Blood and Trauma Update 2016 - Society of Intensive Care Medicine Symposium
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This document discusses trauma resuscitation and the role of blood products. It reviews the history of trauma management from World War I to the modern era. Key developments mentioned include the birth of ATLS and damage control resuscitation. The document also summarizes recent guidelines regarding permissive hypotension, transfusion ratios of blood products, the use of tranexamic acid, and approaches to coagulopathy in trauma.
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Blood and Trauma Update 2016 - Society of Intensive Care Medicine Symposium
- 1. Blood Trauma SISPO 2016 Tan Hon Liang
- 4. Role of CPR in trauma?
- 5. No conflicts of interest to declare
- 8. World War 1 Basic first aid
- 9. Some blood, some fluid, some surgery
- 10. 3L crystalloid, 1L blood Surgery
- 11. Birth of ATLS
- 12. Crystalloid, RBC, Plasma Damage control resuscitation Damage control surgery
- 13. What do we know?
- 14. Trauma Bleeding TBI Chest Abdomen LimbsPelvis Die ATLS Investigations Interventions Medical Surgical Blunt vs Penetrating
- 15. ATLS
- 17. 4 yearly review Financial gains Target audience Dogma/Myth
- 18. Up to Date?
- 19. Cervical Collar
- 20. Resuscitative Endovascular Balloon Occlusion of Aorta (REBOA)
- 27. Manual in-line stabilization Rapid Sequence Induction Glasgow Coma Scale 18 possible permutations exist for GCS 9 17 for scores 8 and 10 14 for scores 7 and 11 10 for scores 6 and 12
- 28. ATLS <=> EGDT
- 30. What do we know about blood and trauma circa 2015 Coagulopathy Acidosis Hypothermia TA C Platelet defect (TBI) Consumption (Clot/DIC) Endothelial injury, Fibrinolysis DCR Medical - Blood/drug Surgical - Laparotomy vs conservative
- 31. 12 Apr 2016 37 Recommendations
- 34. Systolic blood pressure 80-90 mmHg (no TBI). Mean arterial pressure of 80 mmHg (if TBI present) “Restrained resuscitation” “Permissive hypotension” Highlights Recommendation 13
- 36. 95.1% of 245 trauma centers - massive transfusion protocols 67.7% tended toward 1:1:1 ratios
- 37. Highlights Recommendation 25 Tranexamic acid < 3 hours 1 g load, 1 g over 8 hr
- 38. Developing countries (245 centres in 40 countries) Methodology (selection, randomization) (no phone!) 100% follow up Complication screening CRASH-2 Critics
- 39. Advanced Trauma Centres Complication screening CRASH2 MATTERs NNT 67 7 Mortality Benefit 1.5% 6.7% Complication rate <1% 9-12x higher Seriously injured MATTERs
- 41. Highlights Recommendation 28 Recommendation 29 Recommendation 31 Low fibrinogen: 15-20 units of Cryoprecipitate Platelets: >50 or >100 if TBI or on-going bleeding Anti-Platelets: give platelets Recommendation 32 Known platelet dysfunction: desmopressin (0.3 mcg/kg)
- 42. Highlights Recommendation 33 Recommendation 34 Recommendation 35 PCC if Warfarin FXa inhibitors: TXA and high dose PCC Thrombin inhibitors: idarucizumab or TXA and high dose PCC Recommendation 36 Off label rFVIIa only if desperate
- 43. What do we know?
- 44. 1:1:1 Cryoglobulin Calcium Temperature Acidosis “Limit” crystalloids Stop bleeding TXA Reversal agents
- 45. ATLS = Basic More TXA evidence coming NOAC situations = new approaches
- 48. SGicu.com