Damage Control Resuscitation

Question 1

what are some predictors associated with the need for a massive transfusion?

Answer 1

penetrating mechanism
Positive FAST
Lactate concentration > 4mmol/L
Base deficit more than 6mEq/L
pH < 7.25
INR of 1.5 or greater

Question 2

What does REBOA stand for?

Answer 2

resuscitative endovascular balloon occlusion of aorta

Question 3

List resuscitation fluids of choice from most to least preferred:

Answer 3

Whole blood
Plasma;RBCs:platelets in 1:1:1 ratio
Plasma:RBCs 1:1 ratio
Plasma or RBCs alone
Crystalloid  (LR or Plasma-Lyte A)

Question 4

in extreme conditions, how many units of whole blood can be taken from a donor in the PFC setting?

Answer 4

two

Question 5

How do you give TXA by IV push?

Answer 5

over 10 minutes

Question 6

How is the second dose of TXA administered?

Answer 6

1g over 8 hours in 100mL of NaCl

Question 7

What is considered the best practice in regards to calcium administration when doing damage control resuscitation in the PFC setting?

Answer 7

monitor serum calcium
less than 1.2 mmol/L administer:
30mL of calcium gluconate, or
10mL of calcium chloride

Question 8

if you cannot monitor calcium while resuscitating a patient, how should you administer it?

Answer 8

1gm (30mL calcium gluconate or 10mL calcium chloride) immediately after 1st transfusion and an additional does after every four units.

Question 9

If available, what labs should be trended when resucitating in the PFC environment?

Answer 9

Lactate
pH and base deficit
Hemoblobin/hematocrit
INR

Question 10

What are the end points of resucitation?

Answer 10

Hgb > 8.0g/dL
Hct > 27%
Lactate concentration less than 2.5 mmol/L
Base deficit less than 4

Question 11

What is the pediatric TXA dose?

Answer 11

15mg/kg loading dose followed by 2mg/kg/h x 8 hours

Question 12

what is the normal dose of whole blood for pediatrics?

Answer 12

10mL/kg