> setting.
>> With all the talk of permiisve hypotention, I see a limited use in the
>> E.D.
>> Larry Ofiara, RN.
>>
>> -------------- Original message --------------
>> From: "Connie Potter" <Connie at traumafoundation.org>
>>
>>>
>>> Although a Level I may be a coat rack in temperate climates, in icy
>>> cold
>>> rural OR they saved more than one patient's bacon. The ED, OR had the
>>> same equipment saving time to transfer the patient and administer
>>> PRBC's, the tubing snaps in quite easily (compared to some of the old
>>> warmers), and little training was required to get them in use.
>>> Remember, other parts of the US have what is called WINTER!
>>>
>>> Connie Potter,
>>>
>>>
>>> --
>>> 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/
>>
>> Confidentiality Notice
>>
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>> To change your settings or unsubscribe visit:
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>>
>> Confidentiality Notice
>>
>> This e-mail message, including any attachments, is for the sole use of
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>>
>> ------------------------------
>>
>> Message: 2
>> Date: Fri, 18 May 2007 19:03:36 +0100
>> From: <trauma at emergencyunit.com>
>> Subject: RE: Level I Fluid Warmer
>> To: "'Trauma & Critical Care mailing list'"
>> <trauma-list at trauma.org>
>> Message-ID: <003c01c79976$dbe18890$0301a8c0 at vaio>
>> Content-Type: text/plain; charset="US-ASCII"
>>
>> What nonsense. It is impossible to get control of many types of pelvis
>> fracture (such as the vertical shear) and so you have to give fluid to
>> these
>> patients or they exsanguinate into the pelvis. Remember - it's a bucket,
>> and
>> the bigger the bucket the more it holds. The problem comes when the
>> patient
>> gets given the wrong fluid. What the trauma patient needs is blood. What
>> most get is erythrocytes suspended in clotting-agent free mannitol
>> solution.
>> If we give our patients proper fresh blood - mirabile dictu, clot forms.
>> And
>> keeps forming. We have let the haematologists persuade us that they can
>> take
>> everything useful out of a bag of blood and we can give it as though it
>> is
>> blood.
>>
>> And we keep giving the rubbish. Surprise, surprise, 4 units later there
>> is
>> ooze everywhere, and 2 days later a dead patient.
>>
>> BFM.
>>
>>
>> -----Original Message-----
>> From: trauma-list-bounces at trauma.org
>> [mailto:trauma-list-bounces at trauma.org]
>> On Behalf Of Aruni Sen
>> Sent: 18 May 2007 11:43
>> To: Trauma & Critical Care mailing list
>> Subject: RE: Level I Fluid Warmer
>>
>>
>> Volume is serious bad news in pelvis because the bleeding needs longer
>> time
>> to clot.
>>
>> -----Original Message-----
>> From: trauma-list-bounces at trauma.org
>> [mailto:trauma-list-bounces at trauma.org]
>> On Behalf Of MARK FORREST
>> Sent: 17 May 2007 19:15
>> To: Trauma & Critical Care mailing list
>> Subject: Re: Level I Fluid Warmer
>>
>> Ron....remember that high volume crystalloid is still not scientifically
>> proven either!!!! Mark F UK
>>
>>
>> ----- Original Message ----
>> From: Ronald Gross <Rgross at harthosp.org>
>> To: trauma-list at trauma.org
>> Sent: Thursday, 17 May, 2007 2:38:00 PM
>> Subject: Re: Level I Fluid Warmer
>>
>>
>> Larry,
>> Remember that talk is cheap - and with "all the talk of permissive
>> hypotention" that practice is still not universally accepted nor
>> scientifically proven......(sorry, Ken). Ron
>>
>>>>> <ofiara at comcast.net> 5/16/2007 12:22 PM >>>
>> Yes, a Level One Fluid warmer or any type of fluid warmer has it's
>> place.
>> The question is, does a RAPID INFUSER have a place in the trauma
>> setting.
>> With all the talk of permiisve hypotention, I see a limited use in the
>> E.D.
>> Larry Ofiara, RN.
>>
>> -------------- Original message --------------
>> From: "Connie Potter" <Connie at traumafoundation.org>
>>
>>>
>>> Although a Level I may be a coat rack in temperate climates, in icy
>> cold
>>> rural OR they saved more than one patient's bacon. The ED, OR had the
>>> same equipment saving time to transfer the patient and administer
>>> PRBC's, the tubing snaps in quite easily (compared to some of the old
>>> warmers), and little training was required to get them in use.
>>> Remember, other parts of the US have what is called WINTER!
>>>
>>> Connie Potter,
>>>
>>>
>>> --
>>> 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/
>>
>> Confidentiality Notice
>>
>> This e-mail message, including any attachments, is for the sole use of
>> the
>> intended recipient(s) and may contain confidential or proprietary
>> information which is legally privileged. Any unauthorized review, use,
>> disclosure, or distribution is prohibited. If you are not the intended
>> recipient, please promptly contact the sender by reply e-mail and
>> destroy
>> all copies of the original message.
>> --
>> 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/
>>
>>
>> _________________________________________________________________
>>
>> Links to North East Wales NHS Trust email disclaimers.
>>
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>>
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>> _________________________________________________________________
>>
>> --
>> trauma-list : TRAUMA.ORG
>> To change your settings or unsubscribe visit:
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>>
>>
>>
>> ------------------------------
>>
>> Message: 3
>> Date: Fri, 18 May 2007 14:03:40 EDT
>> From: KMATTOX at aol.com
>> Subject: Re: Level 1 Fluid Infusor
>> To: trauma-list at trauma.org, cmursic at gmail.com
>> Message-ID: <d6a.692c452.337f447c at aol.com>
>> Content-Type: text/plain; charset="US-ASCII"
>>
>>
>> In a message dated 5/17/2007 11:08:50 P.M. Central Daylight Time,
>> SeppelI at wahs.nsw.gov.au writes:
>>
>> Thanks, Ken - just the picture I was looking for. Are you happy if I
>> show it in a public presentation (with due credit)?
>> Thanks, Ian
>>
>>
>> You or anyone on this list can show it anywhere anytime
>>
>> k
>>
>>
>>
>> ************************************** See what's free at
>> http://www.aol.com.
>>
>>
>> ------------------------------
>>
>> Message: 4
>> Date: Fri, 18 May 2007 22:58:29 +0000
>> From: bensonblues at comcast.net
>> Subject: Level I Fluid Warmer
>> To: trauma-list at trauma.org
>> Message-ID:
>> <051820072258.15533.464E2F95000862B300003CAD22165514069C0A9A040D02019C020A0D at comcast.net>
>>
>> Content-Type: text/plain
>>
>> High volume infusion, permissive hypotension, ad nauseum: It all
>> depends.
>> Dogma is something that the internists can get away with, but not those
>> of
>> us who take care of the injured. Give me a pt with a GSW to the groin
>> and
>> on-scene exsanguination, hemostasis achieved with direct pressure, but
>> without a blood pressure, the early experiments by Arthur Guyton on
>> hemorrhage still prevail: Aggressive volume resuscitation is more likely
>> than not to decrease morbidity and mortality. However, give me a pt
>> struck
>> by an auto with multiple injuries, uncontrolled intracavitary
>> hemorrhage,
>> and no blood pressure, and with the exception of high volume transfusion
>> of fresh whole blood (when was the last time you administered that?),
>> high
>> volume resuscitation is likely to contribute to hemodilution and
>> coagulopathy and continued and worsening hemorrhage. I'm under the firm
>> belief that it doesn't really matter what you do preoperatively (with
>> few
>> exceptions). The most important determinant of
>> surviv
>> al from trauma is 1) the time it takes to get the patient to the OR and
>> 2)
>> the skills of the surgeon. I hope that this statement is without
>> controversy. Every trauma victim is a little different from the next,
>> and
>> judgement should prevail. No matter what your management strategy, it
>> always depends on the patient injuries, pre-existing medical problems,
>> medications the patient is taking, and your available resources. In
>> short,
>> there is a role for the high-volume infuser in selected cases. It's
>> utility would be greatly increased if fresh whole blood were to be used.
>>
>> DB
>>
>> ------------------------------
>>
>> Message: 5
>> Date: Sat, 19 May 2007 06:45:46 +0200
>> From: "Hardcastle, Tim, Dr <tch at sun.ac.za>" <tch at sun.ac.za>
>> Subject: RE: Level I Fluid Warmer
>> To: "Trauma & Critical Care mailing list" <trauma-list at trauma.org>
>> Message-ID:
>> <3FE6F2A76FE75C418D3E0481CD75EA1E329066 at TYGEVS01.tyg.sun.ac.za>
>> Content-Type: text/plain; charset="iso-8859-1"
>>
>> BFM
>>
>> That is why the consensus is now that blood-products should not be used
>> in
>> isolation. The recommended ratio is 1:1:1,i.e. 1PRBC, 1FFP and 1
>> platelet
>> consentrate particularly where the transfusion load will exceed 6 PRBC.
>> (See the J Trauma Suppl 2006 (May or June) and the ISBT-Science Series
>> vol
>> 1(1) from 2006 - their new conference consensus series issue)
>>
>> PRBC alone should not be used in trauma.
>>
>> Tim
>> Dr T C Hardcastle
>> M.B.,Ch.B.(Stell); M.Med(Chir); FCS(SA)
>> Senior Surgeon / Senior Lecturer: Surgery (Trauma and ICU)
>> ATLS instructor and DSTC Cape Town Course Director
>> Intern program Coordinator: Surgery
>> M.Med (Emergency Medicine) Executive Committee member
>> Clinical Head (Director): Diana Princess of Wales Trauma Unit
>> Division of Surgery (General) Room 4064
>> Department of Surgical Sciences
>> Tygerberg Hospital / University of Stellenbosch
>> PO Box 19063
>> Tygerberg 7505
>> Western Cape
>> South Africa
>> e-mail: tch at sun.ac.za
>> Cell: +27824681615
>> Office: +27219389281 or 4911 pager 0302
>>
>>
>>
>> -----Original Message-----
>> From: trauma-list-bounces at trauma.org
>> [mailto:trauma-list-bounces at trauma.org]On Behalf Of
>> trauma at emergencyunit.com
>> Sent: Friday, May 18, 2007 8:04 PM
>> To: 'Trauma & Critical Care mailing list'
>> Subject: RE: Level I Fluid Warmer
>>
>>
>> What nonsense. It is impossible to get control of many types of pelvis
>> fracture (such as the vertical shear) and so you have to give fluid to
>> these
>> patients or they exsanguinate into the pelvis. Remember - it's a bucket,
>> and
>> the bigger the bucket the more it holds. The problem comes when the
>> patient
>> gets given the wrong fluid. What the trauma patient needs is blood. What
>> most get is erythrocytes suspended in clotting-agent free mannitol
>> solution.
>> If we give our patients proper fresh blood - mirabile dictu, clot forms.
>> And
>> keeps forming. We have let the haematologists persuade us that they can
>> take
>> everything useful out of a bag of blood and we can give it as though it
>> is
>> blood.
>>
>> And we keep giving the rubbish. Surprise, surprise, 4 units later there
>> is
>> ooze everywhere, and 2 days later a dead patient.
>>
>> BFM.
>>
>>
>> -----Original Message-----
>> From: trauma-list-bounces at trauma.org
>> [mailto:trauma-list-bounces at trauma.org]
>> On Behalf Of Aruni Sen
>> Sent: 18 May 2007 11:43
>> To: Trauma & Critical Care mailing list
>> Subject: RE: Level I Fluid Warmer
>>
>>
>> Volume is serious bad news in pelvis because the bleeding needs longer
>> time
>> to clot.
>>
>> -----Original Message-----
>> From: trauma-list-bounces at trauma.org
>> [mailto:trauma-list-bounces at trauma.org]
>> On Behalf Of MARK FORREST
>> Sent: 17 May 2007 19:15
>> To: Trauma & Critical Care mailing list
>> Subject: Re: Level I Fluid Warmer
>>
>> Ron....remember that high volume crystalloid is still not scientifically
>> proven either!!!! Mark F UK
>>
>>
>> ----- Original Message ----
>> From: Ronald Gross <Rgross at harthosp.org>
>> To: trauma-list at trauma.org
>> Sent: Thursday, 17 May, 2007 2:38:00 PM
>> Subject: Re: Level I Fluid Warmer
>>
>>
>> Larry,
>> Remember that talk is cheap - and with "all the talk of permissive
>> hypotention" that practice is still not universally accepted nor
>> scientifically proven......(sorry, Ken). Ron
>>
>>>>> <ofiara at comcast.net> 5/16/2007 12:22 PM >>>
>> Yes, a Level One Fluid warmer or any type of fluid warmer has it's
>> place.
>> The question is, does a RAPID INFUSER have a place in the trauma
>> setting.
>> With all the talk of permiisve hypotention, I see a limited use in the
>> E.D.
>> Larry Ofiara, RN.
>>
>> -------------- Original message --------------
>> From: "Connie Potter" <Connie at traumafoundation.org>
>>
>>>
>>> Although a Level I may be a coat rack in temperate climates, in icy
>> cold
>>> rural OR they saved more than one patient's bacon. The ED, OR had the
>>> same equipment saving time to transfer the patient and administer
>>> PRBC's, the tubing snaps in quite easily (compared to some of the old
>>> warmers), and little training was required to get them in use.
>>> Remember, other parts of the US have what is called WINTER!
>>>
>>> Connie Potter,
>>>
>>>
>>> --
>>> 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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>> Links to North East Wales NHS Trust email disclaimers.
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>>
>>
>> ------------------------------
>>
>> Message: 6
>> Date: Thu, 17 May 2007 09:09:53 -0400
>> From: "Ronald Gross" <Rgross at harthosp.org>
>> Subject: Re: Herniaion of Lung
>> To: <trauma-list at trauma.org>
>> Message-ID: <464C1BDF.7FF1.00B9.0 at harthosp.org>
>> Content-Type: text/plain; charset="us-ascii"
>>
>> Gross, R.I; Eversgerd, J.L.. Transthoracic Lung Herniation Due to Blunt
>> Trauma.
>> J Trauma, May 2006; 60:1149.
>>
>>
>>>>> rm khattar <dr_rm_khattar at yahoo.co.in> 5/17/2007 8:01 AM >>>
>> How to diagnose Herniation Of Lung clinically and
>> radiologically?What is the differential diagnosis?How
>> to treat it?
>>
>>
>>
>> __________________________________________________________
>> Yahoo! India Answers: Share what you know. Learn something new
>> http://in.answers.yahoo.com/
>> --
>> trauma-list : TRAUMA.ORG
>> To change your settings or unsubscribe visit:
>> http://www.trauma.org/index.php?/community/
>>
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>>
>> This e-mail message, including any attachments, is for the sole use of
>> the
>> intended recipient(s) and may contain confidential or proprietary
>> information which is legally privileged. Any unauthorized review, use,
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>> recipient, please promptly contact the sender by reply e-mail and
>> destroy
>> all copies of the original message.
>> -------------- next part --------------
>> A non-text attachment was scrubbed...
>> Name: Figure 2A.jpg
>> Type: image/jpeg
>> Size: 30839 bytes
>> Desc: not available
>> Url :
>> http://list.mistral.net/pipermail/trauma-list/attachments/20070517/c915dfce/Figure2A.jpg
>> -------------- next part --------------
>> A non-text attachment was scrubbed...
>> Name: Figure 1.JPG
>> Type: image/jpeg
>> Size: 772830 bytes
>> Desc: not available
>> Url :
>> http://list.mistral.net/pipermail/trauma-list/attachments/20070517/c915dfce/Figure1.jpg
>>
>> ------------------------------
>>
>> --
>> trauma-list : TRAUMA.ORG
>> To change your settings or unsubscribe visit:
>> http://www.trauma.org/index.php?/community/
>>
>> End of trauma-list Digest, Vol 47, Issue 26
>> *******************************************
>>
>
>
>
> -------------------------------------------
> South Africas premier free email service - www.webmail.co.za
> ------------------------------------------------------------------
> For super low premiums, click here http://www.webmail.co.za/dd.pwm
>
>
>
> ------------------------------
>
> Message: 5
> Date: Tue, 22 May 2007 12:52:45 -0400
> From: "Ronald Gross" <Rgross at harthosp.org>
> Subject: RE: [ccm-l] "Sicko" premise
> To: "Trauma & Critical Care mailing list" <trauma-list at trauma.org>
> Message-ID: <4652E79C.7FF1.00B9.0 at harthosp.org>
> Content-Type: text/plain; charset=US-ASCII
>
> Hey Bill,
>
> Which pile are you referring to????
>
> Ron
>
>>>> "William Bromberg" <brombwi1 at memorialhealth.com> 5/22/2007 12:47 PM
>>>> >>>
> Seriously, how many times do you have to sniff dog dirt to make a fairly
> solid prediction that the next pile STILL won't smell like roses.
>
> William J. Bromberg, MD, FACS
> Chair, EAST Practice Management Guidelines Committee
> Savannah Surgical Group
> 912 350-7412
>
>>>> "Thomas Anthony Horan" <thoran at sarah.br> 05/21/07 6:12 PM >>>
> Charles,
>
> What a treat this topic has been, a forcefull K diatriabe against a movie
> he has not seen, supported by someone who never will.
>
> Such arrogance leaves me in awe.
>
> Tom
>
>> ----------
>> From:
>> trauma-list-bounces at trauma.org[SMTP:trauma-list-bounces at trauma.org] on
>> behalf of KMATTOX at aol.com[SMTP:KMATTOX at aol.com]
>> Reply To: Trauma & Critical Care mailing list
>> Sent: segunda-feira, 21 de maio de 2007 16:48
>> To: trauma-list at trauma.org
>> Subject: Re: [ccm-l] "Sicko" premise
>>
>>
>> In a message dated 5/21/2007 12:03:09 P.M. Central Daylight Time,
>> c_brault at yahoo.com writes:
>>
>>
>> Especialyinthe sensethatthe USAas a disproportionate
>> problem with:
>> drinking while driving, drug misuse, availability of guns and other
>> weapons
>> especially when there is a mxture of ETOH, drugs, and excitement,
>> driving
>> fast, etc.
>>
>>
>>
>> We can all learn a valuable lesson from Australia.
>>
>> k
>>
>>
>>
>> ************************************** See what's free at
>> http://www.aol.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/
>
>
> --
> trauma-list : TRAUMA.ORG
> To change your settings or unsubscribe visit:
> http://www.trauma.org/index.php?/community/
>
> Confidentiality Notice
>
> This e-mail message, including any attachments, is for the sole use of the
> intended recipient(s) and may contain confidential or proprietary
> information which is legally privileged. Any unauthorized review, use,
> disclosure, or distribution is prohibited. If you are not the intended
> recipient, please promptly contact the sender by reply e-mail and destroy
> all copies of the original message.
>
>
> ------------------------------
>
> Message: 6
> Date: Tue, 22 May 2007 12:56:26 -0400
> From: "Ronald Gross" <Rgross at harthosp.org>
> Subject: Re: trauma-list Digest, Vol 47, Issue 26
> To: <trauma-list at trauma.org>
> Message-ID: <4652E87A.7FF1.00B9.0 at harthosp.org>
> Content-Type: text/plain; charset=US-ASCII
>
> Level I - no way. Too big.
> Hot Line, sure it is small enough. The real question, however, is do we
> believe the resuscitators or the non-resuscitators. If we believe the
> latter, then there would never be any need for either
> anywhere...........unless you needed a coat hanger!
>
>>>> <mls at webmail.co.za> 5/22/2007 12:49 PM >>>
> Do you think it possible to get these (fluid warmers) in all the ESV
> (emergency service vehicle)? If hypothermia can be prevented by having
> them, why not have them.
>
>
>
>
>
>
>
>
>>
>> Today's Topics:
>>
>> 1. Re: Level I Fluid Warmer (Ronald Gross)
>> 2. RE: Level I Fluid Warmer (trauma at emergencyunit.com)
>> 3. Re: Level 1 Fluid Infusor (KMATTOX at aol.com)
>> 4. Level I Fluid Warmer (bensonblues at comcast.net)
>> 5. RE: Level I Fluid Warmer (Hardcastle, Tim, Dr <tch at sun.ac.za>)
>> 6. Re: Herniaion of Lung (Ronald Gross)
>>
>>
>> ----------------------------------------------------------------------
>>
>> Message: 1
>> Date: Fri, 18 May 2007 11:47:15 -0400
>> From: "Ronald Gross" <Rgross at harthosp.org>
>> Subject: Re: Level I Fluid Warmer
>> To: "Trauma & Critical Care mailing list" <trauma-list at trauma.org>
>> Message-ID: <464D9243.7FF1.00B9.0 at harthosp.org>
>> Content-Type: text/plain; charset=US-ASCII
>>
>> Truth be told, not only have both modes of therapy (high volume infusion
>> and permissive hypotension) been questioned, but depending on who you
>> read, they have actually been felt to be detrimental to the patient.
>> Hmmmmm........................
>>
>>>>> MARK FORREST <atacc.doc at btinternet.com> 5/17/2007 2:15 PM >>>
>> Ron....remember that high volume crystalloid is still not scientifically
>> proven either!!!!
>> Mark F
>> UK
>>
>>
>> ----- Original Message ----
>> From: Ronald Gross <Rgross at harthosp.org>
>> To: trauma-list at trauma.org
>> Sent: Thursday, 17 May, 2007 2:38:00 PM
>> Subject: Re: Level I Fluid Warmer
>>
>>
>> Larry,
>> Remember that talk is cheap - and with "all the talk of permissive
>> hypotention" that practice is still not universally accepted nor
>> scientifically proven......(sorry, Ken).
>> Ron
>>
>>>>> <ofiara at comcast.net> 5/16/2007 12:22 PM >>>
>> Yes, a Level One Fluid warmer or any type of fluid warmer has it's
>> place.
>> The question is, does a RAPID INFUSER have a place in the trauma
>> setting.
>> With all the talk of permiisve hypotention, I see a limited use in the
>> E.D.
>> Larry Ofiara, RN.
>>
>> -------------- Original message --------------
>> From: "Connie Potter" <Connie at traumafoundation.org>
>>
>>>
>>> Although a Level I may be a coat rack in temperate climates, in icy
>>> cold
>>> rural OR they saved more than one patient's bacon. The ED, OR had the
>>> same equipment saving time to transfer the patient and administer
>>> PRBC's, the tubing snaps in quite easily (compared to some of the old
>>> warmers), and little training was required to get them in use.
>>> Remember, other parts of the US have what is called WINTER!
>>>
>>> Connie Potter,
>>>
>>>
>>> --
>>> 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/
>>
>> Confidentiality Notice
>>
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>> intended recipient(s) and may contain confidential or proprietary
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>> recipient, please promptly contact the sender by reply e-mail and
>> destroy
>> all copies of the original message.
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>> trauma-list : TRAUMA.ORG
>> To change your settings or unsubscribe visit:
>> http://www.trauma.org/index.php?/community/
>>
>> Confidentiality Notice
>>
>> This e-mail message, including any attachments, is for the sole use of
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>> intended recipient(s) and may contain confidential or proprietary
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>> destroy
>> all copies of the original message.
>>
>>
>> ------------------------------
>>
>> Message: 2
>> Date: Fri, 18 May 2007 19:03:36 +0100
>> From: <trauma at emergencyunit.com>
>> Subject: RE: Level I Fluid Warmer
>> To: "'Trauma & Critical Care mailing list'"
>> <trauma-list at trauma.org>
>> Message-ID: <003c01c79976$dbe18890$0301a8c0 at vaio>
>> Content-Type: text/plain; charset="US-ASCII"
>>
>> What nonsense. It is impossible to get control of many types of pelvis
>> fracture (such as the vertical shear) and so you have to give fluid to
>> these
>> patients or they exsanguinate into the pelvis. Remember - it's a bucket,
>> and
>> the bigger the bucket the more it holds. The problem comes when the
>> patient
>> gets given the wrong fluid. What the trauma patient needs is blood. What
>> most get is erythrocytes suspended in clotting-agent free mannitol
>> solution.
>> If we give our patients proper fresh blood - mirabile dictu, clot forms.
>> And
>> keeps forming. We have let the haematologists persuade us that they can
>> take
>> everything useful out of a bag of blood and we can give it as though it
>> is
>> blood.
>>
>> And we keep giving the rubbish. Surprise, surprise, 4 units later there
>> is
>> ooze everywhere, and 2 days later a dead patient.
>>
>> BFM.
>>
>>
>> -----Original Message-----
>> From: trauma-list-bounces at trauma.org
>> [mailto:trauma-list-bounces at trauma.org]
>> On Behalf Of Aruni Sen
>> Sent: 18 May 2007 11:43
>> To: Trauma & Critical Care mailing list
>> Subject: RE: Level I Fluid Warmer
>>
>>
>> Volume is serious bad news in pelvis because the bleeding needs longer
>> time
>> to clot.
>>
>> -----Original Message-----
>> From: trauma-list-bounces at trauma.org
>> [mailto:trauma-list-bounces at trauma.org]
>> On Behalf Of MARK FORREST
>> Sent: 17 May 2007 19:15
>> To: Trauma & Critical Care mailing list
>> Subject: Re: Level I Fluid Warmer
>>
>> Ron....remember that high volume crystalloid is still not scientifically
>> proven either!!!! Mark F UK
>>
>>
>> ----- Original Message ----
>> From: Ronald Gross <Rgross at harthosp.org>
>> To: trauma-list at trauma.org
>> Sent: Thursday, 17 May, 2007 2:38:00 PM
>> Subject: Re: Level I Fluid Warmer
>>
>>
>> Larry,
>> Remember that talk is cheap - and with "all the talk of permissive
>> hypotention" that practice is still not universally accepted nor
>> scientifically proven......(sorry, Ken). Ron
>>
>>>>> <ofiara at comcast.net> 5/16/2007 12:22 PM >>>
>> Yes, a Level One Fluid warmer or any type of fluid warmer has it's
>> place.
>> The question is, does a RAPID INFUSER have a place in the trauma
>> setting.
>> With all the talk of permiisve hypotention, I see a limited use in the
>> E.D.
>> Larry Ofiara, RN.
>>
>> -------------- Original message --------------
>> From: "Connie Potter" <Connie at traumafoundation.org>
>>
>>>
>>> Although a Level I may be a coat rack in temperate climates, in icy
>> cold
>>> rural OR they saved more than one patient's bacon. The ED, OR had the
>>> same equipment saving time to transfer the patient and administer
>>> PRBC's, the tubing snaps in quite easily (compared to some of the old
>>> warmers), and little training was required to get them in use.
>>> Remember, other parts of the US have what is called WINTER!
>>>
>>> Connie Potter,
>>>
>>>
>>> --
>>> 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/
>>
>> Confidentiality Notice
>>
>> This e-mail message, including any attachments, is for the sole use of
>> the
>> intended recipient(s) and may contain confidential or proprietary
>> information which is legally privileged. Any unauthorized review, use,
>> disclosure, or distribution is prohibited. If you are not the intended
>> recipient, please promptly contact the sender by reply e-mail and
>> destroy
>> all copies of the original message.
>> --
>> 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:
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>>
>>
>> _________________________________________________________________
>>
>> Links to North East Wales NHS Trust email disclaimers.
>>
>> Cymraeg www.newalesnhstrust.org.uk/index.php?page=aildisclaimer&lang=
>>
>> English www.newalesnhstrust.org.uk/index.php?page=aildisclaimer&lang=
>> _________________________________________________________________
>>
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>> trauma-list : TRAUMA.ORG
>> To change your settings or unsubscribe visit:
>> http://www.trauma.org/index.php?/community/
>>
>>
>>
>> ------------------------------
>>
>> Message: 3
>> Date: Fri, 18 May 2007 14:03:40 EDT
>> From: KMATTOX at aol.com
>> Subject: Re: Level 1 Fluid Infusor
>> To: trauma-list at trauma.org, cmursic at gmail.com
>> Message-ID: <d6a.692c452.337f447c at aol.com>
>> Content-Type: text/plain; charset="US-ASCII"
>>
>>
>> In a message dated 5/17/2007 11:08:50 P.M. Central Daylight Time,
>> SeppelI at wahs.nsw.gov.au writes:
>>
>> Thanks, Ken - just the picture I was looking for. Are you happy if I
>> show it in a public presentation (with due credit)?
>> Thanks, Ian
>>
>>
>> You or anyone on this list can show it anywhere anytime
>>
>> k
>>
>>
>>
>> ************************************** See what's free at
>> http://www.aol.com.
>>
>>
>> ------------------------------
>>
>> Message: 4
>> Date: Fri, 18 May 2007 22:58:29 +0000
>> From: bensonblues at comcast.net
>> Subject: Level I Fluid Warmer
>> To: trauma-list at trauma.org
>> Message-ID:
>> <051820072258.15533.464E2F95000862B300003CAD22165514069C0A9A040D02019C020A0D at comcast.net>
>>
>> Content-Type: text/plain
>>
>> High volume infusion, permissive hypotension, ad nauseum: It all
>> depends.
>> Dogma is something that the internists can get away with, but not those
>> of
>> us who take care of the injured. Give me a pt with a GSW to the groin
>> and
>> on-scene exsanguination, hemostasis achieved with direct pressure, but
>> without a blood pressure, the early experiments by Arthur Guyton on
>> hemorrhage still prevail: Aggressive volume resuscitation is more likely
>> than not to decrease morbidity and mortality. However, give me a pt
>> struck
>> by an auto with multiple injuries, uncontrolled intracavitary
>> hemorrhage,
>> and no blood pressure, and with the exception of high volume transfusion
>> of fresh whole blood (when was the last time you administered that?),
>> high
>> volume resuscitation is likely to contribute to hemodilution and
>> coagulopathy and continued and worsening hemorrhage. I'm under the firm
>> belief that it doesn't really matter what you do preoperatively (with
>> few
>> exceptions). The most important determinant of
>> surviv
>> al from trauma is 1) the time it takes to get the patient to the OR and
>> 2)
>> the skills of the surgeon. I hope that this statement is without
>> controversy. Every trauma victim is a little different from the next,
>> and
>> judgement should prevail. No matter what your management strategy, it
>> always depends on the patient injuries, pre-existing medical problems,
>> medications the patient is taking, and your available resources. In
>> short,
>> there is a role for the high-volume infuser in selected cases. It's
>> utility would be greatly increased if fresh whole blood were to be used.
>>
>> DB
>>
>> ------------------------------
>>
>> Message: 5
>> Date: Sat, 19 May 2007 06:45:46 +0200
>> From: "Hardcastle, Tim, Dr <tch at sun.ac.za>" <tch at sun.ac.za>
>> Subject: RE: Level I Fluid Warmer
>> To: "Trauma & Critical Care mailing list" <trauma-list at trauma.org>
>> Message-ID:
>> <3FE6F2A76FE75C418D3E0481CD75EA1E329066 at TYGEVS01.tyg.sun.ac.za>
>> Content-Type: text/plain; charset="iso-8859-1"
>>
>> BFM
>>
>> That is why the consensus is now that blood-products should not be used
>> in
>> isolation. The recommended ratio is 1:1:1,i.e. 1PRBC, 1FFP and 1
>> platelet
>> consentrate particularly where the transfusion load will exceed 6 PRBC.
>> (See the J Trauma Suppl 2006 (May or June) and the ISBT-Science Series
>> vol
>> 1(1) from 2006 - their new conference consensus series issue)
>>
>> PRBC alone should not be used in trauma.
>>
>> Tim
>> Dr T C Hardcastle
>> M.B.,Ch.B.(Stell); M.Med(Chir); FCS(SA)
>> Senior Surgeon / Senior Lecturer: Surgery (Trauma and ICU)
>> ATLS instructor and DSTC Cape Town Course Director
>> Intern program Coordinator: Surgery
>> M.Med (Emergency Medicine) Executive Committee member
>> Clinical Head (Director): Diana Princess of Wales Trauma Unit
>> Division of Surgery (General) Room 4064
>> Department of Surgical Sciences
>> Tygerberg Hospital / University of Stellenbosch
>> PO Box 19063
>> Tygerberg 7505
>> Western Cape
>> South Africa
>> e-mail: tch at sun.ac.za
>> Cell: +27824681615
>> Office: +27219389281 or 4911 pager 0302
>>
>>
>>
>> -----Original Message-----
>> From: trauma-list-bounces at trauma.org
>> [mailto:trauma-list-bounces at trauma.org]On Behalf Of
>> trauma at emergencyunit.com
>> Sent: Friday, May 18, 2007 8:04 PM
>> To: 'Trauma & Critical Care mailing list'
>> Subject: RE: Level I Fluid Warmer
>>
>>
>> What nonsense. It is impossible to get control of many types of pelvis
>> fracture (such as the vertical shear) and so you have to give fluid to
>> these
>> patients or they exsanguinate into the pelvis. Remember - it's a bucket,
>> and
>> the bigger the bucket the more it holds. The problem comes when the
>> patient
>> gets given the wrong fluid. What the trauma patient needs is blood. What
>> most get is erythrocytes suspended in clotting-agent free mannitol
>> solution.
>> If we give our patients proper fresh blood - mirabile dictu, clot forms.
>> And
>> keeps forming. We have let the haematologists persuade us that they can
>> take
>> everything useful out of a bag of blood and we can give it as though it
>> is
>> blood.
>>
>> And we keep giving the rubbish. Surprise, surprise, 4 units later there
>> is
>> ooze everywhere, and 2 days later a dead patient.
>>
>> BFM.
>>
>>
>> -----Original Message-----
>> From: trauma-list-bounces at trauma.org
>> [mailto:trauma-list-bounces at trauma.org]
>> On Behalf Of Aruni Sen
>> Sent: 18 May 2007 11:43
>> To: Trauma & Critical Care mailing list
>> Subject: RE: Level I Fluid Warmer
>>
>>
>> Volume is serious bad news in pelvis because the bleeding needs longer
>> time
>> to clot.
>>
>> -----Original Message-----
>> From: trauma-list-bounces at trauma.org
>> [mailto:trauma-list-bounces at trauma.org]
>> On Behalf Of MARK FORREST
>> Sent: 17 May 2007 19:15
>> To: Trauma & Critical Care mailing list
>> Subject: Re: Level I Fluid Warmer
>>
>> Ron....remember that high volume crystalloid is still not scientifically
>> proven either!!!! Mark F UK
>>
>>
>> ----- Original Message ----
>> From: Ronald Gross <Rgross at harthosp.org>
>> To: trauma-list at trauma.org
>> Sent: Thursday, 17 May, 2007 2:38:00 PM
>> Subject: Re: Level I Fluid Warmer
>>
>>
>> Larry,
>> Remember that talk is cheap - and with "all the talk of permissive
>> hypotention" that practice is still not universally accepted nor
>> scientifically proven......(sorry, Ken). Ron
>>
>>>>> <ofiara at comcast.net> 5/16/2007 12:22 PM >>>
>> Yes, a Level One Fluid warmer or any type of fluid warmer has it's
>> place.
>> The question is, does a RAPID INFUSER have a place in the trauma
>> setting.
>> With all the talk of permiisve hypotention, I see a limited use in the
>> E.D.
>> Larry Ofiara, RN.
>>
>> -------------- Original message --------------
>> From: "Connie Potter" <Connie at traumafoundation.org>
>>
>>>
>>> Although a Level I may be a coat rack in temperate climates, in icy
>> cold
>>> rural OR they saved more than one patient's bacon. The ED, OR had the
>>> same equipment saving time to transfer the patient and administer
>>> PRBC's, the tubing snaps in quite easily (compared to some of the old
>>> warmers), and little training was required to get them in use.
>>> Remember, other parts of the US have what is called WINTER!
>>>
>>> Connie Potter,
>>>
>>>
>>> --
>>> trauma-list : TRAUMA.ORG
>>> To change your settings or unsubscribe visit:
>>> http://www.trauma.org/index.php?/community/
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>>
>> ------------------------------
>>
>> Message: 6
>> Date: Thu, 17 May 2007 09:09:53 -0400
>> From: "Ronald Gross" <Rgross at harthosp.org>
>> Subject: Re: Herniaion of Lung
>> To: <trauma-list at trauma.org>
>> Message-ID: <464C1BDF.7FF1.00B9.0 at harthosp.org>
>> Content-Type: text/plain; charset="us-ascii"
>>
>> Gross, R.I; Eversgerd, J.L.. Transthoracic Lung Herniation Due to Blunt
>> Trauma.
>> J Trauma, May 2006; 60:1149.
>>
>>
>>>>> rm khattar <dr_rm_khattar at yahoo.co.in> 5/17/2007 8:01 AM >>>
>> How to diagnose Herniation Of Lung clinically and
>> radiologically?What is the differential diagnosis?How
>> to treat it?
>>
>>
>>
>> __________________________________________________________
>> Yahoo! India Answers: Share what you know. Learn something new
>> http://in.answers.yahoo.com/
>> --
>> trauma-list : TRAUMA.ORG
>> To change your settings or unsubscribe visit:
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>>
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>> destroy
>> all copies of the original message.
>> -------------- next part --------------
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>> -------------- next part --------------
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>>
>> ------------------------------
>>
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>> End of trauma-list Digest, Vol 47, Issue 26
>> *******************************************
>>
>
>
>
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> ------------------------------
>
> Message: 7
> Date: Tue, 22 May 2007 13:08:53 -0400
> From: "Anthony Caruso" <Medic541 at hotmail.com>
> Subject: RE: trauma-list Digest, Vol 47, Issue 26
> To: "'Trauma & Critical Care mailing list'"
> <trauma-list at trauma.org>
> Message-ID: <BAY141-DAV27DEA3D7B0818B2DEDC7799360 at phx.gbl>
> Content-Type: text/plain; charset="US-ASCII"
>
> We have the fluid warmers in our ambulances. However, the one that this
> group has been referring about, is a high volume infuser that is able to
> warm fluids as well. The warmers in the ambulance comes with an issue.
> The
> fluid must be rotated every month (per DPH). I believe the thought behind
> it is that it might become un sterile after a month has passed.
> Thanks,
> Anthony Caruso EMT-P
>
> P.S, I believe the names of the fluid warmer for the ambulances is called
> a
> "hot sac".
>
> -----Original Message-----
> From: trauma-list-bounces at trauma.org
> [mailto:trauma-list-bounces at trauma.org]
> On Behalf Of mls at webmail.co.za
> Sent: Tuesday, May 22, 2007 12:49 PM
> To: trauma-list at trauma.org
> Subject: Re: trauma-list Digest, Vol 47, Issue 26
>
>
> Do you think it possible to get these (fluid warmers) in all the ESV
> (emergency service vehicle)? If hypothermia can be prevented by having
> them,
> why not have them.
>
>
>
>
>
>
>
>
>>
>> Today's Topics:
>>
>> 1. Re: Level I Fluid Warmer (Ronald Gross)
>> 2. RE: Level I Fluid Warmer (trauma at emergencyunit.com)
>> 3. Re: Level 1 Fluid Infusor (KMATTOX at aol.com)
>> 4. Level I Fluid Warmer (bensonblues at comcast.net)
>> 5. RE: Level I Fluid Warmer (Hardcastle, Tim, Dr <tch at sun.ac.za>)
>> 6. Re: Herniaion of Lung (Ronald Gross)
>>
>>
>> ----------------------------------------------------------------------
>>
>> Message: 1
>> Date: Fri, 18 May 2007 11:47:15 -0400
>> From: "Ronald Gross" <Rgross at harthosp.org>
>> Subject: Re: Level I Fluid Warmer
>> To: "Trauma & Critical Care mailing list" <trauma-list at trauma.org>
>> Message-ID: <464D9243.7FF1.00B9.0 at harthosp.org>
>> Content-Type: text/plain; charset=US-ASCII
>>
>> Truth be told, not only have both modes of therapy (high volume
>> infusion and permissive hypotension) been questioned, but depending on
>> who you read, they have actually been felt to be detrimental to the
>> patient. Hmmmmm........................
>>
>>>>> MARK FORREST <atacc.doc at btinternet.com> 5/17/2007 2:15 PM >>>
>> Ron....remember that high volume crystalloid is still not
>> scientifically proven either!!!! Mark F
>> UK
>>
>>
>> ----- Original Message ----
>> From: Ronald Gross <Rgross at harthosp.org>
>> To: trauma-list at trauma.org
>> Sent: Thursday, 17 May, 2007 2:38:00 PM
>> Subject: Re: Level I Fluid Warmer
>>
>>
>> Larry,
>> Remember that talk is cheap - and with "all the talk of permissive
>> hypotention" that practice is still not universally accepted nor
>> scientifically proven......(sorry, Ken). Ron
>>
>>>>> <ofiara at comcast.net> 5/16/2007 12:22 PM >>>
>> Yes, a Level One Fluid warmer or any type of fluid warmer has it's
>> place. The question is, does a RAPID INFUSER have a place in the
>> trauma setting. With all the talk of permiisve hypotention, I see a
>> limited use in the E.D. Larry Ofiara, RN.
>>
>> -------------- Original message --------------
>> From: "Connie Potter" <Connie at traumafoundation.org>
>>
>>>
>>> Although a Level I may be a coat rack in temperate climates, in icy
>>> cold rural OR they saved more than one patient's bacon. The ED, OR
>>> had the same equipment saving time to transfer the patient and
>>> administer PRBC's, the tubing snaps in quite easily (compared to some
>>> of the old warmers), and little training was required to get them in
>>> use. Remember, other parts of the US have what is called WINTER!
>>>
>>> Connie Potter,
>>>
>>>
>>> --
>>> trauma-list : TRAUMA.ORG
>>> To change your settings or unsubscribe visit:
>>> http://www.trauma.org/index.php?/community/
>> --
>> trauma-list : TRAUMA.ORG
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>>
>> ------------------------------
>>
>> Message: 2
>> Date: Fri, 18 May 2007 19:03:36 +0100
>> From: <trauma at emergencyunit.com>
>> Subject: RE: Level I Fluid Warmer
>> To: "'Trauma & Critical Care mailing list'"
>> <trauma-list at trauma.org>
>> Message-ID: <003c01c79976$dbe18890$0301a8c0 at vaio>
>> Content-Type: text/plain; charset="US-ASCII"
>>
>> What nonsense. It is impossible to get control of many types of pelvis
>> fracture (such as the vertical shear) and so you have to give fluid to
>> these patients or they exsanguinate into the pelvis. Remember - it's a
>> bucket, and
>> the bigger the bucket the more it holds. The problem comes when the
>> patient
>> gets given the wrong fluid. What the trauma patient needs is blood. What
>> most get is erythrocytes suspended in clotting-agent free mannitol
>> solution.
>> If we give our patients proper fresh blood - mirabile dictu, clot forms.
>> And
>> keeps forming. We have let the haematologists persuade us that they can
>> take
>> everything useful out of a bag of blood and we can give it as though it
>> is
>> blood.
>>
>> And we keep giving the rubbish. Surprise, surprise, 4 units later
>> there is ooze everywhere, and 2 days later a dead patient.
>>
>> BFM.
>>
>>
>> -----Original Message-----
>> From: trauma-list-bounces at trauma.org
>> [mailto:trauma-list-bounces at trauma.org]
>> On Behalf Of Aruni Sen
>> Sent: 18 May 2007 11:43
>> To: Trauma & Critical Care mailing list
>> Subject: RE: Level I Fluid Warmer
>>
>>
>> Volume is serious bad news in pelvis because the bleeding needs longer
>> time to clot.
>>
>> -----Original Message-----
>> From: trauma-list-bounces at trauma.org
>> [mailto:trauma-list-bounces at trauma.org]
>> On Behalf Of MARK FORREST
>> Sent: 17 May 2007 19:15
>> To: Trauma & Critical Care mailing list
>> Subject: Re: Level I Fluid Warmer
>>
>> Ron....remember that high volume crystalloid is still not
>> scientifically proven either!!!! Mark F UK
>>
>>
>> ----- Original Message ----
>> From: Ronald Gross <Rgross at harthosp.org>
>> To: trauma-list at trauma.org
>> Sent: Thursday, 17 May, 2007 2:38:00 PM
>> Subject: Re: Level I Fluid Warmer
>>
>>
>> Larry,
>> Remember that talk is cheap - and with "all the talk of permissive
>> hypotention" that practice is still not universally accepted nor
>> scientifically proven......(sorry, Ken). Ron
>>
>>>>> <ofiara at comcast.net> 5/16/2007 12:22 PM >>>
>> Yes, a Level One Fluid warmer or any type of fluid warmer has it's
>> place. The question is, does a RAPID INFUSER have a place in the
>> trauma setting. With all the talk of permiisve hypotention, I see a
>> limited use in the E.D. Larry Ofiara, RN.
>>
>> -------------- Original message --------------
>> From: "Connie Potter" <Connie at traumafoundation.org>
>>
>>>
>>> Although a Level I may be a coat rack in temperate climates, in icy
>> cold
>>> rural OR they saved more than one patient's bacon. The ED, OR had the
>>> same equipment saving time to transfer the patient and administer
>>> PRBC's, the tubing snaps in quite easily (compared to some of the old
>>> warmers), and little training was required to get them in use.
>>> Remember, other parts of the US have what is called WINTER!
>>>
>>> Connie Potter,
>>>
>>>
>>> --
>>> trauma-list : TRAUMA.ORG
>>> To change your settings or unsubscribe visit:
>>> http://www.trauma.org/index.php?/community/
>> --
>> trauma-list : TRAUMA.ORG
>> To change your settings or unsubscribe visit:
>> http://www.trauma.org/index.php?/community/
>>
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>>
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>> intended recipient, please promptly contact the sender by reply e-mail
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>>
>>
>> _________________________________________________________________
>>
>> Links to North East Wales NHS Trust email disclaimers.
>>
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>>
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>> _________________________________________________________________
>>
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>>
>>
>> ------------------------------
>>
>> Message: 3
>> Date: Fri, 18 May 2007 14:03:40 EDT
>> From: KMATTOX at aol.com
>> Subject: Re: Level 1 Fluid Infusor
>> To: trauma-list at trauma.org, cmursic at gmail.com
>> Message-ID: <d6a.692c452.337f447c at aol.com>
>> Content-Type: text/plain; charset="US-ASCII"
>>
>>
>> In a message dated 5/17/2007 11:08:50 P.M. Central Daylight Time,
>> SeppelI at wahs.nsw.gov.au writes:
>>
>> Thanks, Ken - just the picture I was looking for. Are you happy if I
>> show it in a public presentation (with due credit)? Thanks, Ian
>>
>>
>> You or anyone on this list can show it anywhere anytime
>>
>> k
>>
>>
>>
>> ************************************** See what's free at
>> http://www.aol.com.
>>
>>
>> ------------------------------
>>
>> Message: 4
>> Date: Fri, 18 May 2007 22:58:29 +0000
>> From: bensonblues at comcast.net
>> Subject: Level I Fluid Warmer
>> To: trauma-list at trauma.org
>> Message-ID:
>>
>> <051820072258.15533.464E2F95000862B300003CAD22165514069C0A9A040D02019C
>> 020A0D at comcast.net>
>>
>> Content-Type: text/plain
>>
>> High volume infusion, permissive hypotension, ad nauseum: It all
>> depends. Dogma is something that the internists can get away with, but
>> not those of us who take care of the injured. Give me a pt with a GSW
>> to the groin and on-scene exsanguination, hemostasis achieved with
>> direct pressure, but without a blood pressure, the early experiments
>> by Arthur Guyton on hemorrhage still prevail: Aggressive volume
>> resuscitation is more likely than not to decrease morbidity and
>> mortality. However, give me a pt struck by an auto with multiple
>> injuries, uncontrolled intracavitary hemorrhage, and no blood
>> pressure, and with the exception of high volume transfusion of fresh
>> whole blood (when was the last time you administered that?), high
>> volume resuscitation is likely to contribute to hemodilution and
>> coagulopathy and continued and worsening hemorrhage. I'm under the
>> firm belief that it doesn't really matter what you do preoperatively
>> (with few exceptions). The most important determinant of surviv al
>> from trauma is 1) the time it takes to get the patient to the OR and
>> 2) the skills of the surgeon. I hope that this statement is without
>> controversy. Every trauma victim is a little different from the next,
>> and judgement should prevail. No matter what your management strategy,
>> it always depends on the patient injuries, pre-existing medical
>> problems, medications the patient is taking, and your available
>> resources. In short, there is a role for the high-volume infuser in
>> selected cases. It's utility would be greatly increased if fresh whole
>> blood were to be used.
>>
>> DB
>>
>> ------------------------------
>>
>> Message: 5
>> Date: Sat, 19 May 2007 06:45:46 +0200
>> From: "Hardcastle, Tim, Dr <tch at sun.ac.za>" <tch at sun.ac.za>
>> Subject: RE: Level I Fluid Warmer
>> To: "Trauma & Critical Care mailing list" <trauma-list at trauma.org>
>> Message-ID:
>> <3FE6F2A76FE75C418D3E0481CD75EA1E329066 at TYGEVS01.tyg.sun.ac.za>
>> Content-Type: text/plain; charset="iso-8859-1"
>>
>> BFM
>>
>> That is why the consensus is now that blood-products should not be
>> used in isolation. The recommended ratio is 1:1:1,i.e. 1PRBC, 1FFP and
>> 1 platelet consentrate particularly where the transfusion load will
>> exceed 6 PRBC. (See the J Trauma Suppl 2006 (May or June) and the
>> ISBT-Science Series vol
>> 1(1) from 2006 - their new conference consensus series issue)
>>
>> PRBC alone should not be used in trauma.
>>
>> Tim
>> Dr T C Hardcastle
>> M.B.,Ch.B.(Stell); M.Med(Chir); FCS(SA)
>> Senior Surgeon / Senior Lecturer: Surgery (Trauma and ICU) ATLS
>> instructor and DSTC Cape Town Course Director Intern program
>> Coordinator: Surgery M.Med (Emergency Medicine) Executive Committee
>> member Clinical Head (Director): Diana Princess of Wales Trauma Unit
>> Division of Surgery (General) Room 4064
>> Department of Surgical Sciences
>> Tygerberg Hospital / University of Stellenbosch
>> PO Box 19063
>> Tygerberg 7505
>> Western Cape
>> South Africa
>> e-mail: tch at sun.ac.za
>> Cell: +27824681615
>> Office: +27219389281 or 4911 pager 0302
>>
>>
>>
>> -----Original Message-----
>> From: trauma-list-bounces at trauma.org
>> [mailto:trauma-list-bounces at trauma.org]On Behalf Of
>> trauma at emergencyunit.com
>> Sent: Friday, May 18, 2007 8:04 PM
>> To: 'Trauma & Critical Care mailing list'
>> Subject: RE: Level I Fluid Warmer
>>
>>
>> What nonsense. It is impossible to get control of many types of pelvis
>> fracture (such as the vertical shear) and so you have to give fluid to
>> these patients or they exsanguinate into the pelvis. Remember - it's a
>> bucket, and
>> the bigger the bucket the more it holds. The problem comes when the
>> patient
>> gets given the wrong fluid. What the trauma patient needs is blood. What
>> most get is erythrocytes suspended in clotting-agent free mannitol
>> solution.
>> If we give our patients proper fresh blood - mirabile dictu, clot forms.
>> And
>> keeps forming. We have let the haematologists persuade us that they can
>> take
>> everything useful out of a bag of blood and we can give it as though it
>> is
>> blood.
>>
>> And we keep giving the rubbish. Surprise, surprise, 4 units later
>> there is ooze everywhere, and 2 days later a dead patient.
>>
>> BFM.
>>
>>
>> -----Original Message-----
>> From: trauma-list-bounces at trauma.org
>> [mailto:trauma-list-bounces at trauma.org]
>> On Behalf Of Aruni Sen
>> Sent: 18 May 2007 11:43
>> To: Trauma & Critical Care mailing list
>> Subject: RE: Level I Fluid Warmer
>>
>>
>> Volume is serious bad news in pelvis because the bleeding needs longer
>> time to clot.
>>
>> -----Original Message-----
>> From: trauma-list-bounces at trauma.org
>> [mailto:trauma-list-bounces at trauma.org]
>> On Behalf Of MARK FORREST
>> Sent: 17 May 2007 19:15
>> To: Trauma & Critical Care mailing list
>> Subject: Re: Level I Fluid Warmer
>>
>> Ron....remember that high volume crystalloid is still not
>> scientifically proven either!!!! Mark F UK
>>
>>
>> ----- Original Message ----
>> From: Ronald Gross <Rgross at harthosp.org>
>> To: trauma-list at trauma.org
>> Sent: Thursday, 17 May, 2007 2:38:00 PM
>> Subject: Re: Level I Fluid Warmer
>>
>>
>> Larry,
>> Remember that talk is cheap - and with "all the talk of permissive
>> hypotention" that practice is still not universally accepted nor
>> scientifically proven......(sorry, Ken). Ron
>>
>>>>> <ofiara at comcast.net> 5/16/2007 12:22 PM >>>
>> Yes, a Level One Fluid warmer or any type of fluid warmer has it's
>> place. The question is, does a RAPID INFUSER have a place in the
>> trauma setting. With all the talk of permiisve hypotention, I see a
>> limited use in the E.D. Larry Ofiara, RN.
>>
>> -------------- Original message --------------
>> From: "Connie Potter" <Connie at traumafoundation.org>
>>
>>>
>>> Although a Level I may be a coat rack in temperate climates, in icy
>> cold
>>> rural OR they saved more than one patient's bacon. The ED, OR had the
>>> same equipment saving time to transfer the patient and administer
>>> PRBC's, the tubing snaps in quite easily (compared to some of the old
>>> warmers), and little training was required to get them in use.
>>> Remember, other parts of the US have what is called WINTER!
>>>
>>> Connie Potter,
>>>
>>>
>>> --
>>> 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/
>>
>> Confidentiality Notice
>>
>> This e-mail message, including any attachments, is for the sole use of
>> the intended recipient(s) and may contain confidential or proprietary
>> information which is legally privileged. Any unauthorized review,
>> use, disclosure, or distribution is prohibited. If you are not the
>> intended recipient, please promptly contact the sender by reply e-mail
>> and destroy all copies of the original message.
>> --
>> 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:
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>>
>>
>> _________________________________________________________________
>>
>> Links to North East Wales NHS Trust email disclaimers.
>>
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>>
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>> _________________________________________________________________
>>
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>> To change your settings or unsubscribe visit:
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>>
>>
>> ------------------------------
>>
>> Message: 6
>> Date: Thu, 17 May 2007 09:09:53 -0400
>> From: "Ronald Gross" <Rgross at harthosp.org>
>> Subject: Re: Herniaion of Lung
>> To: <trauma-list at trauma.org>
>> Message-ID: <464C1BDF.7FF1.00B9.0 at harthosp.org>
>> Content-Type: text/plain; charset="us-ascii"
>>
>> Gross, R.I; Eversgerd, J.L.. Transthoracic Lung Herniation Due to
>> Blunt Trauma. J Trauma, May 2006; 60:1149.
>>
>>
>>>>> rm khattar <dr_rm_khattar at yahoo.co.in> 5/17/2007 8:01 AM >>>
>> How to diagnose Herniation Of Lung clinically and radiologically?What
>> is the differential diagnosis?How to treat it?
>>
>>
>>
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> ------------------------------
>
> Message: 8
> Date: Tue, 22 May 2007 13:25:40 -0400
> From: "William Bromberg" <brombwi1 at memorialhealth.com>
> Subject: RE: [ccm-l] "Sicko" premise
> To: "Trauma & Critical Care mailing list" <trauma-list at trauma.org>
> Message-ID: <4652EF540200003A00002BC0 at memorialhealth.com>
> Content-Type: text/plain; charset=UTF-8
>
> Well, now that you ask âEUR" both, really.
>
> It's a mistake to post a review of a movie that you haven't seen if
> only because it opens you up to the criticism already noted.
>
> OTOH, please, we've all seen the photos of the Cuban hospitals that the
> non-VIPs get to go to are really like (the URLs have been posted on the
> list before), they're appalling. We all know that Cuban refugees
> regularly risk life and limb to swim, row, paddle, etc. to get to the
> U.S. Anyone who has even remote interest in the accuracy of MMs films
> knows that he routinely exaggerates, spins, and IMO lies (e.g. see
> http://www.davekopel.com/Terror/Fiftysix-Deceits-in-Fahrenheit-911.htm
> , and http://www.hardylaw.net/Truth_About_Bowling.html , etc. ). So do I
> think the movie will be worth the time and $8 âEUR" hell no.
>
> That being said, MM preaches to the choir, the opposition opposes and
> nobody changes their minds anyway. It's harmless mental masturbation
> unless it causes rif