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Damage Control Resuscitation
Published in Mansoor Khan, David Nott, Fundamentals of Frontline Surgery, 2021
Avoiding hypothermia by active warming may not be possible in a resource-limited environment; if available, they should be instigated. Avoiding cold fluids is also important (either by minimising the use of fluids as discussed earlier or, if required and resources allow, using fluid warmer). The avoidance of non-haemostatic fluids (e.g., crystalloids) will also reduce the risk of dilution of clotting factors. Using clotting factors containing fluid replacement (whole blood, fresh frozen plasma, lyophilised plasma) will help maintain clotting factors. Using fibrinogen concentrate has also been advocated.
Developments in equipment and therapeutics
Published in Ian Greaves, Military Medicine in Iraq and Afghanistan, 2018
To date, no pre-hospital fluid warmer exists that fits the criteria of being light, compact, robust and battery operated but is able to deliver the heating of cold fluids to body temperature at high flow rates. Although there are multiple companies exploring this and new devices using novel techniques, the DMS will continue to horizon scan for the product that will deliver to its needs.
Principles of paediatric trauma
Published in Sebastian Dawson-Bowling, Pramod Achan, Timothy Briggs, Manoj Ramachandran, Stephen Key, Daud Chou, Orthopaedic Trauma, 2014
Circulation with haemorrhage control – A high index of suspicion is required because vital signs may remain normal (Table 23.1) until substantial blood loss has occurred. The earliest features are tachycardia and reduced peripheral perfusion, which occur after approximately 30 per cent blood volume loss. Hypotension only occurs after more than 45 per cent blood volume loss. Vascular access can be achieved by intraosseous cannulation if necessary, but this must not be distal to a fracture site. Fluid boluses of 20 mL/kg warmed crystalloid are recommended, with frequent re-evaluation. Sources of haemorrhage must be identified and controlled, and the need for urgent surgery must be considered if circulation has not stabilized after two boluses. In addition, 10 mL/kg boluses of red blood cells should be used for further fluid replacement if the circulation remains unstable. Blood products should be administered via a fluid warmer. The paediatric pelvis is relatively small and flexible, so it offers less protection to the pelvic viscera and can transmit significant energy to the organs without being fractured.
Prehospital Transfusion of Low-Titer O + Whole Blood for Severe Maternal Hemorrhage: A Case Report
Published in Prehospital Emergency Care, 2020
Ryan Newberry, C. J. Winckler, Ryan Luellwitz, Leslie Greebon, Elly Xenakis, William Bullock, Michael Stringfellow, Julian Mapp
SAFD EMS units utilize a physiologic-based criterion for the decision of when to transfuse LTO + WB to patients experiencing hemorrhagic shock of either medical or trauma etiology (Figures 1 and 2). SAFD deploys the QinFlowTM Warrior IV fluid warmer and two pressure systems to transfuse LTO + WB, the VentlabTM disposable pressure infuser and the Braun™ Y-type blood set with an inline handpump (Figure 3). Together, these pressure systems consistently allow transfusions of 500 mL of whole blood warmed to 38 degrees Celsius to be completed in approximately 5 minutes (10). In addition to the EMS patient care report that is generated after each EMS response, a triplicate prehospital blood transfusion record is completed by the paramedics with two copies being issued to the receiving emergency department (Figure 4). Subsequently, the prehospital blood transfusion forms are distributed to the patient’s emergency department health record and the receiving hospital’s pathology laboratory.
Characteristics of Nontrauma Patients Receiving Prehospital Blood Transfusion with the Same Triggers as Trauma Patients: A Retrospective Observational Cohort Study
Published in Prehospital Emergency Care, 2022
Susanne Ångerman, Hetti Kirves, Jouni Nurmi
The pRBCs are stored in temperature-controlled portable medical transport bags (Credo S4 2 48 PROMED®, Pelican BioThermal, USA). Every pRBC unit has its temperature logger (Libero Ti1®, Elpro, Switzerland) with programmed alarm limits (+2 °C–+6 °C). The local hospital blood bank near the HEMS base provides new pRBCs 24-hours per day after usage and recycles the units for hospital utilization after three weeks if not used in prehospital setting. pRBCs (and all other resuscitation fluids, if possible) are always infused through a fluid warmer (Belmont Buddy Lite®, Belmont Instrument Corporation, MA, USA).