Transfusion Management of Trauma Patients. Beth H. Shaz, Christopher J. Dente, Robert S. Harris, Jana B. MacLeod, Christopher D. Hillyer. ANESTHESIA and ANALGESIA. Vol.108, No.6, June 2009 P1760- 1768. Early Trauma related Mortality. Head Injury 40 - 50% deaths. Haemorrhage 20 - 40% deaths. Recognised treatment strategies for traumatic major haemorrhage. PALS/APLS. ATLS. ‘Component approach’. Hypotensive resuscitation. Traditional perceived causes of coagulopathy. Dilution secondary to fluid resuscitation developing over hours. Hypothermia. Acidosis. Consumption. Early trauma-induced coagulopathy. Occurs in 25% of trauma victims. INR>1.5 Independent predictor of mortality with associated 35% increase in likelihood of dying . Massive Transfusion Protocols based on experience from Military Hospitals. Early administration of blood products. Predetermined blood product ratios of ideally 1:1:1 PRBCs, FFP, platelets or even whole blood. AVOID HYPOTHERMIA,ACIDOSIS AND COAGULOPATHY. Mortality related to plasma:RBC ratio. 70% 60% 50% 40% low 1:8 medium 1:2.5 30% high 1:1.4 20% 10% 0% Risks of transfusion. Hypothermia. Hyperkalaemia. Acidosis. Hypocalcaemia. TRALI. MOF. Infection. Major Transfusion Protocols for Children. Major haemorrhage in children is a rare event. Are children more susceptible to the hazard of Massive Transfusion? The mortality rate in children of 8yrs. or less is 18% v 4% for older children and adults! (Iraq 2003- 2008 NEJM April 16, 2009).
Pages to are hidden for
"Transfusion Management of Trauma Patients. Beth H. Shaz "Please download to view full document