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Karim Brohi Profile picture
Karim Brohi
@karimbrohi
Trauma Surgeon. Vascular Surgeon. Londoner. Director, London Major Trauma System
Richard Parris Profile picture 1 subscribed
Oct 13, 2023 • 7 tweets • 3 min read
OK here's a run down of why @CRYOSTAT_2 trial results will mark a turning point in the treatment of trauma-induced coagulopathy (TIC)

Paper in @JAMA_current:

and some additional resources on our @CommsC4TS web pages:

Firstly... jamanetwork.com/journals/jama/…
c4ts.qmul.ac.uk/research-progr…
Image We know you can't make a blood clot without fibrinogen. And we know that fibrinogen levels fall to critical levels in TIC. And if they do, patients tend to die.

So fibrinogen is v v important. We hypothesized that if we give a dose early to everyone, we would prevent this drop. Image
Oct 29, 2022 • 8 tweets • 1 min read
Chest drains. So misunderstood.
So misunderestimated. For example: Drains are supposed to swing. It's physics.
If it's not swinging it's blocked.

A drain that's swinging and not doing anything else useful can be removed.

(Useful = draining or bubbling)
Aug 21, 2021 • 9 tweets • 1 min read
Coupla nuggets on from our @TraumaMasters resus thoracotomy practicals at summer school last week:

- The absolute goal of internal cardiac massage is to reperfuse the myocardium (ie the coronaries) - To do massage you need a heart that fills and empties. ie you need adequate volume. [Give volume [Blood]]

Don't massage an empty heart (ie not too quick). [But not too slow].
Jan 25, 2021 • 11 tweets • 2 min read
I agree with the principles of 'good doctor first, then a good surgeon and then an academic'.

But, if you do it in this order it's really too late if you actually want an academic position.

And there are real strengths to developing surgically and academically in parallel... First, as with everything in life, BEing something is pretty irrelevant. It's what you DO that's important.

So question why you want to 'BE' an academic surgeon. Is it just for prestige? (Ego basically). Or to DO something that is uniquely achievable from this position? ...
Oct 31, 2020 • 14 tweets • 4 min read
Thank you @AndersPerner and co for a nice editorial in @yourICM on the ITACTIC Trial. rdcu.be/b9uth

I hope you all won't mind if I give my own view on what ITACTIC means for TEG/ROTEM in trauma.

TL:DR: Use TEG/ROTEM to augment your major haemorrhage protocol. (1/13) I don't think there will ever be another ITACTIC or similar trial. The logistics and complexities were huge. So much like the results of PROPPR, for now we need to take what we can from the ITACTIC results. (2/13)
Aug 14, 2019 • 10 tweets • 9 min read
Why don't trauma patients' platelets work?

Because they're attacked by histones and explode into these (never seen before) balloons (red arrows) that don't aggregate but support thrombin generation!

ncbi.nlm.nih.gov/pubmed/31405966 Good to have this fantastic work finally in print in @PNASNews after several years of hard graft by @CommsC4TS, especially @Miss_GPie and @Paulvulliamy.
Jan 13, 2019 • 15 tweets • 3 min read
Have been asked a few times where I got the 60mmHg figure from in this tweet. Should answer this in a long, well-reasoned paper, not Twitter. But here goes...

First and most importantly, the number 60 is largely irrelevant, the ethos is far more important than the number. ...OK, some background points first:

There is a difference between imminent exsanguination and later effects of systemic malperfusion.

Being shocked is not the same as bleeding to death.