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Massive Transfusion Pearls
- As discussed in previous pearls, massive transfusion (MT) is defined as the transfusion of at least 10 U of packed red blood cells (PRBCs) within 24 hours.
- While the optimal ratio of PRBCs, FFP, and platelets is not known, most use a 1:1:1 ratio.
- Though scoring systems have been published to identify patients who may benefit from MT (ABC, TASH, McLaughlin), they have not been shown to be superior to clinical judgment.
- A few pearls when implementing massive transfusion for the patient with traumatic shock:
- Monitor temperature and aggressively treat hypothermia.
- Monitor fibrinogen levels and replace with cryoprecipitate if needed.
- Monitor calcium and potassium. MT can induce hypocalcemia and hyperkalemia.
References
Elmer J, et al. Massive transfusion in traumatic shock. J Emerg Med 2013; 44:829-838.