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Pharmacy & Acute Care University
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Emergency Medicine Trauma 212

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  1. Increased Intracerebral Pressure Reduction
    9 Topics
    |
    2 Quizzes
  2. Open Fracture Antibiotics
    8 Topics
    |
    2 Quizzes
  3. Spinal cord injury
    6 Topics
    |
    2 Quizzes
  4. Trauma resuscitation
    9 Topics
    |
    2 Quizzes
  5. Traumatic brain injury
    9 Topics
    |
    2 Quizzes

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  • Allison Clemens
  • April
  • ababaabhay
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Emergency Medicine Trauma 212 Trauma resuscitation Key Guidelines and Evidence
Lesson 4, Topic 7
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Key Guidelines and Evidence

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ATLS 10th Edition                                     

Administer an initial, warmed fluid bolus of isotonic fluid. The usual dose is 1 liter for adults and 20 mL/kg for pediatric patients weighing less than 40 kilograms. Absolute volumes of resuscitation fluid should be based on patient response to fluid administration, keeping in mind that this initial fluid amount includes any fluid given in the prehospital setting.

Some jurisdictions administer tranexamic acid in the prehospital setting to severely injured patients in response to recent studies that demonstrated improved survival when this drug is administered within 3 hours of injury. The first dose is usually given over 10 minutes and is administered in the field; the follow-up dose of 1 gram is given over 8 hours.

Most patients receiving blood transfusions do not need calcium supplements. When necessary, calcium administration should be guided by measurement of ionized calcium. Excessive, supplemental calcium can be harmful.

Reference:

  • American College of Surgeons. Advanced Trauma Life Support (ATLS) Student Course Manual. 10th ed. Chicago, IL: American College of Surgeons; 2018.

Key Studies

CRASH-2 Trial

The CRASH-2 trial investigated the effects of tranexamic acid (TXA) on death, vascular occlusive events, and blood transfusion in trauma patients with significant hemorrhage. It involved over 20,000 patients from 40 countries, which underscored the universal applicability of its findings across diverse healthcare settings.

The study found that TXA significantly reduced the risk of death in bleeding trauma patients when administered within 3 hours of injury, without increasing the risk of vascular occlusive events, establishing TXA as a cost-effective treatment in acute trauma care. The trial also highlighted the safety profile of TXA, noting that its benefits in reducing mortality were not offset by an increase in adverse outcomes such as heart attacks, strokes, or clots in the lungs.

CRASH-3 Trial

The CRASH-3 trial focused on the use of TXA in patients with traumatic brain injury (TBI). It demonstrated that early administration of TXA to patients with mild to moderate TBI reduced head injury-related deaths, again without a significant increase in adverse events. The findings support the use of TXA in TBI patients, particularly when administered early, highlighting its potential to save lives in a wider range of trauma scenarios