The document summarizes guidelines from the 2011 update to the Society of Thoracic Surgeons and the Society of Cardiovascular Anesthesiologists blood conservation clinical practice guidelines. It discusses recommendations for various preoperative, intraoperative, and postoperative interventions to reduce blood loss and transfusions during cardiac procedures. The guidelines classify recommendations into different evidence-based classes and assign levels of evidence. Areas addressed include management of antiplatelet drugs, use of blood derivatives, minimally invasive procedures, blood salvage techniques, and creation of multidisciplinary blood management teams.
Jehowah's witnesses and blood conservation strategies by Dr.Minnu M. PanditraoMinnu Panditrao
dr. Mrs. Minnu M. Panditrao explains the problems faced by anesthesiologists in anesthetising the Jehowah's Witness patients because of their beliefs. Ina ddition she also discribes various strategies of Blood conservation.
Blood a conversation about conservation ex ss 1010113ess_online
This document summarizes a presentation on blood conservation and patient blood management. It discusses the need to conserve the blood supply due to diminishing donor pools and increasing demand. Current strategies to reduce blood transfusions include anemia management, cell salvage techniques, and restrictive transfusion guidelines. Future strategies may involve oxygen carrying solutions, stem cell derived blood, and group conversion. The presentation emphasizes patient blood management as a multidisciplinary approach to optimizing patient care and blood utilization.
This document provides clinical practice guidelines for blood conservation strategies in cardiac surgery from the Society of Thoracic Surgeons and The Society of Cardiovascular Anesthesiologists. It recommends various preoperative, intraoperative, and postoperative interventions to reduce bleeding and blood transfusions during cardiac procedures. These include discontinuing antiplatelet agents preoperatively, using antifibrinolytics intraoperatively, and employing blood salvage techniques. The guidelines provide evidence and recommendations for different blood derivative products and perfusion strategies to optimize blood conservation.
1. The guidelines provide recommendations for perioperative blood management to reduce transfusions, bleeding, and related adverse outcomes.
2. Preadmission preparation includes treating preexisting anemia, discontinuing anticoagulants under specialist guidance, and considering preadmission autologous blood donation if time allows.
3. Intraoperative and postoperative management focuses on restrictive transfusion protocols, monitoring for bleeding and organ perfusion, and treating coagulopathy guided by targeted laboratory tests before administering blood products.
The document provides an overview of blood conservation strategies in perioperative patients. It discusses why blood conservation is important to conserve limited blood resources and reduce risks of transfusion. Key strategies mentioned include preoperative patient optimization, use of antifibrinolytics like tranexamic acid, controlled hypotension, cell salvaging, normovolemic hemodilution, and autologous blood donation and transfusion to avoid allogeneic transfusions and their associated risks. The document emphasizes a multidisciplinary team approach and utilization of the latest drugs, techniques and technology to minimize blood loss and reduce need for allogeneic blood transfusions in surgical patients.
This document discusses strategies to reduce blood product usage and transfusions in cardiac surgery patients. It notes that cardiac surgery currently consumes a large portion of blood product supplies, with transfusion rates varying widely between procedures and hospitals. The document outlines both current practices and future directions to minimize blood loss and transfusions through preoperative screening and optimization, surgical techniques, perfusion strategies during bypass, pharmacological agents, point-of-care testing, and postoperative management. The implementation of these strategies has led to significant reductions in transfusion rates, blood product usage, costs, and length of stay at the author's hospital.
1) Blood conservation strategies are important in cardiac surgery to reduce bleeding and transfusions which can increase mortality and morbidity.
2) Preoperative interventions include managing antiplatelet drugs and anticoagulants, correcting anemia, and using drugs to increase red cell mass.
3) Intraoperative techniques involve autologous blood donation, maintaining normothermia, pharmacological agents like tranexamic acid, and restrictive transfusion triggers.
4) Close monitoring of bleeding and vital signs is also important intraoperatively to guide transfusions which should be a last resort.
The document summarizes guidelines from the 2011 update to the Society of Thoracic Surgeons and the Society of Cardiovascular Anesthesiologists blood conservation clinical practice guidelines. It discusses recommendations for various preoperative, intraoperative, and postoperative interventions to reduce blood loss and transfusions during cardiac procedures. The guidelines classify recommendations into different evidence-based classes and assign levels of evidence. Areas addressed include management of antiplatelet drugs, use of blood derivatives, minimally invasive procedures, blood salvage techniques, and creation of multidisciplinary blood management teams.
Jehowah's witnesses and blood conservation strategies by Dr.Minnu M. PanditraoMinnu Panditrao
dr. Mrs. Minnu M. Panditrao explains the problems faced by anesthesiologists in anesthetising the Jehowah's Witness patients because of their beliefs. Ina ddition she also discribes various strategies of Blood conservation.
Blood a conversation about conservation ex ss 1010113ess_online
This document summarizes a presentation on blood conservation and patient blood management. It discusses the need to conserve the blood supply due to diminishing donor pools and increasing demand. Current strategies to reduce blood transfusions include anemia management, cell salvage techniques, and restrictive transfusion guidelines. Future strategies may involve oxygen carrying solutions, stem cell derived blood, and group conversion. The presentation emphasizes patient blood management as a multidisciplinary approach to optimizing patient care and blood utilization.
This document provides clinical practice guidelines for blood conservation strategies in cardiac surgery from the Society of Thoracic Surgeons and The Society of Cardiovascular Anesthesiologists. It recommends various preoperative, intraoperative, and postoperative interventions to reduce bleeding and blood transfusions during cardiac procedures. These include discontinuing antiplatelet agents preoperatively, using antifibrinolytics intraoperatively, and employing blood salvage techniques. The guidelines provide evidence and recommendations for different blood derivative products and perfusion strategies to optimize blood conservation.
1. The guidelines provide recommendations for perioperative blood management to reduce transfusions, bleeding, and related adverse outcomes.
2. Preadmission preparation includes treating preexisting anemia, discontinuing anticoagulants under specialist guidance, and considering preadmission autologous blood donation if time allows.
3. Intraoperative and postoperative management focuses on restrictive transfusion protocols, monitoring for bleeding and organ perfusion, and treating coagulopathy guided by targeted laboratory tests before administering blood products.
The document provides an overview of blood conservation strategies in perioperative patients. It discusses why blood conservation is important to conserve limited blood resources and reduce risks of transfusion. Key strategies mentioned include preoperative patient optimization, use of antifibrinolytics like tranexamic acid, controlled hypotension, cell salvaging, normovolemic hemodilution, and autologous blood donation and transfusion to avoid allogeneic transfusions and their associated risks. The document emphasizes a multidisciplinary team approach and utilization of the latest drugs, techniques and technology to minimize blood loss and reduce need for allogeneic blood transfusions in surgical patients.
This document discusses strategies to reduce blood product usage and transfusions in cardiac surgery patients. It notes that cardiac surgery currently consumes a large portion of blood product supplies, with transfusion rates varying widely between procedures and hospitals. The document outlines both current practices and future directions to minimize blood loss and transfusions through preoperative screening and optimization, surgical techniques, perfusion strategies during bypass, pharmacological agents, point-of-care testing, and postoperative management. The implementation of these strategies has led to significant reductions in transfusion rates, blood product usage, costs, and length of stay at the author's hospital.
1) Blood conservation strategies are important in cardiac surgery to reduce bleeding and transfusions which can increase mortality and morbidity.
2) Preoperative interventions include managing antiplatelet drugs and anticoagulants, correcting anemia, and using drugs to increase red cell mass.
3) Intraoperative techniques involve autologous blood donation, maintaining normothermia, pharmacological agents like tranexamic acid, and restrictive transfusion triggers.
4) Close monitoring of bleeding and vital signs is also important intraoperatively to guide transfusions which should be a last resort.
A multidisciplinary, multimodal perioperative patient blood management program should be established to optimize patient outcomes. Key elements of the program include preoperative optimization of red cell mass and coagulation status, minimization of perioperative blood loss through meticulous surgical haemostasis and other strategies, and tolerance of postoperative anaemia. Specific recommendations and practice points cover establishment of a program, preoperative anaemia assessment and management, haemostasis management, blood conservation strategies, appropriate transfusion practices, and procedural guidelines for techniques such as acute normovolemic haemodilution.
This study analyzed 45 observational studies including over 272,000 patients to determine the association between red blood cell transfusion and morbidity and mortality in high-risk hospitalized patients. The analysis found that in 42 of the 45 studies, the risks of red blood cell transfusion outweighed the benefits, with transfusion associated with increased risk of death, infections, multi-organ dysfunction syndrome, and acute respiratory distress syndrome. A meta-analysis found that transfusion was associated with 70% higher odds of death and 80% higher odds of developing an infectious complication. The study suggests current transfusion practices may need reevaluation given the risks appear to outweigh the benefits in most patients.
The document discusses various functions and properties of blood, including transport, regulation, and protection. It then summarizes different blood products like packed red blood cells, platelets, fresh frozen plasma, and cryoprecipitated antihemophilic factor. It discusses their indications, storage requirements, and risks of transfusion such as allergic reactions, hemolytic reactions, febrile reactions, bacterial contamination, transfusion-related acute lung injury, and disease transmission.
This document discusses transfusion support for children with thalassemia major. It notes that transfusion therapy should begin once thalassemia major is diagnosed based on clinical and laboratory findings. The goals of transfusion therapy are to maintain red blood cell viability and function, achieve appropriate hemoglobin levels, minimize effects of anemia, and avoid adverse reactions. The optimal regimen involves phenotype matched and leukoreduced red blood cells transfused every 3 weeks to maintain hemoglobin between 9-10.5 g/dL. Regular screening for transfusion-transmitted infections is also recommended.
Bloodless Medicine Caring Effectively For Patients Who Decline Blood Transf...mcolumbus
Bloodless Medicine and Surgery involves performing medical care without blood transfusions, which some refuse for religious reasons. The history of blood use in medicine shows that practices like bloodletting were once common but are now considered misguided. Current bloodless techniques include acute normovolemic hemodilution, cell salvage, and use of blood substitutes and oxygen therapeutics to avoid transfusions when possible. Studies show bloodless surgery can be performed safely with careful planning and use of alternatives to transfusions.
The document provides guidelines for managing patients with critical bleeding requiring massive
transfusion, including recommendations for developing a massive transfusion protocol that outlines
the dose, timing and ratio of blood component therapy. It also recommends measuring and
monitoring key physiological parameters, and provides consensus-based practice points on issues
where evidence was insufficient, such as appropriate transfusion triggers and the potential role of
recombinant factor VII. A template is provided for a massive transfusion protocol that can be locally
adapted.
Autologous blood transfusion /certified fixed orthodontic courses by Indian ...Indian dental academy
Welcome to Indian Dental Academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy has a unique training program & curriculum that provides students with exceptional clinical skills and enabling them to return to their office with high level confidence and start treating patients
State of the art comprehensive training-Faculty of world wide repute &Very affordable.
The document discusses Patient Blood Management (PBM), which is a multidisciplinary approach to optimize care for patients who may need blood transfusions. It involves strategies before, during, and after surgery/procedures to minimize blood loss and transfusions. Key preoperative strategies include identifying and treating anemia, assessing bleeding risk, and considering preoperative autologous blood donation. Intraoperative strategies focus on techniques to reduce blood loss like cell salvage and tranexamic acid. Postoperative care emphasizes continued efforts to minimize blood loss and optimize physiology. The overall goals are to improve patient outcomes, reduce costs, and ensure an adequate blood supply.
This document discusses different techniques for autologous blood transfusion including pre-operative blood donation, acute normovolaemic haemodilution, and intra-operative and post-operative blood salvage. Pre-operative blood donation allows collection of blood 4-5 weeks before surgery while acute normovolaemic haemodilution involves removing blood just before or after anesthesia and replacing it with fluids. Intra-operative and post-operative blood salvage uses equipment to collect and filter blood from the surgical site for reinfusion. Each technique has advantages and appropriate applications depending on the surgical situation and patient factors. Together, autologous transfusion techniques can significantly reduce the need for allogenic blood transfusions
Autologous transfusion involves collecting and reinfusing a patient's own blood to avoid allogenic blood transfusions. There are several techniques including preoperative blood collection and storage, acute normovolemic hemodilution during surgery, and intraoperative or postoperative blood salvaging from surgical sites. Autologous transfusion can help prevent transfusion-transmitted diseases and reactions, provide compatible blood, and comply with certain religious beliefs. However, it also carries risks of anemia and bacterial contamination. The document discusses the various autologous transfusion methods and their advantages, disadvantages, indications, and complications.
Blood transfusion guidelines provide recommendations for appropriate clinical use of blood and components to reduce risks. The risks of transfusion can be lowered through effective donor selection, screening, testing, component separation, storage, and clinical use. Transfusion is recommended when the hemoglobin is less than 7g/dL or the platelet count is less than 10,000/uL, depending on the clinical situation. Alternatives to allogenic transfusion include autologous donation prior to surgery, acute normovolemic hemodilution, erythropoietin, and blood salvage to reduce transfusion needs.
The document discusses various techniques of autologous blood transfusion where the donor and recipient are the same person, including preoperative autologous donation where patients donate their own blood weeks before elective surgery to avoid allogeneic transfusions, as well as intraoperative and postoperative blood salvage techniques to reduce transfusion needs. The advantages of autologous transfusion are outlined as preventing transfusion reactions and infections, while the disadvantages include potential wastage if transfusions are not needed and risks of clerical errors.
Massive transfusion protocols aim to replace lost blood volume and prevent coagulopathy in severely injured trauma patients. The study found that 7% of trauma patients received over 10 units of red blood cells in the first 24 hours, identifying them at high risk. Early administration of blood products in a 1:1:1 ratio of red cells, plasma, and platelets according to massive transfusion protocols was associated with reduced mortality compared to standard transfusion practices. Simple clinical factors like low blood pressure, high injury severity score, and coagulopathy can help predict patients needing massive transfusion.
This document provides guidelines for blood transfusion and alternatives. It recommends considering alternatives to transfusion such as erythropoietin, intravenous/oral iron, cell salvage, and tranexamic acid for non-bleeding surgery patients. For those requiring transfusion, it provides thresholds and dosing guidelines for red blood cells, platelets, fresh frozen plasma, cryoprecipitate, and prothrombin complex concentrate based on bleeding status and test results. All decisions should consider the full clinical situation to avoid under or over-transfusion.
Transfusion involves preparing and transfusing blood and blood products. It involves whole blood, packed red blood cells, plasma, platelets, and plasma fractions. Major causes of maternal morbidity and mortality are chronic anemia of pregnancy and major obstetric hemorrhage. For hemorrhage, initial resuscitation with fluids is priority to restore volume, followed by packed red blood cells and component replacement based on coagulation tests. Continuous monitoring guides treatment, and identifying/treating the cause of bleeding is important. Risks of transfusion include febrile reactions, infections, and complications from stored blood.
This document defines massive transfusion as replacing one blood volume or more within 24 hours, which corresponds to approximately 10 units of blood for a 70 kg adult. Massive transfusion can cause numerous complications including dilution coagulopathies, hypothermia, acidosis, and tissue hypoxia. The overall mortality for patients requiring massive transfusion is around 40% but increases to over 75% for those who develop hemostatic disorders. Proper use of massive transfusion protocols which rapidly provide blood products can help minimize complications and reduce mortality rates.
Massive transfusion protocols aim to standardize the resuscitation of patients experiencing severe bleeding through the early administration of blood products. The key aspects of such protocols discussed in the document include:
- Definitions of massive transfusion as the replacement of over 50% of total blood volume within 3-4 hours or transfusion of over 10 units of packed red blood cells within 24 hours.
- Common clinical conditions requiring massive transfusion include severe trauma, ruptured aortic aneurysms, and obstetric or surgical complications.
- Current concepts favor permissive hypotension and minimal crystalloid resuscitation to control bleeding before aggressively restoring blood pressure and volume.
- Blood products administered according to protocols include packed red blood
This document provides an updated summary of guidelines for blood conservation in cardiac surgery from The Society of Thoracic Surgeons and the Society of Cardiovascular Anesthesiologists. Major revisions include new recommendations regarding dual anti-platelet therapy management before surgery, drugs that augment red blood cell volume or limit blood loss, blood derivatives, blood salvage management, minimally invasive procedures, extracorporeal membrane oxygenation, hemostatic agents, and insights into team-based interventions. The guidelines were updated based on a literature review using standardized search terms to ensure the recommendations reflect the most current evidence available.
Physiological triggers for blood transfusion in the icuchandra talur
Physiological triggers for blood transfusion in critically ill patients should be based on an individual patient's volume status, evidence of shock or end-organ compromise, and cardiopulmonary parameters rather than a single hemoglobin threshold. A restrictive transfusion strategy (transfusing when Hb <7 g/dL) is as effective as a liberal strategy (Hb <10 g/dL) for hemodynamically stable patients. The decision to transfuse should take into account the patient's hemodynamic status, rate of blood loss, oxygen delivery capabilities, and risk-benefit ratio of transfusion.
A multidisciplinary, multimodal perioperative patient blood management program should be established to optimize patient outcomes. Key elements of the program include preoperative optimization of red cell mass and coagulation status, minimization of perioperative blood loss through meticulous surgical haemostasis and other strategies, and tolerance of postoperative anaemia. Specific recommendations and practice points cover establishment of a program, preoperative anaemia assessment and management, haemostasis management, blood conservation strategies, appropriate transfusion practices, and procedural guidelines for techniques such as acute normovolemic haemodilution.
This study analyzed 45 observational studies including over 272,000 patients to determine the association between red blood cell transfusion and morbidity and mortality in high-risk hospitalized patients. The analysis found that in 42 of the 45 studies, the risks of red blood cell transfusion outweighed the benefits, with transfusion associated with increased risk of death, infections, multi-organ dysfunction syndrome, and acute respiratory distress syndrome. A meta-analysis found that transfusion was associated with 70% higher odds of death and 80% higher odds of developing an infectious complication. The study suggests current transfusion practices may need reevaluation given the risks appear to outweigh the benefits in most patients.
The document discusses various functions and properties of blood, including transport, regulation, and protection. It then summarizes different blood products like packed red blood cells, platelets, fresh frozen plasma, and cryoprecipitated antihemophilic factor. It discusses their indications, storage requirements, and risks of transfusion such as allergic reactions, hemolytic reactions, febrile reactions, bacterial contamination, transfusion-related acute lung injury, and disease transmission.
This document discusses transfusion support for children with thalassemia major. It notes that transfusion therapy should begin once thalassemia major is diagnosed based on clinical and laboratory findings. The goals of transfusion therapy are to maintain red blood cell viability and function, achieve appropriate hemoglobin levels, minimize effects of anemia, and avoid adverse reactions. The optimal regimen involves phenotype matched and leukoreduced red blood cells transfused every 3 weeks to maintain hemoglobin between 9-10.5 g/dL. Regular screening for transfusion-transmitted infections is also recommended.
Bloodless Medicine Caring Effectively For Patients Who Decline Blood Transf...mcolumbus
Bloodless Medicine and Surgery involves performing medical care without blood transfusions, which some refuse for religious reasons. The history of blood use in medicine shows that practices like bloodletting were once common but are now considered misguided. Current bloodless techniques include acute normovolemic hemodilution, cell salvage, and use of blood substitutes and oxygen therapeutics to avoid transfusions when possible. Studies show bloodless surgery can be performed safely with careful planning and use of alternatives to transfusions.
The document provides guidelines for managing patients with critical bleeding requiring massive
transfusion, including recommendations for developing a massive transfusion protocol that outlines
the dose, timing and ratio of blood component therapy. It also recommends measuring and
monitoring key physiological parameters, and provides consensus-based practice points on issues
where evidence was insufficient, such as appropriate transfusion triggers and the potential role of
recombinant factor VII. A template is provided for a massive transfusion protocol that can be locally
adapted.
Autologous blood transfusion /certified fixed orthodontic courses by Indian ...Indian dental academy
Welcome to Indian Dental Academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy has a unique training program & curriculum that provides students with exceptional clinical skills and enabling them to return to their office with high level confidence and start treating patients
State of the art comprehensive training-Faculty of world wide repute &Very affordable.
The document discusses Patient Blood Management (PBM), which is a multidisciplinary approach to optimize care for patients who may need blood transfusions. It involves strategies before, during, and after surgery/procedures to minimize blood loss and transfusions. Key preoperative strategies include identifying and treating anemia, assessing bleeding risk, and considering preoperative autologous blood donation. Intraoperative strategies focus on techniques to reduce blood loss like cell salvage and tranexamic acid. Postoperative care emphasizes continued efforts to minimize blood loss and optimize physiology. The overall goals are to improve patient outcomes, reduce costs, and ensure an adequate blood supply.
This document discusses different techniques for autologous blood transfusion including pre-operative blood donation, acute normovolaemic haemodilution, and intra-operative and post-operative blood salvage. Pre-operative blood donation allows collection of blood 4-5 weeks before surgery while acute normovolaemic haemodilution involves removing blood just before or after anesthesia and replacing it with fluids. Intra-operative and post-operative blood salvage uses equipment to collect and filter blood from the surgical site for reinfusion. Each technique has advantages and appropriate applications depending on the surgical situation and patient factors. Together, autologous transfusion techniques can significantly reduce the need for allogenic blood transfusions
Autologous transfusion involves collecting and reinfusing a patient's own blood to avoid allogenic blood transfusions. There are several techniques including preoperative blood collection and storage, acute normovolemic hemodilution during surgery, and intraoperative or postoperative blood salvaging from surgical sites. Autologous transfusion can help prevent transfusion-transmitted diseases and reactions, provide compatible blood, and comply with certain religious beliefs. However, it also carries risks of anemia and bacterial contamination. The document discusses the various autologous transfusion methods and their advantages, disadvantages, indications, and complications.
Blood transfusion guidelines provide recommendations for appropriate clinical use of blood and components to reduce risks. The risks of transfusion can be lowered through effective donor selection, screening, testing, component separation, storage, and clinical use. Transfusion is recommended when the hemoglobin is less than 7g/dL or the platelet count is less than 10,000/uL, depending on the clinical situation. Alternatives to allogenic transfusion include autologous donation prior to surgery, acute normovolemic hemodilution, erythropoietin, and blood salvage to reduce transfusion needs.
The document discusses various techniques of autologous blood transfusion where the donor and recipient are the same person, including preoperative autologous donation where patients donate their own blood weeks before elective surgery to avoid allogeneic transfusions, as well as intraoperative and postoperative blood salvage techniques to reduce transfusion needs. The advantages of autologous transfusion are outlined as preventing transfusion reactions and infections, while the disadvantages include potential wastage if transfusions are not needed and risks of clerical errors.
Massive transfusion protocols aim to replace lost blood volume and prevent coagulopathy in severely injured trauma patients. The study found that 7% of trauma patients received over 10 units of red blood cells in the first 24 hours, identifying them at high risk. Early administration of blood products in a 1:1:1 ratio of red cells, plasma, and platelets according to massive transfusion protocols was associated with reduced mortality compared to standard transfusion practices. Simple clinical factors like low blood pressure, high injury severity score, and coagulopathy can help predict patients needing massive transfusion.
This document provides guidelines for blood transfusion and alternatives. It recommends considering alternatives to transfusion such as erythropoietin, intravenous/oral iron, cell salvage, and tranexamic acid for non-bleeding surgery patients. For those requiring transfusion, it provides thresholds and dosing guidelines for red blood cells, platelets, fresh frozen plasma, cryoprecipitate, and prothrombin complex concentrate based on bleeding status and test results. All decisions should consider the full clinical situation to avoid under or over-transfusion.
Transfusion involves preparing and transfusing blood and blood products. It involves whole blood, packed red blood cells, plasma, platelets, and plasma fractions. Major causes of maternal morbidity and mortality are chronic anemia of pregnancy and major obstetric hemorrhage. For hemorrhage, initial resuscitation with fluids is priority to restore volume, followed by packed red blood cells and component replacement based on coagulation tests. Continuous monitoring guides treatment, and identifying/treating the cause of bleeding is important. Risks of transfusion include febrile reactions, infections, and complications from stored blood.
This document defines massive transfusion as replacing one blood volume or more within 24 hours, which corresponds to approximately 10 units of blood for a 70 kg adult. Massive transfusion can cause numerous complications including dilution coagulopathies, hypothermia, acidosis, and tissue hypoxia. The overall mortality for patients requiring massive transfusion is around 40% but increases to over 75% for those who develop hemostatic disorders. Proper use of massive transfusion protocols which rapidly provide blood products can help minimize complications and reduce mortality rates.
Massive transfusion protocols aim to standardize the resuscitation of patients experiencing severe bleeding through the early administration of blood products. The key aspects of such protocols discussed in the document include:
- Definitions of massive transfusion as the replacement of over 50% of total blood volume within 3-4 hours or transfusion of over 10 units of packed red blood cells within 24 hours.
- Common clinical conditions requiring massive transfusion include severe trauma, ruptured aortic aneurysms, and obstetric or surgical complications.
- Current concepts favor permissive hypotension and minimal crystalloid resuscitation to control bleeding before aggressively restoring blood pressure and volume.
- Blood products administered according to protocols include packed red blood
This document provides an updated summary of guidelines for blood conservation in cardiac surgery from The Society of Thoracic Surgeons and the Society of Cardiovascular Anesthesiologists. Major revisions include new recommendations regarding dual anti-platelet therapy management before surgery, drugs that augment red blood cell volume or limit blood loss, blood derivatives, blood salvage management, minimally invasive procedures, extracorporeal membrane oxygenation, hemostatic agents, and insights into team-based interventions. The guidelines were updated based on a literature review using standardized search terms to ensure the recommendations reflect the most current evidence available.
Physiological triggers for blood transfusion in the icuchandra talur
Physiological triggers for blood transfusion in critically ill patients should be based on an individual patient's volume status, evidence of shock or end-organ compromise, and cardiopulmonary parameters rather than a single hemoglobin threshold. A restrictive transfusion strategy (transfusing when Hb <7 g/dL) is as effective as a liberal strategy (Hb <10 g/dL) for hemodynamically stable patients. The decision to transfuse should take into account the patient's hemodynamic status, rate of blood loss, oxygen delivery capabilities, and risk-benefit ratio of transfusion.
This document provides an updated summary of the 2011 Society of Thoracic Surgeons guidelines for blood conservation. It outlines changes made to the previous 2007 guidelines, including new recommendations regarding dual anti-platelet therapy management before surgery, drugs to augment red blood cell volume or limit blood loss, use of blood derivatives, blood salvage management, minimally invasive procedures, extracorporeal membrane oxygenation, hemostatic agents, and emphasis on multidisciplinary blood management teams. The methods used to survey the literature for this update differed from previous guidelines by using standardized search terms in the PUBMED database. Major areas of revision from the 2007 guidelines are discussed.
This document discusses blood transfusion indications, complications, and reactions. It outlines factors to consider when determining transfusion thresholds based on hemoglobin levels and patient condition. Complications from transfusions can include changes in oxygen transport, coagulation defects, dilutional thrombocytopenia, decreased coagulation factors, disseminated intravascular coagulation-like syndrome, citrate intoxication, hypothermia, acid-base abnormalities. Transfusion reactions include hemolytic reactions which can be fatal if due to ABO incompatibility.
This document provides information on the various components that can be derived from human plasma. It begins by explaining that plasma is the straw-colored liquid portion of blood that suspends the blood cells and contains water, salts, enzymes, antibodies and proteins. The document then describes different plasma derivatives like fresh frozen plasma, cryoprecipitate, coagulation factors, albumin and fibrin glue/sealants. It provides details on the preparation, composition, storage, indications and administration for each plasma component.
Cryoprecipitate is a concentrate of fibrinogen and other clotting factors that precipitates out when frozen plasma thaws. It is used to treat hypofibrinogenemia, bleeding related to massive transfusions, hemophilia when factor concentrates are unavailable, and von Willebrand disease unresponsive to medication. Cryoprecipitate is produced by freezing plasma, thawing it slowly, and collecting the precipitate, which contains fibrinogen and factors VIII, XIII, and von Willebrand factor.
The document outlines the steps for routinely weaning a patient from cardiopulmonary bypass (CPB). It begins with partially occluding venous return to fill the heart and establish pulsatile arterial flow. The perfusionist gradually decreases pump flow while communicating three parameters: flow rate, reservoir volume, and oxygen saturation. As weaning progresses, the patient is assessed for hemodynamic stability before fully clamping venous return and turning off pump flow. Post-bypass, patients are categorized and carefully monitored, with interventions like fluids, drugs or devices as needed to stabilize their condition.
This patient has a history of myocardial infarction, triple vessel coronary artery disease, and is scheduled for elective non-cardiac surgery. Based on his positive stress test results and coronary angiogram showing severe blockages, the cardiologist recommends coronary artery bypass graft surgery prior to the planned surgery to improve his long-term prognosis and reduce perioperative cardiac risks.
This presentation discusses the latest evidence for blood transfusion triggers in the intensive care unit of various clinical condition including severe sepsis, GI bleed, post surgical cases, and post cardiac surgery among other cnditions
This document provides an overview of cardiac anatomy relevant to cardiac surgery and cardiopulmonary bypass. It includes diagrams labeling the major structures of the heart such as the atria, ventricles, valves, coronary arteries and great vessels. It discusses the surgical approaches to the mediastinum and important considerations for arterial and venous cannulation sites. The document emphasizes understanding anatomy to properly plan surgery and cardiopulmonary bypass management based on the specific clinical situation.
This document discusses cardioplegia and surgical ischemia. It provides an overview of ischemic injury including acute ischemic dysfunction, preconditioning, stunning, hibernation, necrosis, and apoptosis. It then discusses the history and development of cardioplegic protection for the heart during cardiac surgery, including early methods using hypothermia, potassium-based solutions, and the introduction of the St. Thomas' Hospital Cardioplegia solution. The principles of cardioplegic protection are outlined, including inducing cardiac arrest, hypothermia, anti-ischemic agents, reperfusion, and protection of vascular and conduction tissues. Methods of inducing cardiac arrest through depolarized and polarized states are also summarized.
Indications and complications of blood transfusion abhimanyu_ganguly
Blood transfusions are given to increase oxygen-carrying capacity and intravascular volume. Transfusion is rarely indicated when hemoglobin is above 10 g/dL but is almost always needed below 6 g/dL, with determinations between 6-10 g/dL based on patient risk and evaluation. Complications include changes in oxygen transport, coagulation issues like thrombocytopenia, allergic reactions, lung injury, and immunosuppression. The most common causes of transfusion-related death are bacterial contamination, transfusion-related acute lung injury, and mistransfusion.
1. Perioperative fluid management aims to maintain adequate blood volume and tissue oxygenation to improve outcomes. Strict fluid balance is important to avoid complications.
2. Goal-directed hemodynamic therapy using parameters like stroke volume variation can optimize tissue oxygen delivery and reduce postoperative infections and complications.
3. In trauma patients requiring massive transfusion, plasma should be administered in a ratio of 1:1 to 1:2 with packed red blood cells to replace clotting factors and improve outcomes. Point-of-care coagulation monitoring helps guide administration.
Heart lung machine also referred to as extracorporeal circulation...Sharmin Susiwala
The heart lung machine, also known as cardiopulmonary bypass, temporarily takes over the functions of the heart and lungs during surgery by pumping and oxygenating blood outside of the body. It allows surgeons to operate on a still, non-beating heart. The machine filters, warms or cools, oxygenates, and pumps blood back into the body through cannulas while the heart is stopped. It is commonly used for coronary artery bypass surgery, heart valve repair/replacement, and repair of congenital heart defects. Potential complications include hemolysis, clotting in the circuit, air embolism, and acute respiratory distress syndrome.
Blood Transfusion: Rethinking who, what and whenSCGH ED CME
This document summarizes the key points from a presentation on rethinking blood transfusion practice. It discusses how transfusion guidelines have evolved over time, noting some uncertainty around transfusion thresholds. It also outlines both the risks of anaemia but also potential risks and harms of blood transfusion, such as immune modulation effects and increased infection rates. The presentation promotes the importance of patient blood management programs to optimize hemoglobin levels, minimize blood loss, and reduce unnecessary transfusions in order to improve patient outcomes. Specific strategies discussed include single unit transfusion policies, increased use of intravenous iron, and reducing sample collection errors through improved education and policies.
This document discusses patient blood management (PBM), which is a multidisciplinary approach to optimizing patient care and reducing unnecessary blood transfusions. It has three pillars: optimizing erythropoiesis, minimizing bleeding, and harnessing physiological reserves of anemia. The evidence shows PBM can reduce transfusions by 39% without increasing risks. It has led to reduced transfusions and costs in various settings like cardiac and orthopedic surgery. PBM programs require a multidisciplinary team approach led by specialties like anesthesiology. Overall, PBM provides better patient outcomes while reducing allogeneic blood use.
This document provides an overview of blood and blood products used in transfusion medicine. It discusses the historical background of blood transfusion and introduces the main blood components - packed red blood cells, platelets, fresh frozen plasma, and cryoprecipitate. It describes the indications for transfusion of each component in various clinical settings, with a focus on obstetrics and gynecology. Guidelines for ordering, storing, and administering blood products are also reviewed to ensure their safe and appropriate clinical use.
1) Current blood transfusion practices focus on component therapy which allows for targeted replacement of specific blood components like red blood cells, platelets, or plasma factors. This is more effective than whole blood transfusion.
2) Leukoreduction of blood components through filtration is recommended to prevent febrile non-hemolytic transfusion reactions, reduce risk of alloimmunization, and prevent CMV transmission in certain patient groups.
3) In massive hemorrhage situations, a protocol-based massive transfusion involving alternating units of red blood cells, fresh frozen plasma, platelets and cryoprecipitate aims to optimize hemodynamic stability and hemostasis through replacement of blood volume and coagulation factors.
This document summarizes a presentation on therapeutic plasma exchange (PEX) given by Kamal Mohamed Okasha. It provides an overview of the PEX procedure and potential indications for PEX, including Goodpasture's Syndrome, thrombotic thrombocytopenic purpura, cryoglobulinemia, multiple myeloma, and ANCA disease. It discusses complications of PEX and guidelines for efficacy based on recent studies. In particular, it examines the use of PEX for Goodpasture's Syndrome, noting that PEX aims to remove circulating anti-GBM antibodies and that studies have found improved outcomes, including renal function and survival, for patients receiving PEX treatment.
There are several alternatives to blood transfusion that can help reduce its use and risks. These include treating pre-existing anemia, using medications to stimulate red blood cell production or stop bleeding, employing blood-saving surgical techniques and technologies like cell salvage machines. While blood substitutes have been studied, none have gained approval due to safety issues. Implementing strategies of patient blood management can help minimize allogenic blood transfusions.
This document discusses the rationale for using whole blood for trauma resuscitation. It describes the THOR Network, an international collaborative focused on improving outcomes from traumatic hemorrhagic shock. The network aims to develop and implement best practices for prehospital care through completion of acute resuscitation. Low titer group O whole blood is described as optimal for trauma-induced blood failure compared to blood components. Data is presented showing whole blood provides higher concentrations of red blood cells, platelets, and coagulation factors in a smaller volume than separated components. Future directions discussed include developing artificial red blood cells and dried plasma.
Current Component Therapy by Diane Eklund, MDbloodbankhawaii
Lorem ipsum dolor sit amet, voluptaria percipitur has eu. Nibh iriure nostrud ei mea. Vel dicta voluptua convenire ei, id pro libris viderer. Pri et legendos atomorum, vel eu noster probatus menandri. Omnes possim ut eam, sed ea labore maiorum.
Major hemorrhage is a leading cause of mortality world over. Counteracting severe blood loss usually requires transfusion of a large number of blood units, qualifying as massive transfusion more often than not. Concepts in massive transfusion have undergone substantial changes in the past years not just with acquisition of new knowledge on this subject but with technical advances in component preparation. We aim at providing an overview of the changing trends and concepts in management of massive blood loss.
Component therapy provides specific blood products like red blood cells, platelets, fresh frozen plasma, and cryoprecipitate to address distinct clinical needs like restoring oxygen capacity, hemostasis, or coagulation factors. The goal is to use the appropriate component for each patient's condition while maximizing the benefits from each blood donation. Indications for component therapy include restoring blood volume, oxygen carrying capacity, hemostasis, and leukocyte function. The choice of component depends on the specific factor or function that needs to be addressed.
Component therapy provides specific blood products like red blood cells, platelets, fresh frozen plasma, and cryoprecipitate to address distinct clinical needs like restoring oxygen capacity, hemostasis, or coagulation factors. The goal is to use the most appropriate blood product for each patient's needs while maximizing the benefits from each blood unit. Indications for transfusion include restoring or maintaining blood volume, oxygen carrying capacity, hemostasis, and leukocyte function. Careful consideration of each patient's clinical situation and test results is important for determining the best component therapy.
Transfusion support is an integral part of solid organ transplantation. Blood typing and screening for antibodies is important to minimize rejection. Large amounts of blood products may be needed during and after transplantation, especially for liver transplant which can use over 10 units of red blood cells. Monitoring coagulation and using viscoelastic tests like thromboelastography help guide transfusion needs. Special attention must be paid to CMV status, leukoreduction, and irradiation of blood to prevent complications. Advances in desensitization have helped breach some immunological barriers to transplantation.
A 6-year-old boy presented with recurrent painful swelling of the left knee joint since age 2 and a history of prolonged bleeding from cuts. On examination, his left knee was swollen and tender. Laboratory tests showed a normal prothrombin time but elevated activated partial thromboplastin time that corrected with factor IX-deficient plasma, confirming a diagnosis of hemophilia B. The boy was advised to receive factor IX replacement therapy if he required a dental tooth extraction to prevent uncontrolled bleeding.
2012 anemo ranucci - plasma free management nel sanguinamento in chirurgia ...anemo_site
This document provides guidelines for the use of fresh frozen plasma (FFP) based on a review by the British Committee for Standards in Haematology. It recommends FFP for single inherited clotting factor deficiencies and severe bleeding associated with disseminated intravascular coagulation or hypofibrinogenemia. The guidelines advise against FFP for warfarin reversal without severe bleeding or to correct prolonged clotting times in ICU patients without bleeding. It also cautions that FFP should not be used as simple volume replacement and discusses risks of transfusion-related adverse events.
This document discusses fluid choice for trauma patients. It describes various fluid options including isotonic saline, hypertonic saline, buffered crystalloids, hypooncotic and hyperoncotic colloids, and allogeneic blood products. The risks of overhydration, endothelial damage, and adverse outcomes from fluid therapy are highlighted. Massive transfusion protocols aiming for higher plasma to red blood cell ratios and faster therapy are recommended to improve survival. The risks of plasma therapy including volume overload, immunomodulation and infections are also reviewed. Monitoring of volume status, tissue perfusion and potential side effects of fluids is advised.
This document discusses massive transfusion protocols (MTPs) which provide rapid blood replacement for severe hemorrhage. MTPs aim to transfuse blood products in a 1:1:1 ratio of fresh frozen plasma, platelets, and red blood cells. Early transfusion according to MTPs is essential to sustain organ function. Complications of massive transfusion include hypothermia, acidosis, coagulopathy, and electrolyte abnormalities which can further impair coagulation. Regular monitoring of coagulation factors and viscoelastic tests can guide targeted treatment to correct deficiencies. Hospitals should establish standardized MTPs and train personnel to optimize outcomes for massively bleeding patients.
This document summarizes key findings from a study on coagulation abnormalities in patients with acute or chronic liver disease. It finds that while routine coagulation tests often indicate a bleeding tendency, the situation is complex as both pro-coagulant and anti-coagulant factors are affected. Patients can be in a balanced state but are at risk of tipping into a hypo- or hyper-coagulable condition. Tests such as thromboelastography and thrombin generation testing provide a more comprehensive assessment than standard coagulation tests. The balance of factors in liver disease patients may shift with conditions like sepsis or renal failure, increasing bleeding or thrombosis risk.
Anemia is common in cancer patients, occurring in 30-86% of cases depending on malignancy type and Hb level definition of anemia. Anemia can be caused by the disease itself through cytokine-mediated effects on erythropoiesis or nutritional deficiencies, or be treatment-related due to chemotherapy, radiotherapy or other drugs. Erythropoietin treatment is effective at reducing transfusion needs and improving quality of life by increasing Hb levels and reducing fatigue in the majority of anemic cancer patients. However, some patients do not respond due iron deficiency or other factors. Iron supplementation can help improve response rates to EPO treatment.
This document discusses blood conservation techniques used in the perioperative period. It begins by defining blood conservation and appropriate transfusion. It then lists guiding principles, including that transfusions carry risks and conservation provides alternatives. It discusses autologous versus allogeneic transfusions. Techniques discussed include preoperative autologous donation, intraoperative methods like positioning, regional anesthesia, deliberate hypotension, and pharmacological agents. Intraoperative blood salvage and postoperative salvage are also mentioned.
Similar to Dafydd Thomas on Blood Conservation (20)
Systematic review of 26 studies with 55,792 patients found that dedicated neurocritical care (NCC) was associated with decreased risk of mortality (17% relative risk reduction) and decreased risk of poor functional outcomes (17% relative risk reduction) in critically ill brain-injured adults. A survey of Australian ICUs found limited availability of NCC, with only 4 centers specializing in it and 9 employing an intensivist subspecializing in NCC. Continuous EEG monitoring was found to have higher sensitivity for detecting nonconvulsive seizures than routine EEG monitoring, and was associated with reduced in-hospital mortality, though barriers to its universal use include infrastructure and personnel requirements.
CORTICAL SPREADING DEPOLARISATION IN NEUROLOGICAL DISEASE – AN INTRODUCTION
By Toby Jeffcote
Cortical spreading depolarization (CSD) is a spreading loss of ion homeostasis, altered vascular response, change in synaptic architecture, and subsequent depression in electrical activity following an inciting neurological injury.
It was first described by Leão in 1944, a disturbance in neuronal electrophysiology has since been demonstrated in a number of animal studies, and recently a few human studies that examine the occurrence of this depolarizing phenomenon in the setting of a variety of pathological states, including migraines, cerebrovascular accidents, epilepsy, intracranial hemorrhages, and traumatic brain injuries. The onset of CSD has been demonstrated experimentally following a disruption in the neuronal environment leading to glutamate-induced toxicity. This initial event leads to pathological changes in the activity of ion channels that maintain membrane potential. Recovery mechanisms such as sodium-potassium pumps that aim to restore homeostasis fail, leading to osmolar shifts of fluid, swelling of the neuron, and ultimately a measurable depression in cortical activity that spreads in the order of millimeters per minute. Equally important is the resulting change in vascular response. In healthy tissue, increased electrical activity is coupled with release of vasodilatory factors such as nitric oxide and arachidonic acid metabolites that increase local blood flow to meet increased energy expenditure. In damaged tissue, not only is the restorative vascular response lacking but a vasoconstrictive response is promoted and the ischemia that follows adds to the severity of the initial injury. Tissue threatened by this ischemic response is then at elevated risk for CSD propagation and falls into a vicious cycle of electrical and hemodynamic disturbance. Efforts have been made to halt this spreading cortical depression using N-methyl-D-aspartate receptor antagonists and other ion channel blockers to minimize the damaging effects of CSD that can persist long after the triggering insult.
Celia Bradford takes us through the latest on the management of subdural haemorrhage (SDH). She covers acute SDH, chronic SDH and middle meningeal artery embolisation, a novel treatment for chronic SDH management in certain circumstances.
Andy Neill - More neuroanatomy pearls for neurocritical careSMACC Conference
Andy Neill shares some more neuroanatomy wisdom that's highly practical for anyone working with neuro emergencies. This time he covers brain herniation syndromes, hydrocephalus, extradural vs subdural haematomas, cervical spinal imaging, vertebral artery dissection and "things you read on CT reports but don't know what they mean"!
Andrew Udy talks about Brain Tissue Oxygen Monitoring:
It’s Not What You’ve Got It’s What You Do With It
The BONANZA Trial
Andrew Udy talks about the ongoing BONANZA Trial which is assessing whether an algorithm that incorporates both ICP and brain tissue oxygen (PbTO2) can improve outcomes after traumatic brain injury (TBI). Like with all monitoring, how the PbTO2 is interpreted and managed is critical and the devil is in the detail!
More on BONANZA here
More on BOOST3 here
R. Loch Macdonald, M.D., Ph.D.
Community Neurosciences Institute
Fresno, California, USA
Angiographic vasospasm and more accurately, delayed cerebral ischemia, continue to contribute to morbidity and mortality in patients with aneurysmal subarachnoid hemorrhage (SAH). It is known that angiographic vasospasm is common after SAH, occurring in two-thirds of patients. Cerebral infarctions that developed days after the SAH have been attributed to angiographic vasospasm, occuring in about a third of patients, although this has always been controversial. Angiographic vasospasm theoretically can only damage the brain by restricting blood flow but there is no easy, accurate, widely available method to measure cerebral blood flow and this is not the measurement we need. Blood flow depends on metabolic demand so what we need to know to determine if angiographic vasospasm is causing ischemia is oxygen extraction fraction in the brain tissue supplied the the spastic artery. Without this measurement, the attribution of ischemia to vasospasm is subjective. Since angiographic vasospasm is essentially the only detectable delayed phenomenon after SAH, we focus on it and apply tremendous resources to preventing or reversing the vasospasm. Undoubtedly angiographic vasospasm can cause cerebral infarctions, but it has to be severe and flow limiting. But SAH is a complex disease. There are many other causes for cerebral infarctions after SAH, the most common being due to the aneurysm repair procedure. And a given degree of vasospasm may cause infarction in a volume-depleted patient with poor collateral blood supply but not in a patient without these things. There also are hypodense brain lesions after SAH that are due to intracerebral hemorrhages. There can be hypodensities in the brain directly under usually thick SAH where the brain dies. This observation in particular supports a role for cortical spreading depolarizations/ischemia as a cause of infarction after SAH. Other macromolecular processes that are hypothesized to cause brain damage after SAH include microthromboembolism, changes in the microcirculation, delayed brain cell apoptosis and capillary transit time heterogeneity. Determining the importance of these things is hindered by the lack of an easy way to detect them in patients. It is also known that poor grade patients, who presumably have more early brain injury and ischemia than good grade patients, are more prone to delayed cerebral ischemia, suggesting increased sensitivity to secondary insults of the already injured brain. We also assume delayed neurological deterioration when attributed to vasospasm or delayed cerebral ischemia, is purely due to ischemia. While knowledge about what happens pathophysiologically after SAH is increasing, management of delayed cerebral ischemia still focuses on detecting angiographic vasospasm and then augmenting the blood pressure to improve cerebral blood flow or dilating the spastic arteries with balloons or drugs.
By Catherine Bell and Andrew Udy
Catherine Bell takes us through how to troubleshoot problems commonly encountered when looking after patients who have an external ventricular drain (EVD) in situ. Issues with using brain tissue oxygen monitors are also discussed. A highly practical session aimed at bedside clinicians.
There is no such thing as mild, moderate and severe TBI - by Andrew UdySMACC Conference
Part 2 of a debate over the classification of TBI. Andrew Udy then argues that this classification is fundamentally flawed. He discusses the issues with the Glasgow Coma Scale, and therefore the follow-on issues in TBI classification, including all the confounders to the GCS, the issues with timing of the score as well as GCS not taking baseline function or specifics subtypes of TBI into account. He makes teh argument that biomarkers may better categorise the diffuse entity we call TBI.
TBI Debate - Mild, moderate and severe categories workSMACC Conference
Andrew Chow, Intensivist with a neurosurgical background, argues that the current categorisation system for traumatic brain injury (TBI) works, and makes sense! He tackles us through the history of this system, and why it’s important to differentiate different types of TBI. The arguments in favour of this categorisation include the consistency and benefits of a universal language, the implications for triage and management, and the fact that this system has been endorsed by all major organisations
Dr Nick Little is an experienced Neurosurgeon who's looked after patients with traumatic brain injury for his whole career. Here he discusses the difficulties of prognostication following traumatic brain injury (TBI). He talks about the statistics of outcomes following mild, moderate and severe TBI and then goes on to tackle the harder topic of how we try to work out what an individual would want if they knew the spectrum of outcomes that they may face. The issues with the clinical examination findings we use to prognosticate are covered, as well as which imaging findings he finds most helpful. He also mentions the difficulties with current prognostic calculators.
Historically, when it came to brain injury, ketamine had a bad rap. Much of that dogma was dispelled in the last decade, and ketamine is now frequently used as an induction agent in acute brain injury, especially traumatic brain injury, due to it’s favorable effects on haemodynamics.
However a new application of ketamine is now being explored - whether ketamine may be able to reduce secondary brain injury.
Managing Complications of Chronic SCI by Bonne LeeSMACC Conference
20 million people around the world are living with a spinal cord injury (SCI). The medical issues they develop over the years differ to any other patient cohort.
These complications include autonomic dysreflexia, management of pressure areas, specific infections, nuanced peri-operative care and highly specific issues such as baclofen pump management and syringomyelia
Do look at the NeuroResus section on this and listen to Spinal Rehab Specialist Bonne Lee talk about this side of SCI care.
Keywords
SCI, spinal, spinal cord injury, autonomic dysreflexia, pressure areas, infection, peri-operative care, baclofen pump, syringomyelia, chronic SCI, spinal trauma, spinal rehab, incomplete SCI
Tania is a neurologist and epileptologist with expertise in continuous EEG (cEEG) and status epilepticus (SE). This talk covers what a seizure is, what status is, including focal and generalised status epilepticus.
So why do we do cEEGs for patients with suspected SE?
To confirm the diagnosis
To see if patient just post ictal or still seizing
To establish that the clinical and electric seizures have stopped
To see if burst suppression is achieved
To exclude other differential diagnoses
She makes a good argument for why cEEG is such an important tool in managing SE.
In the questions after the talk, the issue of availability of cEEG in the Australian setting was discussed. Limited montage EEGs are discussed including their pros and cons.
Stuart Browne is a Neuro Rehab specialist from Sydney. These slides accompany a talk he gave at the Brian Symposium in 2023. He discusses what "severe disability" really means.
Severe disability is more common than many realise - about 6% of the Australian population.
Stuart discusses how health is more than simply physical recovery and how it is a multidimensional construct. He covers how permanent disability doesn't necessarily equate to a poor quality of life. He also discusses the long timespan of recovery, which is often much longer than appreciated.
He specifically discusses "Locked-in Syndrome" and how the survivors have surprisingly positive self-reported health-related quality of life and well-being.
Stuart also covers how severely disabled people face various forms of discrimination.
Shree Basu is a Paediatirc Intensivist in Sydney. These slides from the Brain Symposium 2023 accompany the talk she gave. She discusses how Paediatric stroke presents, what neuroimaging is required and what interventions are available, including thrombolysis and the role of endovascular thrombectomy.
Hypertensing Spinal Cord Injury - gold standard or wacky?SMACC Conference
This document discusses the concept of maintaining higher blood pressure levels, known as hypertension, after a spinal cord injury to improve spinal cord perfusion pressure and reduce secondary injury. It notes that while animal studies and some human trials have shown improved neurological outcomes, the evidence is still limited. It calls for larger randomized controlled trials in humans that also incorporate multi-modal monitoring and standardized outcome measures to further evaluate if inducing hypertension after spinal cord injury should be considered the gold standard of care.
Mark Weedon takes us through the increasingly utilised concept of an optimal cerebral perfusion pressure (CPPopt) for each unique patient. He discusses the background to CPPopt, including intrcranial pressure (ICP), the Monroe Kelly hypothesis, neurovascular coupling, and cerebral autoregulation in health and following brain injury. He shows how intracranial pressure is affected by intracranial compliance and how this affects ICP waveforms. Cerebral perfusion pressure in relation to the Brain Trauma Foundation guidelines is covered including management of elevated ICP (EICP). The currently recommended tiered approach to managing cerebral perfusion pressure and EICP is mentioned citing recent guidelines. He uses a clinical case of a TBI to illustrate how the CPPopt can be ascertained and used to guide therapy, including the easy to perform “MAP Challenge”. Mark also describes the Pressure Reactivity Index (PRx) and how it can be used as a target for therapy. Finally, he covers the exciting results of the preliminary COGiTATE pilot study.
Social Worker Victoria Whitfield and Bereavement councilor Louise Sayers discuss the power of words when health professionals are communicating topics around of death and serious injury with relatives and patients in critical care. They use role plays to bring theories to life.
Sepsis and Antimicrobial Stewardship - Two Sides of the Same CoinSMACC Conference
Undertreatment of sepsis can lead to mortality, while overdiagnosis and overtreatment can increase future risk of antimicrobial resistance. Antimicrobial stewardship aims to balance these risks by prioritizing patient safety and appropriate antimicrobial use. Data shows variability in appropriateness of antimicrobial prescribing between different types of hospitals. Embedding antimicrobial stewardship principles throughout sepsis diagnosis and treatment, from initial microbiology testing to post-treatment review, can help standardize care and optimize outcomes.
Being able to prognosticate in the aftermath of a traumatic brain injury (TBI) is important as it assists with counselling patients and families. Moreover, it helps rationally allocate healthcare resources.
However, due to the heterogenous nature of TBI and variable pre brain injury patient factors and post brain injury course, this has proven to be a difficult task.
Large cohort studies have enabled improved accuracy in the prediction of 6 month mortality and unfavourable outcome.
Furthermore, many of the factors that contribute to long-term outcome have also emerged. However, it is not yet possible to use them in prediction algorithms or mathematical models.
There is emerging evidence that pre injury psychosocial and demographic factors may be of more relevance than injury severity. Moreover, that 'outcome' becomes increasingly subjective and complex as the post injury duration increases.
We end with three brief vignettes which highlight the fraught nature of long term outcome prediction.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kol...rightmanforbloodline
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Versio
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Version
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Version
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Kat...rightmanforbloodline
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
2. Declaration of Interests
•No conflicts
•No conflict of interest with ICS
manufacturers
•Past President BBTS
•Chair of NATA
•Chair of SHOT Steering Committee
•Seconded to Welsh Blood Service/National
Wales Informatics Service
•No current research funding/commercial
interests to declare
3. Transfusion Alternatives
• Future blood supply
– New pathogen risks
– Plentiful supply
– Ageing demographics
• Benefits of transfusion
• Adverse effects of transfusion
– TRIM, TACO, ATR etc
– Outcome better or worse
– Cost to Health Service?
4. Transfusion alternatives
Even if you wish to continue
using allogeneic blood
someone needs to cut their
use so you can continue if
supply demand is an issue
5. Transfusion alternatives?
• Other ways of treating anaemia
• Transfusion needs to become last
resort
• Integrate alternatives in main
stream practice
• Integrate in blood services
planning
6.
7. Reducing risks of allogeneic transfusion
Donor selection
Testing
Transfusion
Transmitted
Infection
Better process
ABO
Incompatibility
Transfusion
Related ALI
TRALI
Leucodepletion
Male only plasma
Transfusion
Related
Immunomodulation
TRIM
Transfusion
Associated
Circulatory
Overload
TACO
6th Seminar of the Hellenic Blood Transfusion Society-March 13-14, 2009, Athens-Greece
8.
9. Attendance of WBS donors in response to
calling letters: 1990/01 – 2005/06
Donors Called
Donors Attending
6th Seminar of the Hellenic Blood Transfusion Society-March 13-14, 2009, Athens-Greece
12. 6th Seminar of the Hellenic Blood
Transfusion Society-March 13-14, 2009,
Athens-Greece
13. 6th Seminar of the Hellenic Blood
Transfusion Society-March 13-14, 2009,
Athens-Greece
14. 6th Seminar of the Hellenic Blood
Transfusion Society-March 13-14, 2009,
Athens-Greece
15. The Journal of Thoracic and
Cardiovascular Surgery Volume 142,
Number 2 249.e1
16. The Journal of Thoracic and
Cardiovascular Surgery Volume 142,
Number 2 249.e1
17. The Journal of Thoracic and
Cardiovascular Surgery Volume 142,
Number 2 249.e1
18. Transfusion effect ? How can we separate from surgical effect ?
Variance
Massive Haemorrhage
Complicated or Unexpected
Difficult surgery
Withhold transfusion
Minimal Haemorrhage
Complicated surgery
Straightforward Surgery
Moderate or
controlled haemorrhage
Mortality
Transfusion
19.
20.
21. Inter-Hospital Variability of Transfusion Rates
in Matched THR Patients
1st and 2nd Austrian Benchmark Study (n=2,570)
Transfusion rate
90%
68%
27.7% reduction in txn rate
44.1% reduction in units txed per patient
0.00% mortality
45%
23%
0%
15
Study I
Study II
12
13
16
9
3
1
7
2
11
4
6
5
8
10
Center
Gombotz H, Rehak P, Hofmann A. Blood use in elective surgery: Comparison - Austrian benchmark study I and II. Unpublished Data, 2011
Acknowledgements to Axel Hofmann & Shannon Farmer
22. The Red Cell Storage Lesion:
Structural Changes.
6th Seminar of the Hellenic Blood
Transfusion Society-March 13-14, 2009,
Athens-Greece
23. 6th Seminar of the Hellenic Blood
Transfusion Society-March 13-14, 2009,
Athens-Greece
26. What is Patient Blood Management ?
In MJA 1988 Professor Isbister proposed the need
for a paradigm shift in the care of patients who
are being considered for transfusion of fresh blood
products.
Originator of the term PBM
Clinical Professor James Isbister BSc(Med), MB BS, FRACP, FRCPA.
Emeritus Consultant, Haematology & Transfusion Medicine, Royal North Shore
Hospital, Sydney, Australia.
Clinical Professor of Medicine, University of Sydney, Sydney, Australia;
Adjunct Professor, University of Technology, Sydney, Sydney, Australia;
Adjunct Professor, Monash University, Melbourne, Australia;
27. How to best manage the patients own
oxygen carrying capacity…..
….to minimise dependence on the blood
bank
Author of ‘Peri-operative Blood Transfusion’
28. PBM = good clinical medicine
An approach to safe, quality patient care….
Defined as –
“the timely application of evidence-based
medical and surgical concepts designed to
maintain haemoglobin concentration,
optimise haemostasis and minimise blood loss
in an effort to improve patient outcome”,
patient blood management is expected to
reshape the future of transfusion medicine
and the way blood components are used in
clinical practice.
29. PBM = good clinical medicine
An approach to safe, quality patient care….
• Aim is to optimise, conserve and manage the
patient’s own blood to minimise or avoid
exposure to allogeneic blood
• Changing the transfusion paradigm from a
product focus to a patient focus
• Patient-specific team approach
• And results in improved patient outcomes
30.
31.
32. Confirms an observation by Clement Finch
decades ago that there is functional
iron deficiency …..even with
oral iron supplementation
Transferrin saturation (%)
26.0
19.5
PLACEBO
300
600
13.0
6.5
0.0
0
Basal
1
2
3
4
5
6
7
Days
Mercurali the first to show the decrease in transferrin saturation in
peri-surgical patients stimulated to donate autologous blood with EPO
33. Intravenous versus oral iron supplementation for
preoperative stimulation of hemoglobin synthesis using
recombinant human erythropoietin
Neither group required allogeneic transfusion
112 versus 110g.L-1
Blood loss 1583 ± 685 versus 1325 ± 767mls
Rohling RG, Zimmermann AP, Breymann C Journal of
Hematotherapy & Stem Cell Research. 2000;9:497-500
34. Intravenous iron and recombinant erythropoietin
for the treatment of postoperative anemia
IV iron plus EPO on day 1 and 3
IS +EPO IS
0
IS +EPO
1
5
2
3
4
6
Increase in Hb
7
Post Operative Days
Karkouti K et al Can J Anaesth 2006 Jan;53(1):11-19
35. Intravenous iron and recombinant erythropoietin for
the treatment of postoperative anemia
At six weeks increases were
37+/- 14g.L-1 40+/-7g.L-1 and 45+/- 12g.L -1
0
1
2
3
4
5
6
7
Post Operative Weeks
Karkouti K et al Can J Anaesth 2006 Jan;53(1):11-19
36. Update on adverse drug events
associated with parenteral iron
Iron sucrose
Sodium ferric gluconate
LMW iron dextran
HMW iron dextran
0.6 per million
0.9.per million
3.3 per million
11.3 per million
Chertow GM et al Nephrology Dialysis Transplantation. 2006 21(2):
378-382
41. Preoperative haemoglobin assessment and optimisation template
This template1 is for patients undergoing procedures in which substantial blood loss is anticipated such as cardiac surgery, major orthopaedic, vascular and
general surgery. Specific details, including reference ranges and therapies, may need adaptation for local needs, expertise or patient groups.
Preoperative tests
• Full blood count
• Iron studies2 including ferritin
• CRP and renal function
Is the patient anaemic?
Hb <130 g/L (male) or
Hb <120 g/L (female)
NO
YES
Ferritin <30 mcg/L2,3
Ferritin 30–100 mcg/L2,3
Ferritin >100 mcg/L
CRP4
Raised
No anaemia: ferritin
<100 mcg/L
•Consider iron therapy# if
anticipated postoperative Hb
decrease is ≥30 g/L
•Determine cause and need for GI
investigations if ferritin is
suggestive of iron deficiency <30
mcg/L2,3
Iron deficiency anaemia
• Evaluate possible causes based
on clinical findings
• Discuss with gastroenterologist
regarding GI investigations and
their timing in relation to
surgery3
• Commence iron therapy#
Normal
Possible iron deficiency
• Consider clinical context
• Consider haematology advice or,
in the presence of chronic
kidney disease, renal advice
• Discuss with gastroenterologist
regarding GI investigations and
their timing in relation to
surgery3
• Commence iron therapy#
Possible anaemia of chronic
disease or inflammation, or other
cause5
• Consider clinical context
• Review renal function, MCV/MCH
and blood film
• Check B12/folate levels and
reticulocyte count
• Check liver and thyroid function
• Seek haematology advice or, in
the presence of chronic kidney
disease, renal advice
50. Surgical Control of Bleeding
• Digital pressure
• Sutures and clips
• Thermal coagulation
• Topical hemostatic agents
• Organ wrapping- mesh net
51. Methods of achieving hemostasis
• Mechanical methods and devices
– Digital pressure, suture, packing, tourniquet
– Band ligation - elastic ligatures for endoscopic
ligation of esophageal varices or other blood vessels
– Hemoclips – endoscopic and laparoscopic ligation of
blood vessels
– Detachable loops – endoscopic loops / nylon, teflon/
– Intraluminal grafts and stents for aneurism repair
52. • Thermal agents – electrocautery, produce hemostasis
by heating and denaturing proteins, resulting in
coagulation
• Pharmacologic agents :
– vasoconstriction -Vasopressin, Somatostatin, epsilon-aminocaproic
acid
– Matrix for attracting blood elements
– Agents enhancing clotting factor activity –Desmopressin,
r-FVIIa .
Topical hemostatic agents should have several properties:
1) rapid hemostasis, 2) easily applied 3) hold sutures
4) little tissue reaction, 5) low infectious risk, 6) absorbable,
7) easily removed
53. Fibrinogen-based products
•
Liquid Fibrin Sealant -Tisseel® fibrinogen, factor
•
TachoComb / TachoSil®
•
•
•
•
Fibrin foam
Autologous fibrin glue
Topical thrombin
Hemostatic dressings -with Ca alginate
XII and thrombin +antifibrinolytic (aprotinin) . Sealing of bleeding
tissue starts with fibrin formation, the end stages of natural
blood coagulation. Fibrinogen is converted to fibrin strands that
join into net-like matrices
and aprotonin on collagen mesh
- dry fibrinogen, thrombin
54. Collagen-based products
• Avitene®
(Alcon,Inc.)
• Floseal®
(Baxter)
Microfibrillar collagen hemostat Effective
in controlling arterial bleeding. Can be used on irregular surfaces.
Easy removal with irrigation and suction reduces rebleeding and the
need for multiple applications.
Gelatin matrix of collagen and topical
human thrombin. Works on wet, actively bleeding tissue, can be
applied focally or extruded and spread to cover a large area of
diffuse bleeding
55. Oxidized Regenerated Cellulose
•
For control of capillary, venous and arterial bleeding in
cases when conventional methods for hemostasis are
ineffective.
SURGICEL®
•
•
•
•
•
Fast resorption (1-2 weeks)
Minimal tissue reaction
No allergenic reaction
Easy to apply
Antibacterial properties!
ARISTA ® (Ethicon,Inc.)
absorbable hemostat, based on microporous
polysaccharide hemospheres. Used in the
control of profuse bleeding. The particles act
as a molecular filter producing “instant gelling”,
followed by the formation of a fibrin mesh
56. Nonsurgical Interventions
to Achieve Hemostasis
• Pneumatic antishock garment
• patients with pelvic and lower extremity
fractures
• hypovolemic shock
• Angiographic embolization
• Temporary balloon occlusion
58. Some things don’t change
• It still rains in Wales
• There are still instances when blood
components are given without good reason
or are wasted
• More instances of wastage than of failure to
provide
• Big difference between withholding a
transfusion on clinical grounds and not
transfusing when indicated.
61. Cell salvage in emergency bleeding
•
•
•
•
Life saving provision of autologous blood
May be the only available blood
Warm, active O2 carriage High 2,3 DPG
Decreases demand on allogeneic supplies
6th Seminar of the Hellenic Blood
Transfusion Society-March 13-14, 2009,
Athens-Greece
62. Grade IV Liver trauma
6th Seminar of the Hellenic Blood
Transfusion Society-March 13-14, 2009,
Athens-Greece
66. Early coagulopathy in multiple injury: an analysis from
the German Trauma Registry on 8724 patients
90
68
ISS 1-15
ISS 16-24
ISS 25-49
ISS 50-75
45
23
0
<1000
1000+
2000+
3000+
4000+
0C
67. 3
2.5
2
1.5
1
0.5
pH
0
Relative Rate of FVIIa Generation
Meng ZH et al J Trauma 2003;55:886-891
6.2 6.6 7
7.4 7.8 8.2 8.6 9
Inhibition of 70% at pH 7.0 as compared to 7.4
68. Wolberg et al J Trauma 2004;56(6):1221-1228
• Bleeding observed at mildly reduced
temperatures (330C-370C) results primarily
from a platelet adhesion defect and not
reduced enzyme activity or platelet activation
• At temperatures below 330C both reduced
platelet function and enzyme activity likely to
contribute to the coagulopathy
69.
70.
71. Tissue Oxygen partial pressure, mmHg
Organ Specific PO2 During a Wide Range of Hcts
70
60
50
40
30
20
10
0
Cardiac output, %
180
150
120
100
0
42
30
25
19
Arterial hematocrit, %
Skeletal muscle
Liver
Pancreas
Small instestine
Kidney
Messmer K, et al. Res Exp Med (Berl) 1973;159:152-166
72.
73. O2 – consumption (VO2)
!T
iss
ue
Hy
po
xia
!
Limit of Hemodilution
„critical“ DO2
O2 – delivery (DO2)
74.
75. Transfusion requirements in critical care
(TRICC): a multicentre, randomised, controlled
clinical study
• 30 day mortality similar in both groups
Apache <20 23% P=0.11)16.1% P0.03)
(8.7% v
(18.7% v’s
< 50yrs 5.7%(8.7% v’s 16.1% P0.03)
• Apache <20 v 13% P 0.02%)
• < 50yrs 5.7% v’s 13% P 0.02%)
• Significant cardiac disease 20.5% v’s
22.9%
Paul C Hébert et al NEJM 1999 No6 Vol 340 p409-17
76. Transfusion triggers: have we gone too low?
Transfusion Requirements
in Orthopedic Surgery (TRIOS)
Élise Vuille-Lessard, B.Sc.
Monique Ruel, R.N.
Jean-François Hardy, M.D.
Department of Anesthesiology
CHUM Notre-Dame
Montreal, Canada
NATA Annual Symposium
Dublin, 7-8 April 2011