Tamingthesru

Journal Club, Grand Rounds Jeffery Hill, MD M.Ed Journal Club, Grand Rounds Jeffery Hill, MD M.Ed

Whole Blood - More than the Sum of Its Components?

Q: For a patient in hemorrhagic shock from acute blood loss, what is the best resuscitative fluid?  

A: If they've lost blood, give them blood.  

It's never quite that simple though right?  For a generation now, we have practiced primarily by transfusing patient's with acute blood loss varying ratios of blood product components.  Thanks to the PROPPR trial, we most recently arrived on a generally accepted ratio of 1:1:1 for Plasma, Platelets, and Red Blood Cells for severely injured bleeding trauma patients.  Recent military literature however, suggests that there may be another strategy (which is in and of itself a bit of a throwback) that could offer additional benefits over a component transfusion strategy.  If were are trying to recreate a whole blood with a 1:1:1 plasma:platetel:PRBC ratio, why not just give whole blood?

Read More
Grand Rounds Guest User Grand Rounds Guest User

Grand Rounds Recap 5.23.18

This week’s Grand Rounds opened with Dr. Koehler leading small group discussions on the applications and limitations of VBGs. Dr. Bonomo expertly identified the correct test of choice and diagnosis in Dr. Spigner’s CPC. Dr. Soria then gave an interesting talk on the history behind naloxone as well as common uses. Finally, the Air Care team led a great hands-on procedure workshop!

Read More
Diagnostics, Grand Rounds Jeffery Hill, MD M.Ed Diagnostics, Grand Rounds Jeffery Hill, MD M.Ed

What's in a Blood Gas? VBG vs ABG

You’re deep into a busy shift. Pushing yourself to see more volume towards the end of the year, you find yourself actively managing 8 patients.  You have 2 patients with difficulty breathing you believe have COPD exacerbations and 1 patient with a history of T1DM who has a critical high finger stick blood sugar and ketones in their urine.  You send VBGs as part of the work up for all these patients finding hypercarbia for the patients who have COPD exacerbations and a significant metabolic acidosis in the patient with T1DM confirming your diagnosis of DKA. You are in the process of admitting these patients when you face questions from your colleagues in-house as to why you didn’t perform an ABG on these patients?

Read More