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Background: Appropriate blood component transfusion might differ between intraoperative massive bleeding and traumatic massive bleeding in the emergency department because trauma patients initially bleed undiluted blood and replacement typically lags behind blood loss. We compared these two blood loss scenarios, intraoperative and traumatic, using a computer simulation.Methods: We modified the multi-compartment dynamic model developed by Hirshberg and implemented it using STELLA 9.0. In this model, blood pressure changes as blood volume fluctuates as bleeding rate and transcapillary refill rate are controlled by blood pressure. Using this simulation, we compared the intraoperative bleeding scenario with the traumatic bleeding scenario. In both scenarios, patients started to bleed at a rate of 50 ml/min. In the intraoperative bleeding scenario, fluid was administered to maintain isovolemic status; however, in the traumatic bleeding scenario, no fluid was supplied for up to 30 min and no blood was supplied for up to 50 min. Each unit of packed red blood cells (PRBC) was given when the hematocrit decreased to 27%, fresh frozen plasma (FFP) was transfused when plasma was diluted to 30%, and platelet concentrate (PC) was transfused when platelet count became 50,000/ml.Results: In both scenarios, the appropriate ratio of PRBC:FFP was 1:0.47 before PC transfusion, and the ratio of PRBC:FFP:platelets was 1:0.35:0.39 after initiation of PC transfusion.Conclusion: The ratio of transfused blood component did not differ between the intraoperative bleeding and traumatic bleeding scenarios.

Endotracheal tube (ETT) suction is frequently required to remove a mucosal plug or clots to prevent airway obstruction. We encountered a case of a suction catheter that was stuck in an ETT and split by forcible pulling. The patient was intubated with a 6.5 mm oral-preformed ETT. At the end of surgery, a 12-French suction catheter became lodged in the ETT. The catheter was pulled forcibly, and it split into two parts. Normal saline was injected into the ETT for lubrication and, using forceps, the catheter was pulled in small increments and successfully removed. To prevent this complication, physicians should carefully select the appropriate catheter size, and the catheter should be lubricated. If a suction catheter becomes stuck in an ETT, instillation of normal saline and use of forceps may facilitate removal.