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Massive Hemorrhage Protocols: The 7 Ts

By Anton Helman, MD, CCFP(EM), FCFP | on May 18, 2021 | 0 Comment
EM Cases
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References

  1. King DR, Ramly EP. Resuscitation of the trauma patient. In:Cohn SM, Dolich MD, Inaba K, eds. Acute Care Surgery and Trauma. 2nd ed. Boca Raton, FL: CRC Press; 2016:71-78.
  2. Callum J, Yeh CH, Petrosoniak A, et al. A regional massive hemorrhage protocol developed through a modified Delphi technique. CMAJ Open. 2019;7(3):E546-E561.
  3. Meyer DE, Vincent LE, Fox EE, et al. Every minute counts: time to delivery of initial massive transfusion cooler and its impact on mortality. J Trauma Acute Care Surg. 2017;83(1):19-24.
  4. Jennings LK, Watson S. Massive transfusion. In: StatPearls. Treasure Island, FL: StatPearls Publishing; 2021.
  5. Vandromme MJ, Griffin RL, Kerby JD, et al. Identifying risk for massive transfusion in the relatively normotensive patient: utility of the prehospital shock index. J Trauma. 2011;70(2):384-388; discussion: 388-390.
  6. Hanna K, Harris C, Trust MD, et al. Multicenter validation of the revised assessment of bleeding and transfusion (RABT) score for predicting massive transfusion. World J Surg. 2020;44(6):1807-1816.
  7. Meyer DE, Cotton BA, Fox EE, et al. A comparison of resuscitation intensity and critical administration threshold in predicting early mortality among bleeding patients: a multicenter validation in 680 major transfusion patients. J Trauma Acute Care Surg. 2018;85(4):691-696.
  8. Holcomb JB, Tilley BC, Baraniuk S, et al. Transfusion of plasma, platelets, and red blood cells in a 1:1:1 vs a 1:1:2 ratio and mortality in patients with severe trauma. JAMA. 2015;313(5):471-482.
  9. Levy JH, Welsby I, Goodnough LT. Fibrinogen as a therapeutic target for bleeding: a review of critical levels and replacement therapy. Transfusion. 2014;54(5):1389-1405.
  10. Hicks C, Petrosoniak A. The human factor: optimizing trauma team performance in dynamic clinical environments. Emerg Med Clin North Am. 2018;36(1):1-17.
  11. Simmons JW, Pittet JF, Pierce B. Trauma-induced coagulopathy. Curr Anesthesiol Rep. 2014;4(3):189-199.
  12. Sahin AS, Ozkan S. Treatment of obstetric hemorrhage with fibrinogen concentrate. Med Sci Monit. 2019;25:1814-1821.
  13. Verma A, Kole T. International normalized ratio as a predictor of mortality in trauma patients in India. World J Emerg Med. 2014;5(3):192-195.
  14. Brenner A, Afolabi A, Ahmad SM, et al. Tranexamic acid for acute gastrointestinal bleeding (the HALT-IT trial): statistical analysis plan for an international, randomised, double-blind, placebo-controlled trial. 2019;20(1):467.
  15. CRASH-2 trial collaborators, Shakur H, Roberts I, et al. Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial. Lancet. 2010;376(9734):23-32.
  16. Gayet-Ageron A, Prieto-Merino D, Ker K, et al. Effect of treatment delay on the effectiveness and safety of antifibrinolytics in acute severe haemorrhage: a meta-analysis of individual patient-level data from 40 138 bleeding patients. Lancet. 2018;391(10116):125-132.
  17. CRASH-3 trial collaborators. Effects of tranexamic acid on death, disability, vascular occlusive events and other morbidities in patients with acute traumatic brain injury (CRASH-3): a randomised, placebo-controlled trial. Lancet. 2019;394(10210):1713-1723.
  18. Helman A, Callum J, Haas B, et al. The 7 Ts of massive hemorrhage protocols. Emergency Medicine Cases website. Available at: https://emergencymedicinecases.com/7-ts-massive-hemorrhage-protocols. Accessed March 10, 2021.
  19. Kander T, Schött U. Effect of hypothermia on haemostasis and bleeding risk: a narrative review. J Int Med Res. 2019;47(8):3559-3568.

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Explore This Issue
ACEP Now: Vol 40 – No 05 – May 2021

Pages: 1 2 3 | Single Page

Topics: Critical CareHemorrhagemassive hemorrhage protocolsTrauma & Injury

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About the Author

Anton Helman, MD, CCFP(EM), FCFP

Dr. Helman is an emergency physician at North York General Hospital in Toronto. He is an assistant professor at the University of Toronto, Division of Emergency Medicine, and the education innovation lead at the Schwartz/Reisman Emergency Medicine Institute. He is the founder and host of Emergency Medicine Cases podcast and website (www.emergencymedicinecases.com).

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