Welcome back to the Internet Book of Critical Care Podcast.

I'm here with Adam Thomas and we're going to talk about massive transfusion protocol.

Yay!

Something fun and not COVID!

Yeah, everyone loves the MTP.

Josh, I have to say this is our patient's worst day, but there's something really exciting

about an MTP from a

work perspective, because they're always intense resuscitations that are a lot of fun. Is that harsh

to say? I think it's fair. You know, life is tough. You need to take joy where you can take it. And I think

most of these patients end up doing well. So I'm happy to, you know, be satisfied of this resuscitation. So this chapter,

I think is really, really important. Again, like all IBCC chapters, the evidence here is wanting,

shall we say, but hemo-static resuscitation that Josh is going to get into is really important. And I think we're learning more and more that we cause coagalopathies because of how we resuscitate patients.

So let's back up. What is the concept of a massive transfusion protocol? And why is this important?

The concept is essentially patients are losing lots of blood. And if you don't approach them in an

organized fashion, you can run into a lot of problems with dilution of clotting factors, hypothermia,

acidosis, hypokalcemia. So I think the whole concept of a massive transfusion protocol is you have a

patient who's in hemorrhagic shock, who's rapidly bleeding, and you're going to take really

like a well-organized, orchestrated approach that's going to avoid a lot of these problems and

fix others simultaneously. Wait, wait, wait. By they're losing blood,

do you mean they're losing just pack cells and crystalloid, right? Exactly. They filter it out.

Okay. We're also going to talk about those so-called triad or the, the aspects that worsen

coagalopathy. So we got some dilution of clotting factors Josh already brought up. That includes

...