CCMCP Shock - Hemorrhagic

Question 1

CCMCP Shock - Hemorrhagic - Initial actions?

Answer 1

Assessment

Point of care testing for chemistry and gases

Question 2

CCMCP Shock - Hemorrhagic - Traumatic?

Answer 2

Control bleeding: Direct pressure, hemostatics, tourniquet, pelvic binding, TXA

Question 3

CCMCP Shock - Hemorrhagic - Fluid resuscitation?

Answer 3

<20 ml/kg - consult TP if more required

Just enough to meet perfusion goals

Question 4

CCMCP Shock - Hemorrhagic - Perfusion goals?

Answer 4

MAP of 65 mmHg

Head injury = MAP of 85 mmHg

Question 5

CCMCP Shock - Hemorrhagic - Indications of shock?

Answer 5

Shock index 1.2 or greater (HR / Systolic Blood Pressure)
Lactate >4 mmol/L
Hemoglobin (Hgb) < 90 g/L
Base excess

Question 6

CCMCP Shock - Hemorrhagic - Indicators of shock or consideration of blood administration?

Answer 6

Shock index 1.2 or greater (HR / Systolic Blood Pressure)
Lactate >4 mmol/L
Hemoglobin (Hgb) < 90 g/L
Base excess

Question 7

CCMCP Shock - Hemorrhagic - Consult TP to consider TX options of?

Answer 7

Fluid
Blood products
TXA

Question 8

CCMCP Shock - Hemorrhagic - Pt anticoagulated?

Answer 8

Consult TP to consider:

Prothrombin complex concentrate (Octaplex)

Question 9

CCMCP Shock - Hemorrhagic - Pt non-traumatic hemorrhage?

Answer 9

Consider GI bleed or post partum bleed protocols concurrently

Question 10

CCMCP Shock - Hemorrhagic - Tranexamic acid indications?

Answer 10

Patients with significant hemorrhage within 3 hours of trauma:
Systolic BP < 90 mmHg after 10 mL/kg crystalloid solution
and/or:
HR > 110 bpm after 10 mL/kg bolus and adequate analgesia

Question 11

CCMCP Shock - Hemorrhagic - Tranexamic acid dose?

Answer 11

Adult - 1 g IV/IO in 100 mL NS or D5W over 10 min

Ped - 10 - 15 mg/kg IV/IO max of 1 g over 10 min

Question 12

CCMCP Shock - Hemorrhagic - Tranexamic acid contraindications?

Answer 12

Hypersensitivity to TXA

Question 13

CCMCP Shock - Hemorrhagic - Tranexamic acid precautions?

Answer 13

Not compatible with ringers lactate

Question 14

CCMCP Shock - Hemorrhagic - Tranexamic acid maintenance dose?

Answer 14

Adult - 1 g IV/IO in 250 mL NS or D5W over 8 hours

Ped - 2 mg/kg/hr IV/IO max 1 g over 8 hours

Question 15

CCMCP Shock - Hemorrhagic - prothrombin complex concentrate indication?

Answer 15

Consult TP - Major, life-threatening bleeding in patients with an INR greater than 1.5 on warfarin therapy or vitamin K deficiency

Question 16

CCMCP Shock - Hemorrhagic - prothrombin complex concentrate dose?

Answer 16

1000 units IV/IO start at 1 mL/min for 5 - 10 minutes, to max rate of 2 - 3 mL/min

Question 17

CCMCP Shock - Hemorrhagic - prothrombin complex concentrate contraindications?

Answer 17

History of heparin induced thrombocytopenia

Question 18

CCMCP Shock - Hemorrhagic - prothrombin complex concentrate precautions?

Answer 18

No other drugs / solutions can be co-administered in the same line while prothrombin complex concentrate is being infused