14 Early transfusion of high ratio of FFP:Platelet:PRBC improved survival SurvivialEarly transfusion of high ratio of FFP:Platelet:PRBC improved survival
15 Hemostatic Resuscitation No consensus yetMore fluid: risk of hemodilution & disruption of early hemostatic clotsVsLimit fluid: prolonging shock & cellular ischemia may become irreversibleHypotensive resuscitation:Aggressive crystalloid fluid resuscitation in patient with uncontrolled hemorrhage -> increase hemorrhage & coagulopathyTarget SBP >90mmHg or Heart rate <130 bpm until hemorrhage is controlledApart from blood transfusion, the traditioal ATLS protocol suggested giving 2L of crystalloid in maintaining the circulating volume
16 Massive Transfusion Protocol In the past:Crystalloid -> PRBCFFP / Platelets: upon request when there is lab evidence of coagulopathyCurrent era:prevention of coagulopathy & thrombocytopeniaPRBC: FFP: Platelet = 1:1:1
18 Retrospective review, cohorts Stanford University Medical Center Level I trauma CenterMTP since July 20056 PRBC: 4 FFP: 1 apheresis pack of Platelet2 yrs pre (n=40), post MTP (n=37)FFP:PRBC ratio the same: 1:1.8 (p=0.97)Plt : PRBC ratio: 1:1.8 -> 1:1.3 (p=0.05)Subjects: adm through AED, transfusion of 10 unit in 24hrs
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