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Overview :
West et al developed a simple guide for the transfusion of a
trauma patient. This can help minimize unnecessary blood transfusion while
maintaining adequate oxygenation. The authors are from multiple hospitals in the
United States participating in the Large Scale Collaborative Project.
Patient selection: Trauma patient following immediate
resuscitation.
Goal: To minimize the amount of blood transfused.
Parameters:
(1) underlying status of the patient
(2) hemoglobin value used as the decision level to
transfuse
(3) evidence of hypovolemia
(4) evidence of impaired oxygen delivery
The hemoglobin value used to trigger transfusion varies with
the underlying status of the patient:
(1) The
default level set by the authors was a hemoglobin < 7 g/dL.
(2) A
healthy patient with no comorbid conditions can tolerate a lower hemoglobin
level.
(3) A
patient with severe cardiovascular disease will often require transfusion at a
higher hemoglobin level to prevent cardiac ischemia. For the implementation I
will use 10 g/dL ("liberal threshold" for acute blood loss)..
Criteria for impaired oxygen delivery - one or more of the
following:
(1) low oxygen saturation in mixed venous blood
(2) persistent base deficit
(3) lactic acidosis
Management steps, performed on an ongoing basis:
(1) If the
hemoglobin is less than the transfusion decision level, then transfuse the
patient.
(2) If the
patient is hypovolemic, then administer fluids to achieve normovolemia.
Following fluid administration recheck hemoglobin.
(3) If there is evidence of impaired oxygen delivery, then
consider:
(3a) placement of a pulmonary
artery catheter
(3b) mesaurement of the cardiac
output
(3c) optimize oxygen delivery
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