Hemorrhage

Question 1

TXA Dose (Adult)

Answer 1

Bolus: 1 gram of TXA SIVP over 5-10 minutes Mix 1 gram in 10 mL

Question 2

TXA Dose (Peds)

Answer 2

15 mg/kg, Max 1 gram

Question 3

Hemorrhage tx (peds)

Answer 3

• 30 days to 14 yrs:
  TXA
  20 mL/kg NS bolus
  Repeat after 5 min if no improvement
  Repeat again after 5 min if no improvement
• <30 days old
  10 ml/kg NS bolus
  Repeat once after 5 min if no improvement

Question 4

TXA Inclusion Criteria

Answer 4

• Traumatic injury with suspected or observed internal and/or external hemorrhage requiring large volume crystalloid resuscitation or predicted blood product administration
• Moderate traumatic brain injury(GCS greater than 8 and less than 13) presenting within three hours of injury
• Postpartum hemorrhage with suspected or observed internal and/or external hemorrhage requiring large volume crystalloid resuscitation or predicted blood product administration.

Question 5

TXA Exclusion Criteria

Answer 5

• Time out from injury greater than 3 hours
• Concomitant administration with other approved procoagulant agents (factor VII, protamine, APCC)

Question 6

Hemorrhage Control

Answer 6

A systolic blood pressure (SBP) can be used to guide crystalloid fluid administration with the
patient’s baseline or required mean arterial pressure (MAP) the target of all resuscitation.
- Penetrating Trauma & Hypovolemia: Permissive hypotension goal SBP 70-
90mmHg, MAP 60-65mmHg
- Blunt Trauma & Traumatic Brain Injury: goal SBP 100-120mmHg with a MAP>85 mmHg.
- Crystalloids only indicated if above BP goals are not met & blood transfusions not immediately available. If crystalloids indicated, give LR in increments of
250 mL to a max 1L until BP goals accomplished