MASSIVE TRANSFUSION PROTOCOL- POD

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MASSIVE TRANSFUSION PROTOCOL WHEN TO INITIATE IT?

  • ABC (assessment of blood consumption) score >2- each assigned 1 point

    • Pulse >120

    • SBP <90

    • + FAST

    • penetrating torso injury

  • Shock index >1.4 (HR/sBP)

  • active bleeding requiring multiple transfusions

WHAT DOES IT CONSIST OF?

  • 1:1:1 ratio of RBC:Plasma:Platelets

TO PREP FOR BLOOD ARRIVAL

  • 2 large bore IVs

  • baseline labs- cbc, type and screen, Pt/PTT/INR, fibrinogen, BMP with magnesium

  • prepare the Belmont- rapid transfusion and warmer to prevent hypothermia

  • If trauma patient give Tranexamic acid 1gm IV over 10 minutes and then 1gm IV over 8 hours.

DURING MTP

  • Repeat labs every hour checking for electrolyte abnormalities. CORRECT THEM!

    • Hyperkalemia

    • Hypocalcemia

    • Hypomagnesemia

  • Ensure patient is not hypothermic

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Takotsubo Cardiomyopathy POD

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broken-heart.jpg

TAKOTSUBO CARDIOMYOPATHYWHAT IS IT?

  • Weakening of the left ventricle after an emotional stress

  • Aka Broken Heart

PRESENTATION

  • Classically in postmenopausal women after an emotional stress

  • Chest pain and SOB

  • ECG resembles a STEMI

  • Rapid but small rise in troponin (actual STEMI troponin takes longer to rise but has higher peak)

  • NEGATIVE angiogram

  • ECHO- ballooning of LV

HOW DID IT GET ITS NAME?

Takotsubo= a pot used to catch octopi—resembles the LV apical ballooning that occurs

takotsubo.jpg

ED MANAGEMENT: STEMI alert

** only way to differentiate from a STEMI is a negative angiogram.

PROGNOSIS: much better than STEMI.

  • Most patient’s fully recover in 2 months

  • In hospital mortality= 4%

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Trauma Tuesday POD- Hare Traction Splint

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What is a Hare Traction Splint?

When to Use a Hare Traction Splint?—Midshaft femur fracture when there is no evidence of pelvic or lower leg injury.

How to apply a Hare Traction Splint?

  1. Expose the injured limb.

  2. Measure distance of splint on uninjured leg- Should be 6-8inches past ankle.

    1. Measure on opposite leg of fracture as femur fracture side can be shortened

    2. Apply ankle hitch

    3. Slide splint under injured leg.

    4. Fasten the ischial strap.

    5. Connect loop of ankle hitch to splint

    6. Tighten the ratchet so the splint holds the traction

    7. Apply the rest of the straps- avoiding the fracture site.

    8. Assess neurovascular function

Here is a link to a video to see how it is applied!

https://youtu.be/498SydRP4jg

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