Monday, January 14, 2008

"why, there's no basement at the alamo!"




I did a case today wherein the patient lost 11 liters of blood, and we ended up transfusing, in addition to assorted exogenous (read: donated by other people) products, 16 units of Cell Saver. The concept of Cell Saver, for those unfamiliar with the technology, is this. The patient is bleeding. The surgeons suck up the blood from the field into a special machine. When the blood in the container reaches a certain level, the perfusionists wash the blood in the bowl and spin it down. Then the anesthesiologist gives the blood back to the patient. Hence, cells are saved. Cell Saver. Ah, one of the few names in medicine that makes sense.

Aside from certain circumstances when Cell Saver cannot be used (soiled bloodstuffs, certain cancers that might get disseminated), Cell Saver can be a great thing. However, in a case like this where there is just so much bleeding, the practice starts to border on the absurd. Imagine this: We give the patient blood. They bleed it all out. We suck it all up and give it back to them. They bleed it all out. We suck it up and give it back to them. They...oh, you get the idea.

It actually reminds me of this quote from "Pee Wee's Big Adventure," a movie that I loved as a kid, and now appreciate as an adult as the first truly avant-garde art film of my (ill-spent) youth. "It's like you're unravelling a cable knit sweater that someone keeps knitting, and knitting, and knitting, and knitting, and knitting, and knitting, and knitting."

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