Transfusion Management of Trauma Patients. Beth H. Shaz by u4pg9WmF

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									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).

								
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