Gas you down

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do you guys type and screen for these? Back in the day, I saw a lot of blood loss...mainly just one surgeon who was known for it.
Nowadays, I still get the T&S but the surgeons say it's not necessary for such a low blood loss case. And I have to say, I haven't given blood to anyone since that one surgeon.
What do you guys/gals do?
 

WashMe

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do you guys type and screen for these? Back in the day, I saw a lot of blood loss...mainly just one surgeon who was known for it.
Nowadays, I still get the T&S but the surgeons say it's not necessary for such a low blood loss case. And I have to say, I haven't given blood to anyone since that one surgeon.
What do you guys/gals do?
Any reason NOT to get one? You don't mention if this is anterior or posterior approach, and what the possibilities would be for you to draw a T+C intra-op based on patient positioning, if things go south. Have nurses send one in pre-op at patient arrival. If Hgb >11 to start then prob don't wait for it to come back. If anemic, vasculopath, repeat surgery, etc. then wait for it, should take less than 30min from when it's sent.
 
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Do what you think is right. We don't tell surgeons how to do the surgery, why should they tell us how to manage the anesthetic?

We have one surgeon who's slow and bloody (16 hour record for an anterior + posterior combo). one of my colleague's patient bled almost a liter from a cervical spine, and died postoperatively (not sure details). There's a reason why my group likes to put in arterial line for spines.
 
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FFP

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When in doubt, just do it.
 
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Gas you down

Gas you down

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Thanks just wondering if what I do is typical, sounds like it is.
 

Arch Guillotti

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For a normal ACDF I probably wouldn't get one.

If it turns into a cluster (which it can) your best bet is to ask for emergency release blood.
 

anbuitachi

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Definitely we do here. Acdf couple level don't have to but multilevel for sure. We put a line in posterior too cause we have no arm access at all . It's a vascular area. Might as well do it.
 

Laryngophed

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Academic place here, but we screen 1-2 levels, and will cross greater than 2 levels.
 

Noyac

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Wow, haven't gotten a T&S on these cases in over 10yrs. We lose about 10cc of blood per level. No ****.

The better discussion is, what's your management of the ACDF pt coming back to the OR from bleeding and airway compromise?
 

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Wow, haven't gotten a T&S on these cases in over 10yrs. We lose about 10cc of blood per level. No ****.

The better discussion is, what's your management of the ACDF pt coming back to the OR from bleeding and airway compromise?
Awake or asleep with surgeon /ENT in room.
 
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SaltyDog

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If you have to transfuse a (non redo) ACDF, even multi-level, then you need to start looking for a new gig ASAP before you get dragged into a lawsuit due working with complete donkey surgeons.
 

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If you have to transfuse a (non redo) ACDF, even multi-level, then you need to start looking for a new gig ASAP before you get dragged into a lawsuit due working with complete donkey surgeons.
Disagree. Even a good surgeon can have things go awry sometimes.
 

SaltyDog

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Disagree. Even a good surgeon can have things go awry sometimes.
Sure, sometimes **** just happens. I'm talking about the "norm" though. Otherwise you're talking about getting a T&C for every single case you do because "things go awry sometimes."
 
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Arch Guillotti

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If you have to transfuse a (non redo) ACDF, even multi-level, then you need to start looking for a new gig ASAP before you get dragged into a lawsuit due working with complete donkey surgeons.
Sure, sometimes **** just happens. I'm talking about the "norm" though. Otherwise you're talking about getting a T&C for every single case you do because "things go awry sometimes."
Your statements are at odds. Which one is it? If you have a single bad bleeder in 20 years with a good surgeon, do you start looking for a new job?
 

SaltyDog

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Your statements are at odds. Which one is it? If you have a single bad bleeder in 20 years with a good surgeon, do you start looking for a new job?
The OP asked if you get T&S's for all cervical fusions. All I'm saying is that if in your practice, needing to transfuse during an ACDF is not unusual, then you need to look for a new job. Are you saying you T&S every single case due to the remote chance of bleeding??

I'm not sure why this is so hard to understand.
 

jwk

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Academic place here, but we screen 1-2 levels, and will cross greater than 2 levels.
How many of these do you transfuse in a month/year? Private practice here - I've done ACDF's for 36 years and have never transfused one - never even close. I mean really - 20cc blood loss? 30? Like anything else in this day and time, you've got to consider cost/benefit. Routine type and screens for truly minimal blood loss procedures, which an ACDF certainly is (or should be) is a tremendous waste of money and resources. Ditto for the crossmatch - if you crossmatch at our facilities, that means you're giving blood. We don't have such thing as a crossmatch just in case you might want to give blood. We're a very busy spine center - I'll bet we do 1000 ACDF's a year. If we even had one transfusion a year, that 0.1% incidence does not warrant a type and screen on the other 99.9%.
 

Laryngophed

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I honestly don't know how many get transfused. I'm a resident so I don't get access to that kind of data. My suspicion is that it is low. But because we live in the academic world, we are a touch sheltered from that and we do it to keep it simple for residents who don't know what to do/order. I can't remember ever transfusing an ACDF. And posterior cervicals? Maybe a few, but not many.
 

anbuitachi

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They should... but sometimes they lose more than anticipated, / esp if patient has a low starting crit or some type of bleeding disorder
 

Urzuz

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I don't even document blood loss in ACDFs.

Agree with SaltyDog's sentiments.
 
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