3. The student shall be able to effectively
recognize uncontrolled hemorrhage and
immediately provide the indicated
treatment.
4. Upon completion of this course, the student will be able to:
1. Recognize uncontrolled hemorrhage
2. Identify the proper method of treatment
3. Discuss the indication for tourniquet use
4. Demonstrate the proper use of a tourniquet
5. Objectives
5. Discuss the indication for the use of Combat Gauze
6. Demonstrate the proper use of Combat Gauze
7. Discuss the indication for the use of Phenylephrine
8. Demonstrate the proper use of Phenylephrine
9. Discuss the indication and use of TXA
47. Did Not reduce
the need for blood
the need for surgery
Did increase survival
48. TXA is Safe
TXA Makes a Difference
TXA Increases Survival
TXA doesn’t create clots in bad places
49. Retrospective
Combat Casualties in Afghanistan
British Helo Physicians
TXA vs No TXA
1+ unit(s) PRBC
10+ units of PRBC
896 Patients
293 received TXA
50. Characterize TXA use in combat injury care
Effect of TXA on
Blood Product Use
Bad Clots
Mortality (24 hrs., 48hrs., 30 days)
55. If a casualty is anticipated to need
significant blood transfusion:
presents with hemorrhagic shock
one or more major amputations
Penetrating torso trauma
Evidence of severe bleeding
Administer 1 gram of tranexamic acid in 100 cc
Normal Saline or Lactated Ringers as soon as
possible but NOT later than 3 hours after injury.
Begin second infusion of 1 gm TXA after Hextend
or other fluidtreatment.
62. Onset of action within 4 hours after IV administration
Delayed effects up to 48 hours consistent with anti-
inflammatory actions.
63. While a theoretical concern, TXA has not been shown
to cause significant increase in:
deep venous thrombosis
pulmonary embolism
myocardial infarction
stroke
64. 1 gram IVPB over 10 minutes.
Administer in 100 mL or 250 mL NS.
65.
66. The CRASH-2 Collaborators. Effects of tranexamic acid on death,
vascular occlusive events, and blood transfusion in trauma patients
with signifcant hemorrhage (CRASH-2): a randomised, placebo-
controlled trial. Lancet 2010; 376: 23–32.
Jonathan J. Morrison; Joseph J. Dubose; Todd E. Rasmussen; Mark J.
Midwinter. Military Application of Tranexamic Acid in Trauma
Emergency Resuscitation (MATTERs) Study. Arch Surg. 2011
Medical Control Board. EMS Protocols for Metropolitan Oklahoma
City and Tulsa. 2013.
Tactical Combat Casualty Care Guidelines. Prehospital Trauma Life
Support. 2012.