State the primary finding from the PATCH-Trauma study (Prehospital Tranexamic Acid for Severe Trauma)
TXA reduced 24-hour mortality from bleeding but did NOT improve overall survival at 6 months.
List two (2) potential benefits of thromboelastography-guided product replacement over a fixed ratio blood transfusion.
- improved survival: through reduced bleeding rate, reduced length of stay and reduced mortality.
- reduced blood product usage: reduced risk of complications and faster identification of specific deficits (fibrinogen) improves targeted correction
in acute trauma List four (4) physiological and/or laboratory parameters that you would target in the ED to
reduce bleeding
- permissive hypotension: MAP >65mmHg, SBP <90 mmHg (until haemorrhage control)
- core temperature >35C: prevent hypothermia-induced coagulopathy)
- pH >7.2, base excess <6
- platelets >50 x10(power9)/L
- fibrinogen >1g/L
- lactate <4
List five (5) potential complications of massive red cell transfusion.
- volume overload (TACO-transfusion asssocated circulatory overload)
- dilutional coagulopathy
- hyperkalaemia (from stored RBCs)
- hypocalcaemia (citrate binding)
- ABO incompatibility, blood borne infections
- TRALI: transfusion related acute lung injury
- metabolic acidosis
list 2 main mechanisms of TRALI in trauma (transfusion related acute lung injury)
- immune-mediated: donor blood contains antibodies that react with recipient’s WBC triggering inflammatory response.
non-immune-mediated: bioactive substances can prime neutrophils in the recipient.
in trauma what is the management of TRALI?
- supportive management: stop transfusion, provide oxygen or mechanical ventilation and monitoring in ICU
in trauma what features might you see in TRALI?
SOB, low oxygen saturation, fever, hypotension, with chest imaging showing bilateral infiltrates.
A fascia iliaca regional anaesthetic block to manage a NOF fracture.
List three (3) potential acute complications of this procedure.
- Local anaesthetic toxicity (intravascular) (e.g., seizures, arrhythmias)
- failure of procedure/inadequate analgesia
- Nerve injury (e.g., femoral nerve damage)
- vascular injury/bleeding femoral vein/artery
A fascia iliaca regional anaesthetic block to manage a NOF fracture. list the drug used, dose and volume to be delivered
- long acting bupivacaine
- (0.5%) 2-2.5mg/kg
- large volume (30ml+)
discuss treatment for lignocaine toxicity
- stop injection, activate resus team
- secure airway if compromised, oxygenate/ventilate (avoid hypoxia/acidosis which worsens condition
- seizure control with benzos (midazolam 2-5mg iv)
- lipid emulsion therapy (20% intralipid): bolus 1.5mL/kg iv over 1 min and infusion 0.25mL/kg/min for 30-60 mins.
- cardiovascular support: bradycardia/hypotension (atropine), fluids, adrenaline, continue lipid emulsion during resuscitation.
List four (4) patient factors that affect healing in elderly patients.
- co-morbidities (DM, PVD)
- impaired immune response
- reduced skin elasticity and collagen production
- poor nutritional status (protein def)
List four (4) situations where delayed wound primary closure is preferred
- delayed presentation >24-48 hours
- contaminated/infected wounds
- bite injuries-human or animal
- special groups (advanced age, DM, chronic steroid usage)
