On this podcast,
I recap from last show, especially the concept of bare minimum normotension (called erroneously permissive hypotension by just about everyone else) and why we should keep the MAP higher if there is suspected elevations in intracranial pressure
I then talk about massive transfusion. This is probably the best strategy for a patient that will require greater than 8-10 units of PRBCs.
What may be the best review of the topic is by Spinella and Holcomb:
(Blood Reviews 2009;23:231-240)
I talk about
- 1:1:1 transfusion
- PCC, Factor VIIa, Cryo
- Calcium
- IV Access
coming up in the next few podcasts: Sedatives for Intubation, Trauma Airway Management, The Crashing A-fib patient
For updated thoughts
Additional New Information
More on EMCrit
Additional Resources
You Need an EMCrit Membership to see this content. Login here if you already have one.
Editor-in-Chief, at EMCrit.org
An ED Intensivist from NY.
Professor
Nassau University Medical Center
No conflicts of interest (coi).
Professor
Nassau University Medical Center
No conflicts of interest (coi).
Latest posts by Scott Weingart, MD FCCM (see all)
- EMCrit Wee – Jason Bartos on the Minneapolis ECPR Experience - December 7, 2023
- EMCrit 363 – Retrograde Intubation - December 2, 2023
- ODR 013 – Should, Must, & Won't - November 25, 2023
how about the place of tranxenamic acid in this algorithm,
regards,
Ken
We’re doing a whole podcast on TXA in the next few weeks, but in GB it costs a few quid, in my hospital $100 per gram ($200 per patient). Have no idea why we are getting reamed on this generic drug in the US.
truly excellent
I work in a small critical access hospital. We have a few units of PRBC’s… maybe a unit or 2 of FFP. I know PCC lacks several coat factors and fibrinogen, but in a kitchen sink trauma (or massive GI bleed) scenario, do you think there would be any utility in trying something like Kcentra?