Lab
The Good Stuff
But Why Though
Fluids And Meds
Potpourri
100
True or False:
ABG, CBC, Calcium, Fibrinogen, PT/PTT/INR
Lactic Acid, BMP
are drawn hourly for 12 hours?
What is:
TRUE!
100
What comes in the initial product pack?
4 units PRBC's
4 units thawed FFP
2 units of thawed cryoprecipitate
4 units platelets
100
Do we really need a runner?
Yes! The Runner runs specimens back and forth from lab (labs are drawn hourly) and blood products from subsequent packs.
You also need a transfusion nurse 1:1 with the Level 1 infuser.
And a documenter, and a House Supervisor, RT, a doctor and a patient care RN/circulating nurse
100
What is the loading dose of Tranexamic Acid (TXA)?
I gram over 10 mins
100
How many transfusions should trigger an MTP?
What is:
Five or more units of blood over three hours
>10 units of PRBC in < 24 hours (think of it as the total volume transfused is now greater than the pts estimated blood volume).
200
Thaw time for cryoprecipitate?
Thaw time for FFP?
Cryo- 16 minutes
FFP- 18 minutes
200
What are some more triggers for initiating MTP?
Persistent hemodynamic instability
Active bleeding requiring angioembolization
200
Why do we give IV Fluid (IVF) so cautiously now in bleeding patients?
Restrictive volume replacement leads to better outcomes in trauma. In patients with traumatic hemorrhagic shock, permissive hypotension reduces mortality. Fluids can dilute coagulation factors.
Fluid may dislodge clots (causing more bleeding) and cause dilutional coagulopathy (part of the trauma triad of death).
200
How much fluid should be given while waiting for the blood products?
A MAX of 2 liters NS or LR
200
Where do platelets come from? :)
Redding! Drive time is 2-4 hours.
Sometimes CHP is available to fly platelets, FYI.
Alsooooo platelets can be requested from Mercy Mt. Shasta now!
300
What is the preferred ratio of giving blood products?
1:1:1PRBCs: FFP: Platelets
300
What is the ABC score?
Note: if this is positive call an MTP!
Score of TWO (2) or greater:
SBP less than 90mm Hg
HR greater than 120
Positive FAST exam (focused assessment sonography in trauma)
Penetrating torso injury
300
Why give TXA?
300
What type of "lines" does the patient need?
2 large bore IV's at minimum!
Consider art line- hourly ABG's for 12 hours!
300
What is the emergency number to page a Massive Transfusion Protocol overhead?
What is:
6999
400
Why monitor potassium, magnesium and calcium levels?
Hyperkalemia can occur from stored RBC degrading over time.
Hypocalcemia and magnesemia can occur due to citrate toxicity. Citrate is used as the anticoagulant in blood. When given fast, the liver may not be able to metabolize it. It will bind to the calcium and cause hypocalcemia.
400
Why isn't cryo in the 1:1:1 ratio and do I care?
Fibrinogen can be depleted due to dilution from massive transfusion. There is fibrinogen in FFP but can be supplemented with cryo.
Journal of Trauma Acute Care Surgery shows one pooled unit of cryo (100ml) per 7-8 units of RBC's could be the optimal dose providing significant survivability while limiting unnecessary blood product transfusions.
400
Why is there a time limit of 3 hours after injury to give TXA>?
TXA given more than 3 hours after injury increases the risk of death due to bleeding.
NOTE: this is from the time of injury NOT the time the pt arrives in the hospital.
400
True of False:
Trauma Triad of death is hypothermia, coagulopathy and hypotension
False
Hypothermia, acidosis and coagulopathy.
400
What are the pros and cons of the ABC score?
CONS: The ABC score does overestimate the need for transfusion, with 45-50% of patients in whom MTP is activated do not actually need a massive transfusion.
PROS: However, it is also excellent at identifying who will NOT need an MTP (less than 5% negative predictive value) and it can identify 95% of all patients who will need a massive transfusion.
500
Where do I keep the blood I didn't use right away? How long do I have to transfuse it?
PRBC and FFP can be kept at he bedside, under ice for up to 4 hours.
Platelets and cryo must be kept at ROOM TEMPERATURE.
Cryo must be given within 6 hours.
500
What is this fibrinogen we speak of?
Fibrinogen is a coagulation factor with a large molecular weight and long half life. With prolonged bleeding, fibrinogen recovery is delayed and clot formation is affected.
500
Why keep the patients warm?
Hypothermia is part of the trauma triad of death.
every 1C0 drop in temp increases blood loss by 16% and mortality increases dramatically below 340
Cold blood has also been shown to induce arrhythmias especially through a central line.
500
IF it was to change to the diamond of death, what would be the last "leg"?
Hypocalcemia!
500
Women under the age of 50 and neonates will be issued O negative RBC's.
All others will get O+ RBC's.
Why?
O negative blood can be given to any blood type. But <7% of the US population have O negative blood. 37% of the population is O+.
Women who are Rh D- who are given Rh D+ blood can develop immune anti-D which can cause hemolytic disease of the newborn in subsequent pregnancies.
O- is safe for neonates, whose blood type may not be known yet.