Ep 152 The 7 Ts of Massive Hemorrhage Protocols

Emergency Medicine Cases

Dr. Anton Helman

Science, Courses, Medicine, Health & Fitness, Education

4.7 • 602 Ratings

🗓️ 9 February 2021

⏱️ 75 minutes

🔗️ Recording | iTunes | RSS

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Summary

Dr. Jeannie Callum, Dr. Andrew Petrosoniak and Dr. Barbara Haas join Anton in answering the questions: How do you decide when to activate the MHP? How do you know when it is safe to terminate the MHP? What lab tests need to be done, how often, and how should the results be shared with the clinical team? Once the dust settles, what do we need to tell the patient and/or their family about the consequences of being massively transfused? What should be the lab resuscitation targets? Why is serum calcium important to draw in the ED for the patient who is exsanguinating? How do we mitigate the risk of hypothermia? What can hospitals do to mitigate blood wastage? If someone is on anti-platelets or anticoagulants what is the best strategy to ensure the docs in the ED know what to give and how much? Until the results of lab testing come back and hemorrhage pace is slowed, what ratio of plasma to RBCs should we target? What's better, 1:1:1 or 2:1:1? Should we ever consider using Recombinant Factor 7a? If the fibrinogen is low, what is the optimal product and threshold for replacement? When and how much TXA? Anyone you wouldn’t give it to? and many more...

Transcript

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0:00.0	Welcome to the Emergency Medicine Cases podcast. I'm your host, Dr. Anton Hellman, bringing you Canada's brightest minds in emergency medicine from EMC studios in Toronto.
0:13.7	EM cases is part of Shremi, the Schwartz-Riseman Emergency Medicine Institute. That's the nonprofit organization dedicated to improving EM care through high
0:21.5	quality research and education. The opinions expressed on this podcast are intended for general information and educational purposes only and should not be used to diagnose treat or prevent any medical condition, nor should they be used as a substitute for medical advice from qualified practicing physician. Unless stated otherwise, the opinions expressed by the hosts or guests are made in their individual capacity, not on behalf of the Institute nor medicine cases. There comes a point after maybe the sixth or seventh liter of normal saline for the hemorrhaging
0:39.9	patient when any good doctor asks himself, is it time to switch to blood?
0:46.6	Let's try that again, shall we?
0:48.5	It's not the 90s anymore.
0:50.1	You can say goodbye to your Sony Walkman.
0:52.0	Don't worry about returning those VHS movies to blogpuster.
0:55.4	And for Pete's sake, stop giving hemorrhaging patients fluid that you can see through.
1:01.3	The pendulum has swung in recent years and for good reason.
1:06.0	The formula has changed.
1:07.2	And now even those just starting to learn EM are reflexively saying, replace blood
1:12.5	with blood products. But it turns out that like most things in medicine, the idea of initiating
1:19.0	massive hemorrhage protocols is slightly more complicated than at first blush. There's more to
1:24.7	it than C-blood on floor equals order blood in bag.
1:29.5	Thankfully, today we have an all-star lineup.
1:32.9	They will demystify the red stuff for us and help navigate the murky waters of massive hemorrhage protocols.
1:40.0	We have everyone we need right here.
1:42.6	A trauma team leader and ED doc and Andrew Petrosonic, who you are sure to recognize
1:47.5	from our EM Quick Hits podcast.
1:50.7	An ICU doc and trauma surgeon in Barbara Haas from Sunnybrook Hospital, who is new
1:56.6	to EM cases.
	...

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