Tuesday, June 27, 2006

Grand Rounds Vol. II No. 40....
Hosted this week at Medviews

Monday, June 26, 2006

Blood Goes Round and Round......
A supplement to this month's Journal of Trauma titled Early Massive Trauma Transfusion: State of the Art has made for some interesting reading. The indications and risks for the use of whole blood as well as component therapy are presented very well and the discussions are entertaining and informative as well. One that is more of the former than the latter is as follows:
I think the last two talks amount to a damning criticism of the use of red cells. The product is difficult to handle, can easily be given to the wrong person, has technically difficult storage requirements and a complication rate when given on the order of one to 100 to one to several million, depending upon the complications. As it ages and becomes less effective, there are data showing that in the critically ill population this product doesn't deliver oxygen. In fact, it becomes so toxic or so ineffective at 42 days that it is simply thrown away. Furthermore, use of this product is independently associated with increased risk of infection, increased hospital stay, increased mortality, and with increased risk of multiple organ failure. So I only have one question for the speakers and the audience, and that is: Can a compassionate, caring, evidence-based physician in 2005 ever prescribe this product?


Sunday, June 25, 2006

What's Going On?
The demands of real life (cases, call, and installing our EMR) have been keeping me away from the blog. Things have slowed down somewhat and I hope I can give it some attention. I wanted to respond to a comment to this post:
I would be interested to know why it is you are "falling out of love" with general surgery. Thanks

Perhaps "falling out of love" was a poor choice of words. I am finding that I find general surgery less rewarding than I think concentrating on trauma/critical care would be. My current practice has fellowship trained subspecialists and others who have over the years "self-selected" and limited their practice. As the "catchall" general surgeon I find that the primary care physicians tend to want to their patients to see the "specialists" in the group. Also my partners tend to dislike tending to the trauma service. A win-win on both counts for me. The process is slowly progressing on. It has been awhile since I had to register for a match.

Thursday, June 08, 2006

Happy Happy Day......
I wrote the last check for my medical school loans today. My (poorly applied, some may say) education is mine free and clear.
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