Trauma

Question 1

What are indications for activation of the MTP?

Answer 1

• Replacement of 50% of patients blood volume in 1 hour
• Replacement of 100% blood volume in 24h

Requiring
- 4 units in 1 hour
- 10 units in 6 hours

Question 2

What is a grading system for pancreatic trauma?

Answer 2

American Association for the Surgery of Trauma (AAST)

Proximal pancreas is defined as the gland to the right of the SMV-portal vain axis. Distal is to the left. Deep refers to down to level of the duct.

Grade 1: haematoma with minor contusion or superficial laceration without duct injury

Grade 2: Major contusion or laceration without duct injury

Grade 3: Distal transection or deep parenchymal injury with duct injury

Grade 4: Proximal transection or deep parenchymal injury involving the ampulla and or intrapancreatic CBD.

Grade 5: Massive disruption of the pancreatic head “shattered pancreas”.

Question 3

What is the MTP?

Answer 3

It varies slightly between institutions however the general principles are that the MTP is a protocol of blood loss replacement with a
1:1:1 ratio between RBC, plts and FFP in patients with significant and ongoing blood loss with regular monitoring of ABG and coagulation and 10ml CaCl with every pack

The first box is often unmatched O neg blood and follow up boxes are matched to Group and hold results.

It continues until deactivated and stopped. It requires ongoing clear communication pathways between involved clinicians, orderlies and blood bank.

Question 4

Classes of haemorrhagic shock

Answer 4