Podcast 22: On Blood, Geir Strandenes at SOMSA 2017

Are you familiar with the concept of oxygen debt or oxygen deficit?  What constitutes a “dose” of shock?  What systolic BP constitutes hypotension on the battlefield?  Where did the concept of permissive hypotension come from?  Is it still valid? How long can fresh whole blood last?

Blood Transfusions were a huge topic at this year’s meeting in Charlotte with no less than 3 major speakers giving multiple talks on the subject.  This talk was recorded during the Prolonged Field Care Pre-Conference Lab during the Special Operations Medicine and Scientific Assembly (SOMSA).  Dr. Geir Strandenes

is a founding member of the THOR (Tactical Hemostasis, Oxygenation, and Resuscitation) Group, the Senior Medical Officer of the Norwegian Naval Special Operations, and a Researcher in the Department of Immunology and Transfusion Medicine at Haukeland University Hospital in Bergen, Norway.  He has worked hand-in-hand with the U.S. Army Institute of Surgical Research and the US Armed Forces Blood Program.  You can read more about his research and other articles at www.RDCR.org.  Our PFC working group has always gone to the THOR network with any blood questions that we have, as they usually have an answer or best practice already established.  I have included a link to the THOR/RDCR.org publication page below along with other notable publications which he helped to author such as the recently published JTS ISR Clinical Practice Guideline on Damage Control Resuscitation and the Frequently Asked Questions we sent to Geir and the THOR network over the last couple years.

THOR-Crest-v2

Here are some notable quotes from the episode:

  • Understanding physiology is the most important thing.
  • Salt water is for cooking pasta blood is for resuscitation.
  • A low urine output is one thing that will keep me awake at night in the ICU.
  • Blood pressure does not equal perfusion.
  • We can’t escape Fick’s equation   DO2 = 1.34 x Hb x SaO2 x CO
  • Hypotensive resuscitation is a problem in the prolonged field care setting because you die from shock dose.
  • Permissive hypotension is not a treatment it’s a hemostatic procedure.
  • A systolic blood pressure below 100 on the battlefield is hypotension.
  • Once you give Type-O continue giving Type-O, not Type-Specific (Anything after ~4 Units)
  • Don’t cling to a mistake just because you spent a long time making it.

Listen to the podcast Now:


Here are the slides I was able to get pictures of using the Microsoft Lens App:

 

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Here are just a few of his publications:

Tactical Damage Control Resuscitation Military Medicine 2015

Remote Damage Control Resuscitation Field Donor Triage

THOR PFC Fresh Whole Blood Transfusion FAQ’s part1 (December, 2014)

THOR PFC Fresh Whole Blood Transfusion FAQ’s part 2 (2016)

Advances in the Use of Whole Blood in Combat Resuscitation

Damage Control Resuscitation ISR CPG 03Feb2017


Check out these other great podcasts on the subject of blood and resuscitation by Doc Rush of the PJ Medcast:

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PJ Medcast #54 The Ranger Blood Program

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PJ Medcast #46 Andre Cap and the Best Blood and Resuscitation Talk Ever

 

 

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