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How do you guesstimate EBL?
Do you care what it is? Why or why not?
Do you care what it is? Why or why not?
look at the suction minus irrigation.
if you're running patients relatively dry you can do a hct and work out the EBL from the max allowable blood loss formula.
i like to transfuse right before the patients become symptomatic by anticipating likely changes. if i have a pt with ischemic CM i will not wait till patient is symptomatic. if i have a kid who is bleeding, i will transfuse before they become symptomatic - because once they're symptomatic they go downhill QUICKLY.
How do you guesstimate EBL?
Do you care what it is? Why or why not?
Heres my EBL (calling out to surgeon):
"Dude, whatcha gonna put down for blood loss?"
It doesnt matter, as long as its reasonable.
If they need blood, transfuse.
The only part about blood loss I care about is when its not ending...
you know, when the room is incessantly filled with the surgical suction making that wet, sucking noise...
FOR A LONG TIME....
THHHHHHHHHHHHHHHHHHH
"uhhhh, Dude, ya gotta make that stop or we're gonna start having problems..."
Arguing over EBL with the surgeon is dumb. What good does that do?
Just write down what he's gonna document.
Pick your battles, friends.
Pick your battles.
So when they ask me "what's the EBL?"
I say, "not enough to transfuse."
What about the laps, drapes, floor, etc. Suction minus irrigation is not enough, IMHO.
What if you are not running them dry?
So when is "before they become symptomatic"? And why transfuse at all if they are healthy otherwise? I have seen Jehovah's Witness pts who have bled to a Hgb of 3 (Hct 9) who have survived without sequela. We currently have one in our ICU. She got down to 2.7 Hgb if I remember right after a MVA with multiple trauma. Maybe the little "sick" kids go downhill quickly but the healthy ones don't. They can take a hit and not miss a beat. Again, my opinion.
as an aside, had a surgeon lose 3.5 L (clearly suction - irrigation) on a case. he argued he lost only 1.5 L. this DOES matter..
Out of curiosity, how many days for her Hgb to get above 8?