Chris Wakeman is a General Surgeon with research interests in familial bowel cancer and polyposis disorders, and colorectal cancer treatment and outcomes. He is also joint chair of the Christchurch hospital trauma committee.
Chris graduated from Otago University Medical School in 1996 and completed general surgical training in Christchurch, gaining his Fellowship of the Royal Australasian College of Surgeons in 2007.
He spent two years training in colorectal surgery as a CSSANZ fellow in Melbourne, Australia at the Alfred hospital and then at the Royal Melbourne Hospital.
He was then awarded the Murray and Unity Pheils Travel Fellowship to travel to London to train for a further year at St Marks hospital – the oldest specialist colorectal hospital in the world.
Chris returned to Christchurch in early 2011 to an appointment at Christchurch Hospital as a general and colorectal surgeon.
Shortly afterwards he was appointed as medical advisor to the familial gastrointestinal cancer registry.
In 2013, he was awarded a Scholarship from the American College of Surgeons to travel to America to present at their annual conference and to visit some of the top hospitals in the United States. During this time, he completed his robotic surgical training scheme.
In 2015, Chris was appointed as a Senior Lecturer for Otago University and is now a course convenor for the 4th Year SEGO (Surgery, Emergency Medicine, Gastroenterology, Oncology) module, and teaches 4th to 6th year medical students.
In 2018 he began studying for a Masters of trauma Science.
Is It Time For A Change? – Non-Compliance With Trauma Resuscitation Guidelines An Ongoing Problem
Historical management of trauma often involved aggressive fluid resuscitation with crystalloid fluid prior to the use of any blood products; however, for many years it has been theorised that excessive parenteral fluids worsens patient outcomes by causing hydraulic disruption to an early essential thrombus, and contributing to haemodilutional coagulopathy [1-5]. Mounting evidence suggests limiting crystalloid fluid administration and introducing blood products early (after no more than 1L of crystalloid resuscitation) can reduce coagulopathy [6-8].
Also recognised, is that massive blood transfusion of packed red cells (pRBC) alone, rapidly decreases clotting factors and therefore concurrent transfusion of plasma (FFP)- containing clotting factors and fibrinogen, should take place in a massive transfusion.
There has been a shift in ideology in the resuscitation of the trauma patient. Early delivery of blood products and limitation of crystalloid has been recognised as the preferred approach. The summation of this advancement in trauma resuscitation is reflected in the latest ATLS guidelines, suggesting that an infusion of crystalloid greater than 1.5L has been associated with increased mortality. . Compliance with Massive transfusion protocols and predetermined transfusion ratios has been shown to be associated with improved patient outcomes
Can we do better with reduced crystalloid use and better compliance of ratios of blood products.