Emergency Medicine Reports – March 23, 2014
March 23, 2014
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Massive Transfusion: Part II
There are several relatively new adjuvant treatments for patients with massive hemorrhage. Of these, TXA is most widely recommended. It is inexpensive and has been shown to reduce mortality when given within three hours of injury. A new test, viscoelastic hemostatic assay, identifies the patient's stage of coagulability and fibrinogen status. The result of the test is a curve, which can help determine the need for fibrinogen, clotting factors, and platelets. Massive transfusion is an independent predictor of increased mortality, increased infection rate, SIRS, andmulti-organ failure. Complications of massive transfusion include acid/base derangement, electrolyte abnormalities (particularly hyperkalemia with rapid infusion), immune system changes, acute lung injury, and fluid overload.