EMCrit 353 - Massive Hemorrhage Protocol, the Trauma Anesthesiologist's Perspective with Roman Dudaryk
Jul 13, 2023
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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.
Selecting appropriate central venous access for rapid transfusion in trauma cases.
Managing MTP-induced cardioplegia with timely calcium replacement and insulin infusion during massive transfusion resuscitation.
Deep dives
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.