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

The Trauma Pro

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. Reference: An analysis of the use of cold-stored platelets in combat trauma.

Military 113
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Imported Malaria

Pediatric EM Morsels

With concern for malaria, it is very important to identify who is non-immune and semi-immune as this can affect both the timeframe for illness after departure from the endemic country as well as severity of illness. Food and Drug Administration Approval of Artesunate for Severe Malaria: Enough to Achieve Best Practice? Clin Infect Dis.

Seizures 281
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CRYOSTAT-2: Early Empiric Cryoprecipitate in Major Trauma

RebelEM

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.

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ToxCard: Iron

EMDocs

In 1997, the Food and Drug Administration (FDA) mandated unit-dose packaging for all iron-containing products with more than 30 milligrams of elemental iron. Blood transfusion for clinically significant blood loss. Can titrate up to maximum of 40 mg/kg/hr, although hypotension may limit dose of deferoxamine.

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Trauma Resuscitation Updates

RebelEM

CRYSTALLOIDS Too much crystalloid resuscitation in traumatic hemorrhagic shock can increase dilutional coagulopathy, as well as increase morbidity and mortality Bickell WH et al. The Role of Whole Blood Transfusions in Civilian Trauma: A Review of Literature in Military and Civilian Trauma. NEJM 1994. [2] Cureus 2022.

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

RebelEM

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? Demographics were well balanced in the two groups. Prehospital Tranexamic Acid for Severe Trauma.

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

PulmCCM

Intuitively, plasma seemed even less likely to help the very sickest of the sick— those mechanically ventilated with ARDS from Covid-19, whose mortality rate was well over 50% at many centers. Based on this data, transfused cryoprecipitate does not seem to a merit addition as a component of massive transfusion protocols for trauma.