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Mon Jul 23 06:10:41 BST 2007

Karim

No written protocol as such, but mostly try and follow a almost 1:1:1 rule
For every 6 units PRBC (we don't get whole blood) we give 4 - 6 FFP and a pooled platelets (which in our blood bank is 6 pooled donors). Baseline labs may be sent pre-op in the ED, but not always since we don't do "routine labs" to CYA

We don't do labs (INR/PTT) in the OR, they take too long - empiric therapy = take about 1,5 hours to get result. We check ionised Ca on ABG, use TEG liberally in the OR (cos its there!) and then do the formal testing once the patient is in the ICU ward or back in the Resus holding area if the ICU is full (not an uncommon occurance in South Africa due to limited resources)

Regards
Tim
Dr T C Hardcastle
M.B.,Ch.B.(Stell); M.Med(Chir); FCS(SA)
Senior Surgeon / Senior Lecturer: Surgery (Trauma and ICU)
ATLS  instructor and DSTC Cape Town Course Director
Intern program Coordinator: Surgery
M.Med (Emergency Medicine) Executive Committee member
Clinical Head (Director): Diana Princess of Wales Trauma Unit
Division of Surgery (General) Room 4064
Department of Surgical Sciences
Tygerberg Hospital / University of Stellenbosch
PO Box 19063
Tygerberg 7505
Western Cape
South Africa
e-mail: tch at sun.ac.za
Cell: +27824681615
Office: +27219389281 or 4911 pager 0302

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org]On Behalf Of Karim Brohi
Sent: Sunday, July 22, 2007 11:37 PM
To: 'Trauma & Critical Care mailing list'
Subject: Massive Transfusion Protocol: What's in YOUR pack?

Dear All,

A straw poll if you don't mind on massive transfusion protocols for
traumatic haemorrhage.  Please base your answers on your current practice or
your institution's current practice, not latest research / hearsay etc:

A. If you HAVE a massive transfusion protocol in your hospital:

	1. Are you given packs of FFP according to how many units of blood
have been administered?
		(eg. 2 units of FFP after every 6 units of blood)

	2. How much FFP after how much blood?

	3. If your answer to (1) was NO, what's the make-up of your packs

B. If you have just administered 6 units of blood:

	1. Do you always give a certain amount of FFP or do you wait for
labs? Which labs?

	2. If you give FFP, how much for those 6 units would you consider
standard?

	3. What is the minimum that should be given (0 is an acceptable
answer)

C. Labs:

	1. You send a PT/PTT from the ED or Operating room.  How soon do you
get it back? (really)

	2. Do you have point of care testing for PT/PTT in the ED & OR?

	3. Do you do thromboelastometry routinely on bleeding trauma
patients in the ED and OR?

There are no right or wrong answers, as practice varies so widely.  I'm just
trying to see the breadth of responses. So as many replies as possible
please - even from the lurkers :-)

Karim

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Massive Transfusion Protocol: What's in YOUR pack?