[HSF] To be or not to be

[erdinç naseri]

Hal,
I will mention the importance of packing with sponges soaked in hot water( burn my hands).in aortic root cases. If not completely dry then pack and close and then reopen the next day and depack.This has been my protocol for these cases and I am happy with it.For the other cases I use hot packes liberally if the case seems wet to me.Never more than 200 cc of draianage for routine cases if I close the sternum.
erdinc> From: anianyanwu at hotmail.com> To: openheart-l at lists.hsforum.com> Subject: RE: [HSF] To be or not to be> Date: Sun, 5 Aug 2007 14:40:19 +0000> > Hal> > We use the TEG liberaly but I cannot say with certainty that it is beneficial. I think what it achieves is it makes the team think more and thik logically before they transfuse blood products. I think it is this 'stop and think' effect raher than the TEG itself that reduces use of blood products.> > The main values I find for a TEG is > > 1) In the complex operation such as a reop or VAD or bentall, when we reverse protamine, if the TEG is normal then it is highly unlikely the patient is severely coagulopathic. We then do not give any products we apply topical thrombin as required, pack and wait. If bleeding persists after this initial period we search for surgical bleeders and repeat TEG. If the TEG is abnormal, and the clinical field is 'wet' then we give platelets or FFP or cryo depending on what the TEG suggests. > > 2) If a patient is bleeding profusely and you have a normal TEG then you are likely dealing with a surgical bleed. In such a patient the surgeon should make a thorough search and stop the bleeder (or re-explore if patient in ICU) rather than give tons of products.> > In general I do not give blood products in the operating room unless evidence of coagulopathy can be demonstrated either on a TEG or platelet studies or INR (we also have a machine that give a stat INR, platelet count and platelet function but I don't know much about it). I practically never give prophylactic products (i.e. before a TEG is performed) except in patients with pre-existing coagulopathy or massive intra-op transfusions.> > Ani> > > > > From: Hgrmd at aol.com> Date: Sun, 5 Aug 2007 09:59:21 -0400> Subject: Re: [HSF] To be or not to be> To: OpenHeart-L at lists.hsforum.com> CC: > > Ani,> I'm thinking that the way for me to get away from "empiric platelets" is > the TEG. What are your thoughts on this test?> > Hal> > > > ************************************** Get a sneak peek of the all-new AOL at > http://discover.aol.com/memed/aolcom30tour> _______________________________________________> OpenHeart-L mailing list> > Send postings to:> OpenHeart-L at lists.hsforum.com> > To UNSUBSCRIBE, to CHANGE email address, or to view archives:> http://mmp.cjp.com/mailman/listinfo/openheart-l> > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at:> http://www.hsforum.com/listdisclaim> -----------------------------------------> _________________________________________________________________> Feel like a local wherever you go with BackOfMyHand.com> http://www.backofmyhand.com_______________________________________________> OpenHeart-L mailing list> > Send postings to:> OpenHeart-L at lists.hsforum.com> > To UNSUBSCRIBE, to CHANGE email address, or to view archives:> http://mmp.cjp.com/mailman/listinfo/openheart-l> > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at:> http://www.hsforum.com/listdisclaim> -----------------------------------------