EMCrit 353 - Massive Hemorrhage Protocol, the Trauma Anesthesiologist's Perspective with Roman Dudaryk

Massive Transfusion Logistics and Anesthesia Perspective

In trauma anesthesia, the logistics of massive transfusion are critical. Rapid and effective transfusion is vital during resuscitation. Anesthesia plays a hands-on role in managing this process, necessitating unique approaches due to limited support. Roman Duderic discusses the challenges trauma anesthesiologists face when dealing with massive transfusion scenarios, highlighting the importance of timely interventions and specialized strategies for effective resuscitation.

Choosing Access for Massive Transfusion Patients

During massive transfusion scenarios, selecting the appropriate access point is crucial. Central venous access, particularly via subclavian route when feasible, is preferred for rapid and reliable access. The choice of catheter, such as MAC and triple lumen catheters, plays a significant role in ensuring efficient and safe delivery of blood products during resuscitation. In complex trauma cases, the selection of access points based on specific injuries and patient conditions is essential to streamline the transfusion process effectively.

Optimizing Blood Product Resuscitation in Trauma Scenarios

Efficient and timely administration of blood products is vital in trauma resuscitation. Utilizing a three-spiked Belmont bucket for high-speed infusions helps prevent volume overload and ensures effective delivery of blood products. Practitioners emphasize the importance of maintaining an accurate count of blood product units to track and monitor the transfusion progress during a high-stakes resuscitation. Strategies such as keeping all blood bags for accountability are crucial in avoiding errors and ensuring patient safety during critical transfusions.

Mitigating MTP-Induced Cardioplegia

One of the critical challenges in massive transfusion is MTP-induced cardioplegia, resulting from factors like hyperkalemia and decreased ionized calcium levels. Adequate and timely replacement of calcium is essential to prevent cardiac complications. Additionally, aggressive administration of insulin to counter hyperkalemia in trauma patients undergoing massive transfusion plays a crucial role in managing critical potassium levels. Alongside insulin infusion, interventions like bicarbonate and albuterol inhalation can help stabilize potassium levels and mitigate the risk of cardioplegia during resuscitation.

EMCrit Podcast

EMCrit 353 - Massive Hemorrhage Protocol, the Trauma Anesthesiologist's Perspective with Roman Dudaryk

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Deep dives

Massive Transfusion Logistics and Anesthesia Perspective

Choosing Access for Massive Transfusion Patients

Optimizing Blood Product Resuscitation in Trauma Scenarios

Mitigating MTP-Induced Cardioplegia

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