Patient with massive hemorrhage presents to the ER after A. What's not to be done?
- ATLS updates (2018): Give only 1 liter of warm isotonic crystalloids for adults (old edition recommended 1-2 liters of warm crystalloid solution) - ATLS updates (2018): In children <40kg, give 20ml/kg of warm isotonic crystalloids The initial resucitation with crystalloid fluid still begins with a 1 litre bolus of warmed isotonic fluid.Early control of external hemorrhage is pivotal to the management of the injured patient. Thromboelastography and rotational thromboelastometry are helpful when available to pinpoint the precise ocagulation deficiency." CRASH-2 Trial (ATLS updates 2018 ) - Use of tranexamic acid in hypotensive trauma patients
Massive transfusion of fluid challenge
IV crystalloid 2L, within few minutes
Early tranexamic acid recommended
Check coagulation with thromboelastography, if available
Trauma