Trauma

Question 1

warfarin reversal

Answer 1

The goal of warfarin reversal is to increase the available amount of Vitamin–K dependent clotting factors, which will lead to a decrease in INR
Warfarin is a vitamin-K dependent clotting factor inhibitor, specifically Factors 10-9-7-2
treatment options include withholding warfarin, administering oral or intravenous vitamin K, fresh frozen plasma (FFP), and prothrombin complex concentrate (PCC)
Rapid reversal is 4F-PCC + Vitamin K. If no 4F-PCC use FFP + Vitamin K

Question 2

targets for correcting anticoagulation in traumatic brain injury

Answer 2

Platelets >100
INR <1.5 (If supratherapeutic INR consider octaplex)
Target PTT <40 (If PTT too high, consider FFP)
If patient is heparinized consider protamine sulphate
Fibrinogen >1 (if fibrinogen <1 consider cryoprecipitate)
Target Hgb >90 (transfuse PRBC if necessary)
Consider TXA in low pressure bleed (such as SDH)

Question 3

reversal of heparin/LMWH

Answer 3

Protamine sulfate
Protamine sulfate binds to either heparin or LMWH to form a stable ion pair, which does not have anticoagulant activity
Provides rapid reversal of anticoagulation d/t heparin or LMWH

Question 4

cornerstone principles of damage control resuscitation

💵💵💵💵 MONEY SLIDE 💵💵💵💵

Answer 4

Permissive hypotension
Balanced haemostatic resuscitation
Early Damage control surgery

Question 5

cornerstone principles of balanced hemostatic resuscitation

💵💵💵💵 MONEY SLIDE 💵💵💵💵

Answer 5

Minimal administration of crystalloid
Prevention of acidemia
Reduce coagulopathy of trauma
prevent hypothermia
Early transfusion of blood

Question 6

bleeding reversal for direct thrombin inhibitors (dabigatran)

Answer 6

Idarucizumab
TXA
4F-PCC

Question 7

bleeding reversal for factor Xa inhibitors (Rivaroxaban, apixaban)

Answer 7

4F-PCC
2. TXA

Question 8

bleeding reversal for fibrinolytic agents

Answer 8

Cryoprecipitate
TXA
FFP

Question 9

bleeding reversal for anti platelet agents

Answer 9

DDAVP
2. platelets

Question 10

VGH/BC Burn Network burn resuscitation guidelines 2020

Answer 10

fluid resuscitation for major burns should start at 3cc/kg/%TBSA.
Perform hourly calculation of “ins” and “outs”. Titrate fluid resuscitation hour-by-hour, especially in the early phase of major burns trauma. Clinical endpoints include responses in blood pressure, heart rate, and lactate clearance.
Titrate urine output to 30-50cc/hr for major burns (50-100cc/hr in electrical burns to facilitate clearance of myoglobin and decrease the risk of acute kidney injury).
Use warmed, balanced crystalloids (Ringer’s Lactate or Plasmalyte-A) in major burns
Keep the patient warm