new guidlines ???

[DJ-100]

hello,

I heared from our trauma team that new recommendations in trauma is to resuscitate the patients immediately with blood not RL as fluids can only raise the bp but cant increase oxygen delivery to the vital organs:eek:.

I was asked to provide the resources that support the above but I couldnt find any.

I need your help if you have links that support the above plz share it here:yeah:.

do you think this is practical ?using blood immediately ,how many units we will use in every case!?

thank you

[traveljen]

no its not pratical for so many reasons. number 1 if the pt has a high hbg and hct and there not bleeding out you can cause just as many problems. does the lab know about this because you would have to be somewhere that has a supply of O neg and O pos on hand because probably don't know blood types so depeding on there might not be enough blood avaliable to give.

[MikeyJ, RN]

Well, to find the newest guidelines go to http://www.guidelines.gov

I have searched for the past 20 minutes and can't find much on blood administration during a trauma. The only guideline on this I found says "During resuscitation, attempts should be made to increase oxygen delivery to normalize base deficit, lactate, or pHi during the first 24 hours. The optimal algorithms for fluid resuscitation, blood product replacement, and the use of inotropes and/or vasopressors have not been determined."

[S.T.A.C.E.Y, LPN]

I heard from our trauma director that this will be a coming trend. I don't think it will be intended for all our trauma patients, but just the serious ones. The ones we know are likely to recieve blood anyways. The big traumas, the messy traumas, the really bloody traumas. Those trauma patients who end up not really being a trauma, or being a stable trauma will likely continuing to receive RL as per normal, as the blood isn't needed. I think the idea is to start the blood earlier if we know they're going to recieve it anyways.

[DJ-100]

Thank U For Ur Reply ,i Think It Is Still Very New Topic With Many Challanges.

[EMTandNurse2B]

I work as an RN in a level 1 trauma center, and this is indeed the practice we are moving toward. If (and only if) the patient has obvious bleeding (inside or out-we use ultrasound), we try to limit fluids to a max of 1-3 liters, including what they got prior to arrival. We have 3-4 units of O- blood in the trauma ready to go, before the patient arrives. If there is no obvious bleeding, we use NS or LR until we know the H & H (about 5 minutes). We are also going to warming everything that goes into the patient to prevent hypothermia, another new study. Obviously, we used typed and crossmatched blood as soon as it is available, but in a bad trauma there is no time to wait for it to be typed.

[DJ-100]

EMTandNurse2B ,THANK YOU FOR CLEARING UP THINGS .ACTUALLY THIS IS WHAT I MENT OF COURSE NOT EVERY PT NEEDS BLOOD UNTILL IT IS A CONFIRMED HEMORRHAGE .

I HAVE ANOTHER QUESTION SINCE YOU MENTIONED O -VE BLOOD.WHAT IS THE BEST TYPE OF BLOOD TO BE USED O RH NEG OR O RH POS AND WHY? WHY THEY GIVE FEMALES IN THIER PRODUCTIVE AGE O NEG AND MENOPAUSAL ARE GIVEN O POS AS MEN ?

IN OUR DEPT WE USE O RH POS AS THE BLOOD BANK DOESNT SUPPLY THE OTHER ONE BUT WHAT IS THE FACTS THAT WE SHOULD FOLLOW?

HOPEFULLY IAM NOT ASKING TOO MANY QUESTIONS BUT IAM NEWLY GOINED IN A&E AND I DO HAVE SO MANY QUESTIONS WAITING ANSWERS

[edmia, BSN, RN]

Recently attended a trauma conference and one speaker addressed this issue in particular. New experience, especially military resuscitation in Irak, supports 1:1 protocol and sometimes skipping LR altogether. 1:1 refers to 1 unit PRBC to 1 unit platelets during trauma protocol blood transfusions.

They're working on publishing this stuff soon, but many trauma centers are moving towards blood first or rapidly rather than just LR fluid resus in traumatic injuries.