Don't Forget the Bubbles

JANUARY 10, 2024

Transfusion Decisions in Severe Anaemia Reducing child mortality remains high on the global health agenda. Let’s take the humble blood transfusion – used in emergency departments across the globe and playing a key role in critical care. However, there is a huge variation in transfusion practice globally.

Blood Transfusions 78

Blood Transfusions Research Outcomes Hospitals 78

RebelEM

OCTOBER 30, 2023

This could dilute any beneficial effects seen Lack of blinding may bias results (Although mortality is a solid objective primary outcome, bias may still creep in terms of management) Discussion: Authors were looking for an absolute mortality difference of 7% from baseline mortality of 26% with a 90% power. Cryoprecipitate Group: 25.3%

Administration 125

Administration Blood Transfusions Outcomes Hospitals 125

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.

Blood Transfusions 105

Blood Transfusions Outcomes Administration Hyperthermia / Hypothermia 105

EMDocs

MAY 15, 2024

Management includes rapid initiation of opioid and non-opioid agents to treat the pain associated with vaso-occlusive crisis, antimicrobial coverage, incentive spirometry, oxygen supplementation to maintain saturation > 95%, fluid resuscitation based on volume status, consideration for transfusion, and specialist consultation.

Blood Transfusions 97

Blood Transfusions Fluid Resuscitation Dehydration Ultrasounds 97

EMDocs

MAY 28, 2024

Blood transfusion Reduces the overall proportion of HbS. Simple blood transfusion should be considered early in the hypoxemic patient with advancement to red cell exchange transfusion if there are clinical features of severe pathology or evidence of progression despite initial simple transfusion.

Blood Transfusions 94

Blood Transfusions Fluid Resuscitation Dehydration Ultrasounds 94

The Trauma Pro

MAY 10, 2024

And its correlation with outcomes varies. The most important one is that it relies only on the Injury Severity Score (ISS) to judge whether some type of mistriage occurred. The ISS is usually calculated after discharge, so it can only be applied after the fact. What is NFTI, Exactly? They reviewed 2.5

Blood Transfusions 113

Blood Transfusions Radiology Radiology Documentation/Coding 113

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. Anaesth Intensive Care. Li K, Xu Y.

Hyperthermia / Hypothermia 104

Hyperthermia / Hypothermia Resuscitation Administration Blood Transfusions 104

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.

Blood Transfusions 98

Blood Transfusions Operations Infectious Diseases Resuscitation 98

The Skeptics' Guide to EM

DECEMBER 17, 2022

Massive Blood Transfusion Following Older Adult Trauma: the Effect of Blood Ratios on Mortality. Case: A […] The post SGEM386: Blood on Blood – Massive Transfusion Protocols in Older Trauma Patients first appeared on The Skeptics Guide to Emergency Medicine. Date: December 16th, 2022 Reference: Hohle et al.

Blood Transfusions 52

Blood Transfusions Fractures EMS Emergency Department 52

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 143

Shock Sepsis Fluid Resuscitation Resuscitation 143

Emergency Medicine Journal

MAY 23, 2023

Demographic and medical data needed to calculate GBS and CANUKA were collected, as well as outcomes data. Need for intervention was defined as the need for blood transfusion, endoscopic haemostasis or rebleeding within 7 days. In-hospital mortality was also collected.

Emergency Department 40

Emergency Department Blood Transfusions Hospitals Wellness 40

RebelEM

SEPTEMBER 26, 2022

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. Significant coagulopathy: INR > 1.8

Resuscitation 52

Resuscitation Blood Transfusions Outcomes Hospitals 52

PulmCCM

MAY 8, 2023

Among 324 patients with trauma and life-threatening bleeding at 12 French hospitals who were randomized to receive 1ml/kg PCC or placebo, there was no reduction observed in 24-hour blood transfusion needs in the PCC group. PCC was associated with a significantly higher risk for thromboembolic complications (35% vs 24%).

Stroke 52

Stroke Blood Transfusions Hospice Anaphylaxis 52

Downeast Emergency Medicine

APRIL 26, 2021

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] Association between prehospital tranexamic acid administration and outcomes of severe traumatic brain injury. JAMA Neurol.

Head Injuries 52

Head Injuries Administration Outcomes Seizures 52

Northwestern EM Blog

JANUARY 24, 2022

Those at higher risk of hypocalcemia (vitamin D deficiency, ESRD, hyperparathyroidism, burns, multiple blood transfusions, etc.) However, even subclinical hypothyroidism with an elevated TSH but normal T4 increases risk of poor outcomes due to effects on cardiac function. Sources: 1) Amrein K, Martucci G, and Hahner S.

Anaphylaxis 52

Anaphylaxis Shock Sepsis Resuscitation 52

EB Medicine

MARCH 1, 2019

Jeff: In terms of initial resuscitation, there is an ever increasing body of literature to support blood transfusion over crystalloid in patients requiring volume expansion in trauma. There are no specific guidelines for transfusion in the setting of blunt cardiac injury, so stick to your standard trauma protocols.

Emergency Department 40

Emergency Department EKG/ECG Operations Fractures 40

Don't Forget the Bubbles

OCTOBER 28, 2024

To address this, there is ongoing debate about whether we should consider using a whole blood transfusion approach. Rhaenyra continues to receive blood products in a 1:1:1 ratio. In adults, TXA has been shown to reduce transfusion requirements and improve outcomes. It shows a low ionised calcium level of 0.7

Blood Transfusions 72

Blood Transfusions Hyperthermia / Hypothermia Shock Pediatrics 72

EB Medicine

OCTOBER 1, 2018

In other trials, vasopressin also appeared to show a potential benefit in those with AKI and sepsis, although the subsequent VANISH trial (perhaps the best name for a clinical trial so far) failed to demonstrate a benefit to vasopressin titration with regard to renal outcomes in septic shock. Jeff : Next we have epinephrine.

Sepsis 40

Sepsis Shock Fluid Resuscitation Hospitals 40

RebelEM

FEBRUARY 1, 2024

Limitations : Open label study design Outcome assessments were done via telephone interview. mg/kg, max 25mg) vs. intravenous alteplase (0.09 mg/kg followed by 0.81 vs Alteplase 34.8% Unadjusted risk difference 2.1% [ 95% CI -2.6 mg/kg, max 25mg) vs. intravenous alteplase (0.09 mg/kg followed by 0.81 vs Alteplase 34.8% mg/kg followed by 0.81

Stroke 132

Stroke Blood Transfusions Outcomes EMS 132

PulmCCM

JANUARY 8, 2024

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.

Blood Transfusions 96

Blood Transfusions Hospitals Outcomes Operations 96

EMDocs

MARCH 6, 2024

There is no clear improvement with idarizucimab or andexanet alfa on patient-oriented outcomes. TXA: Several studies have found no benefit in patient-oriented outcomes with TXA in patients with significant lower GI bleeding. Red Blood Cell Transfusion: 2023 AABB International Guidelines. 2023 Nov 21;330(19):1892-1902.

Blood Transfusions 103

Blood Transfusions Outcomes Resuscitation Radiology 103

EMDocs

JULY 3, 2023

Introduction SAH has the potential for rapid progression and devastating outcomes. Hematoma expansion Reducing blood pressure to a level that limits bleeding but maintains perfusion is critical to limit hematoma expansion, especially in spontaneous SAH. Short- and long-term outcome of patients with aneurysmal subarachnoid hemorrhage.

Seizures 98

Seizures Stroke Outcomes EMS 98

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.

Blood Transfusions 98

Blood Transfusions Hospitals Stroke Anaphylaxis 98

EMDocs

JUNE 3, 2023

Management and outcomes of open pelvic fractures: An update. Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial. Lateral compression 2 pelvic fracture. Radiopaedia.org. Published April 18, 2023.

Fractures 60

Fractures Resuscitation Operations EMS 60

EMDocs

JUNE 27, 2024

His medical history is significant for three prior admissions for vaso-occlusive crises that have responded well to appropriate therapy, including pain control with NSAIDs and opioids, blood transfusions, antibiotics, and intravenous (IV) crystalloids. Pediatr Blood Cancer. Triage vital signs include BP 127/81, HR 119, T 102.9

Pediatrics 94

Pediatrics Dehydration EMS Hospitals 94

RebelEM

FEBRUARY 22, 2024

Background : Concurrent anemia worsens outcomes in patients that present with acute myocardial infarctions. Transfusions increase the oxygen carrying capacity of blood which can improve the perfusion of at-risk cardiac tissue. An optimal transfusion hemoglobin cutoff has not yet been established in these patients.

Blood Transfusions 58

Blood Transfusions Outcomes Wellness Research 58

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 126

Blood Transfusions Stroke Dehydration Sepsis 126

Don't Forget the Bubbles

FEBRUARY 24, 2025

However, our true success is measured by how effectively we share knowledge, foster understanding, and improve patient outcomes. Despite these limitations, multiple similar case reports demonstrate that single or double-volume exchange transfusion (ET) effectively reduces leucocytosis. Revista Paulista de Pediatria , 37 (3), pp.351-362.

Pediatrics 59

Pediatrics Outcomes Blood Transfusions Sepsis 59

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 98

Pediatrics Ultrasounds Blood Transfusions Sepsis 98

The Bottom Line

DECEMBER 17, 2024

NEJM 2024 DOI:10.1056/NEJMoa2410962 Clinical Question In patients following acute aneurysmal subarachnoid haemorrhage, does a liberal strategy of blood transfusion compared with a restrictive strategy of blood transfusion reduce unfavourable neurological outcome?

Blood Transfusions 62

Blood Transfusions Outcomes 62

RebelEM

DECEMBER 23, 2024

There has been ongoing study about the clinical significance of these effects, as well as whether and for whom LR might provide meaningfully better clinical outcomes ( Myburgh 2013 , Self 2018 , Semler 2018 , Self 2020 ). The enrollment was multicenter, large, and adequately powered for clinically meaningful changes in outcome.

Fluid Resuscitation 124

Fluid Resuscitation Resuscitation Documentation/Coding Outcomes 124

PulmCCM

JANUARY 13, 2025

However, large observational cohorts have associated greater degrees of anemia with worse outcomes in patients with cardiac disease. In MINT, 3,504 patients with acute myocardial infarction and anemia were randomized to either a transfusion threshold of ≤8 g/dL, or a liberal transfusion threshold of ≤10 g/dL.

Blood Transfusions 52

Blood Transfusions Outcomes 52

Taming the SRU

JUNE 6, 2023

then need further evaluation Usually with CTA imaging If normal physical exam & ABI>0.9,

Documentation/Coding 64

Documentation/Coding Seizures Psychiatric Wellness 64

Broome Docs

DECEMBER 22, 2024

Restrictive vs Liberal Transfusion Strategy in Patients With Acute Brain Injury: The TRAIN Randomized Clinical Trial. Their primary outcome was survival at 30 days, and there was no difference between the two groups (4.5% Favourable neurologic outcomes were seen in 2.7% 2024 Oct 9. doi: 10.1001/jama.2024.20424. 2024.20424.

Blood Transfusions 52

Blood Transfusions Hospitals Outcomes Emergency Department 52

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 59

Sepsis Shock Hyperthermia / Hypothermia Administration 59