Damage Control Resuscitation, Permissive Hypotension, Fluid Restrictive Resuscitation… Regardless of name, with all the enthusiasm surrounding permissive hypotension in the actively bleeding trauma patient, what do we do when they have a TBI? Take a dive into the literature surrounding ideal perfusion pressures of patients suffering from TBIs and traumatic injury to find out if we know what pressure is really the best.Read More
Q: For a patient in hemorrhagic shock from acute blood loss, what is the best resuscitative fluid?
A: If they've lost blood, give them blood.
It's never quite that simple though right? For a generation now, we have practiced primarily by transfusing patient's with acute blood loss varying ratios of blood product components. Thanks to the PROPPR trial, we most recently arrived on a generally accepted ratio of 1:1:1 for Plasma, Platelets, and Red Blood Cells for severely injured bleeding trauma patients. Recent military literature however, suggests that there may be another strategy (which is in and of itself a bit of a throwback) that could offer additional benefits over a component transfusion strategy. If were are trying to recreate a whole blood with a 1:1:1 plasma:platetel:PRBC ratio, why not just give whole blood?Read More
A couple weeks back we met for the first journal club of the year in our residency. For this first session, we tackled the clinical conundrum of transfusion ratios in trauma. The question came from a brainstorming session with the PGY-1 and 2 residents, where the following PICO question was derived:
Patients: Victims of both blunt and penetrating trauma in need of blood transfusion as a part of the their initial resuscitation
Intervention: high plasma and platelet to PRBC ratio transfusion
Comparison: low plasma and platelet to PRBC ratio transfusion
Outcome: Mortality (in patient and 30 day mortality)Read More