This POTD was inspired by a CED that we recently did on a level 1 trauma in the ED. Special shout out to RN Mel Besett for answering some of my questions I had about this topic.
The trauma case went something like this...an EMS note was called, stating that a man had stabbed himself in the abdomen with a kitchen knife. He was tachycardic, BP was stable, GCS 15.
When the patient arrived, he was noted to have HR of 120-130s, BP initially 130s systolic. eFAST positive for free fluid in the RUQ. Throughout the trauma, he remained tachycardic and his BP started to trend downwards - SBP 130s...then 120s...110s...100s.
It was decided that the patient should receive a blood transfusion, but...what type of blood should we order? How emergent was this?
Let's dive into it. There's a few different types of blood transfusions we can initiate in the ED:
Regular, cross-matched blood:
- For patients who are stable enough to wait. Typically, with waiting for the T&S, requesting blood, and starting blood, this could take more than 1-2 hours.
- Requires 2 type and screens in the chart - if patient has a previous one in their chart, you can order just 1
- Blood transfusion consent on Taylor Health
Emergent blood:
- Can take 10-15minutes depending on if there is someone available to run to the blood bank and back. Otherwise, the blood bank will have to send the blood through the chute, which can also take around that amount of time
- Requires a "Emergency Blood Transfusion Request" on Taylor Health
- Also requires patient consent. If patient is unable to be consented, requires 2 attending consent.
"Cracking the fridge":
- There is a fridge in resus 51 stocked with pRBCs, platelets, and plasma
- Charge RN has code to the fridge
- The fridge also has whole blood (which is all the elements combined), but only the trauma attending can call for whole blood from the fridge
Massive transfusion protocol (MTP):
- At least 6 units of blood, comes from the blood bank
- If starting MTP, typically we start giving units of blood from the fridge, then call for MTP from the blood bank
To end the case, given the patient's BP was declining, he was taken emergently to the OR. Because the OR was ready and patient couldn't wait ~10-15 minutes for emergent blood to arrive, he received his first unit of blood from the fridge while being transported to the OR.