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Understanding pre-hospital blood transfusion decision-making for injured patients: an interview study

Emergency Medicine Journal

Background Blood transfusion for bleeding trauma patients is a promising pre-hospital intervention with potential to improve outcomes. However, it is not yet clear which patients may benefit from pre-hospital transfusions. The last theme focuses on the issues with decision-making itself.

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The AcT Trial: Tenecteplase vs Alteplase for Acute Ischemic Stroke

RebelEM

What they Did : Investigator-initiated, Multicenter, Parallel-ground, Open-label, Registry-linked, Randomized, Controlled, Non-Inferiority trial 22 Canadian Primary and Comprehensive Stroke Centers from December 2019 to January 2022 Eligible ischemic stroke patients randomized 1:1 to receive intravenous tenecteplase (0.25 vs Alteplase 34.8%

Stroke 135
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Trauma Resuscitation Updates

RebelEM

vs 3U) but no difference in mortality (Study not powered for this outcome) Clinical Take Home Point: The use of vasopressors is controversial and requires a nuanced approach SUMMARY OF MINIMIZING IATROGENIC INJURY RESTORE PERFUSION VOLUME REPLACEMENT Blood Products >>> Crystalloids Holcomb JB et al. NEJM 1994. [2]

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ToxCard: Iron

EMDocs

7 Workup other than serum iron concentration at 4 hours after ingestion not shown to accurately predict clinical outcomes or severity of toxicity. Blood transfusion for clinically significant blood loss. McGraw Hill; 2019. 6 Absence of visualized tablets on x-ray does not exclude iron ingestion. 2 L/hr in adults.

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The Latest in Critical Care, 1/8/23 (Issue #24)

PulmCCM

million gallons) of blood are wasted in this fashion, every year—enough to fill about 700 railroad tanker cars with blood, or about four times the total amount of blood transfused annually. Smaller-volume blood collection tubes are widely available at equivalent cost and are compatible with standard blood analyzers.

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TEG-Guided Resuscitation of Patients with Cirrhosis and Non-Variceal Bleeding

RebelEM

Randomized study design Blind adjudication of transfusion reaction outcomes Follow-up was complete. The primary outcome was disease-oriented The enrolled cohort appears to be a convenience sample Sealed envelopes are a weak type of allocation and prone to error and manipulation. Hayes-Larson 2019).

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Journal Club - Tranexamic Acid in Trauma

Downeast Emergency Medicine

4] We also know that severe TBI is commonly associated with the development of intracranial hemorrhage where the presence and volume of blood are associated with increased mortality and poor outcomes.[5] Lancet 2019; Vol 394, Iss 10210, P 1713-1723[ Full Text ]. There were no differences found in the secondary outcomes.