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Bloodtransfusion for clinically significant blood loss. 5 Consider exchange transfusion in addition to deferoxamine for serum iron concentrations greater than 1000 g/dL, or those who clinically deteriorate despite supportive care and chelation. Radiology in the management of acute iron poisoning. doi: 10.1097/PEC.0b013e3182302604.
Lancet 2010 [10] >20,000 adult trauma patients with SBP <90mmHg Patients randomized to TXA 1g over 10 min + 1g IV over 8hrs vs Placebo given within 8hrs of injury In-hospital mortality by 28d reduced (14.5% NEJM 1994. [2]
It also standardizes comparisons between hospitals that use STAT. Once again, let’s look at over- and undertriage experience in the paper: Undertriage: 9.1% undertriage (Cribari) reduced to 3.3% This may be helpful for future triage-related research. What Does It All Mean?
Priorities for the bleeding trauma patient must include: Minimum time to control of bleeding (tourniquets / haemostatics / knife / interventional radiology) Normothermia Appropriate choice of destination (knife / IR) ? Prehospital transfusion of plasma and red blood cells in trauma patients. Prehosp Emerg Care 19(1):1–9, 2015.
In other patients who are stable and the bleeding has resolved, CTA is of low yield If they are critically ill and have severe bleeding, resuscitate first and consult IR, radiology, and surgery. 2023 ACG guidelines recommend against transfusing platelets to reverse an antiplatelet agent. 2023 Nov 21;330(19):1892-1902. 2017;2(5):354–60.
10,11 Magnetic resonance imaging (MRI) is not recommended as a primary imaging modality for the diagnosis of SAH due to test duration (which can delay life-saving interventions), as well as the fact that the mixing of blood with cerebrospinal fluid (CSF) may delay the transition of hemoglobin to its deoxyhemoglobin state that is best imaged on MRI.
Her Glasgow Coma Scale (GCS) is 14 (3E-5V-6M), and she arrives in a cervical collar placed pre-hospital. 6 Especially for the 15% of unstable pelvic fracture patients who have arterial bleeding, angioembolization performed in the interventional radiology (IR) suite or operating room will provide critical source control. doi:10.1097/TA.0b013e3182ab0cde
If you have a patient with a spleen or liver injury that has contrast extravasation or a pseudoaneurysm, consider this a patient that needs hemorrhage control by interventional radiology under Standard 4.15 in the 2022 ACS Resources for Optimal Care of the Injured Patient.
Allows for the patient to be held for a psychiatric evaluation Varies greatly based on state laws In OH, this means patient can be held for 24h prior to being evaluation by a psychiatrist & may be held for additional 72h after that initial evaluation is performed In OH, can be signed by physician, psychologist, mental health NP, mental health clinical (..)
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