EMCrit Podcast EMCrit 353 - Massive Hemorrhage Protocol, the Trauma Anesthesiologist's Perspective with Roman Dudaryk
Jul 13, 2023
Roman Dudaryk, The Trauma Anesthesiologist, discusses optimizing trauma resuscitation strategies, the logistics of massive transfusion in trauma anesthesia, and managing hyperkalemia in trauma patients. Topics include subclavian access, central line placement, tranexamic acid use, and risks of MTP-induced cardioplegia.
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Choose High-Flow Central Access
- Prefer large-bore subclavian or internal jugular central access for massive hemorrhage when skilled at placement.
- Use MAC®-type multi-lumen catheters for reliable high-flow access in trauma resuscitation.
Avoid Flow-Restricting Line Caps
- Remove flow-restricting caps and minimise interposed connectors on resuscitation lines to preserve infusion speed.
- Use the Belmont injection port so you can give meds without stopping the rapid infuser.
Start With Whole Blood When Possible
- Start massive transfusion with whole blood when available and limit initial in-bay whole blood to four units.
- After whole blood, proceed to balanced 1:1:1 component MTP with ongoing platelet support.