Administration, Blood Transfusions and Outcomes

Best Of AAST #7: How Do You Like Your Platelets – Warm Or Cold?

The Trauma Pro

SEPTEMBER 20, 2023

Until the last few years, massive transfusion in trauma consisted of component therapy, an admixture of packed red cells, plasma, and platelets. Whole blood transfusion is making inroads again, but it is used in a minority of centers. They identified soldiers who received either room-temperature or cold-stored platelets.

Military

Military Blood Transfusions Administration Outcomes

CRYOSTAT-2: Early Empiric Cryoprecipitate in Major Trauma

RebelEM

OCTOBER 30, 2023

Most major hemorrhage protocols give a balanced transfusion of PRBCs, FFP, and platelets in ratios approaching concentrations found in whole blood. The optimal approach to fibrinogen administration in massive hemorrhage protocols is unknown. Fibrinogen products may also be needed to stabilize clots and stem bleeding.

Administration

Administration Blood Transfusions Outcomes Hospitals

Rethinking the Role of TXA: Are We Asking Too Much?

RebelEM

JUNE 19, 2023

PMID: 37314244 Clinical Question: In advanced trauma systems, does prehospital administration of TXA increase the rate of survival with a favorable neurologic outcome in patients at risk for trauma-induced coagulopathy? 1.00 (0.9 – 1.12) Secondary Outcome Mortality 24h 9.7% Prehospital Tranexamic Acid for Severe Trauma.

Outcomes

Outcomes Blood Transfusions Administration Hyperthermia / Hypothermia

Low Risk Intra-Abdominal Trauma: Rebaked Morsel

Pediatric EM Morsels

MAY 24, 2024

Cohort of 12,000 children with blunt IAI were prospectively enrolled to determine the number of subjects requiring acute intervention .

Pediatrics

Pediatrics Blood Transfusions EMS Fractures

emDOCs Podcast – Episode 102: Hypocalcemia in Trauma and the Diamond of Death

EMDocs

JUNE 12, 2024

HypoCa is common in trauma patients and is associated with poor outcomes. A meta-analysis found that 56% of patients with severe trauma resulting in hypotension have hypoCa.There was an increase in mortality, increased need for transfusion, and increased risk of coagulopathy in patients with hypoCa. Target an ionized Ca level over 1.2

Hyperthermia / Hypothermia

Hyperthermia / Hypothermia Resuscitation Administration Blood Transfusions

Trauma Resuscitation Updates

RebelEM

MAY 25, 2023

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]

Resuscitation

Resuscitation Fluid Resuscitation Head Injuries Shock

Sickle Cell Disease Module

Don't Forget the Bubbles

JULY 5, 2023

Furthermore, educating both patients and their families is important in order to achieve good treatment compliance and better clinical outcomes. Be careful if the patient has received a recent blood transfusion since it may be misinterpreted as sickle cell trait instead of sickle cell disease.

Blood Transfusions

Blood Transfusions Stroke Dehydration Sepsis

The Latest in Critical Care, 11/6/23 (Issue #19)

PulmCCM

NOVEMBER 6, 2023

Uncertainty has persisted about the ideal blood transfusion strategy to resuscitate and support trauma victims as they are prepared to undergo surgical and other mechanical interventions to achieve hemostasis. Thromboelastometry (e.g., The balloon generally required 30 minutes to insert. Read in JAMA

Blood Transfusions

Blood Transfusions Operations Resuscitation Infectious Diseases

Neonatal Hypotension

Don't Forget the Bubbles

NOVEMBER 18, 2024

Research and guidelines from Australian centres, like those published by the Australian and New Zealand Neonatal Network (ANZNN), emphasize early detection and management to improve outcomes. If anaemia is confirmed, a blood transfusion may be necessary to restore adequate circulatory volume and improve oxygen-carrying capacity.

Sepsis

Sepsis Shock Hyperthermia / Hypothermia Administration

Bubble Wrap PLUS – January 2024

Don't Forget the Bubbles

JANUARY 1, 2024

Outcomes From a Randomized Clinical Trial. Two-Year Autism Risk Screening and 3-Year Developmental Outcomes in Very Preterm Infants. Hemoglobin Threshold for Blood Transfusion in Young Children Hospitalized with Iron Deficiency Anemia. Cannabis Exposure and Adverse Pregnancy Outcomes Related to Placental Function.

Pediatrics

Pediatrics Ultrasounds Blood Transfusions Sepsis

Journal Club - Tranexamic Acid in Trauma

Downeast Emergency Medicine

APRIL 26, 2021

2][3] If earlier treatment with TXA is better, would there be benefit in its administration in the prehospital setting? 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]

Head Injuries

Head Injuries Administration Outcomes Seizures

A Beginner’s Guide to Vasoactive Drug use in Children with Septic Shock

Don't Forget the Bubbles

NOVEMBER 27, 2023

Either is reasonable as first-line, and there are not currently any studies which directly compare outcomes against each other for children with septic shock. The citrate in blood products can also bind to calcium and cause a drop in calcium levels, so do anticipate this for any children requiring blood transfusion.

Shock

Shock Sepsis Fluid Resuscitation Resuscitation

Vasopressor Nonresponse

Northwestern EM Blog

JANUARY 24, 2022

At those levels, bicarbonate administration has not been shown to improve cardiac output, MAP or pressor response. For example, a patient in cardiogenic shock will likely worsen with the administration of fluids and the wrong vasopressors. A loading dose of 100mg IV should be given, followed by 50mg every 6 hours thereafter.

Anaphylaxis

Anaphylaxis Shock Sepsis Resuscitation

The AcT Trial: Tenecteplase vs Alteplase for Acute Ischemic Stroke

RebelEM

FEBRUARY 1, 2024

Tenecteplase, a modified version of alteplase, is being increasingly utilized for AIS due to its favorable pharmacological profile, ease of administration, and cost effectiveness. Earlier studies looking at tenecteplase dosing began in 2005 and have largely settled on a dose of 0.25 mg/kg at this time for the potential treatment of AIS.

Stroke

Stroke Blood Transfusions Outcomes EMS

Unstable Pelvic Trauma Patient: ED Presentations, Evaluation, and Management

EMDocs

JUNE 3, 2023

Early administration of antibiotics may not be prioritized in the setting of hemodynamic instability but antibiotics are a critical portion of management if open fracture is suspected. Management and outcomes of open pelvic fractures: An update. 12 An AP x-ray of the pelvis should be obtained in the ED for unstable patients.

Fractures

Fractures Resuscitation Operations EMS

Episode 21- Updates and Controversies in the Early Management of Sepsis and Septic Shock

EB Medicine

OCTOBER 1, 2018

Current guidelines recommend that broad spectrum antibiotics be administered within the first hour of presentation for those with sepsis or septic shock, ideally with blood cultures being drawn beforehand. In one study, every hour of delayed abx administration was associated with an 8% increase in mortality.

Sepsis

Sepsis Shock Fluid Resuscitation Hospitals

Diagnostics: GI Bleeding

Taming the SRU

OCTOBER 25, 2023

Ultimately, patients with variceal bleeding require endoscopic variceal ligation (EVL) but it is important to understand what therapies should be initiated promptly in the ED to improve overall outcomes. 100U (30-60 min prior), 0.25-0.375/100U

Blood Transfusions

Blood Transfusions Hospitals Stroke Anaphylaxis