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ANESTHESIA and ANALGESIA. Vol.108, No.6, June 2009 P1760- 1768.

Transfusion Management of Trauma Patients. Beth H. Shaz, Christopher J. Dente, Robert S. Harris, Jana B. MacLeod, Christopher D. Hillyer. ANESTHESIA and ANALGESIA. Vol.108, No.6, June 2009 P1760- 1768. Early Trauma related Mortality. Head Injury 40 - 50% deaths.

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ANESTHESIA and ANALGESIA. Vol.108, No.6, June 2009 P1760- 1768.

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  1. Transfusion Management of Trauma Patients.Beth H. Shaz, Christopher J. Dente, Robert S. Harris, Jana B. MacLeod, Christopher D. Hillyer. ANESTHESIA and ANALGESIA. Vol.108, No.6, June 2009 P1760- 1768.

  2. Early Trauma related Mortality. • Head Injury 40 - 50% deaths. • Haemorrhage 20 - 40% deaths.

  3. Recognised treatment strategies for traumatic major haemorrhage. • PALS/APLS. • ATLS. • ‘Component approach’. • Hypotensive resuscitation.

  4. Traditional perceived causes of coagulopathy. • Dilution secondary to fluid resuscitation developing over hours. • Hypothermia. • Acidosis. • Consumption.

  5. Early trauma-induced coagulopathy. • Occurs in 25% of trauma victims. • INR>1.5 • Independent predictor of mortality with associated 35% increase in likelihood of dying .

  6. Massive Transfusion Protocols based on experience from Military Hospitals. • Early administration of blood products. • Predetermined blood product ratios of ideally 1:1:1 PRBCs, FFP, platelets or even whole blood. • AVOID HYPOTHERMIA,ACIDOSIS AND COAGULOPATHY.

  7. Mortality related to plasma:RBC ratio.

  8. Risks of transfusion. • Hypothermia. • Hyperkalaemia. • Acidosis. • Hypocalcaemia. • TRALI. • MOF. • Infection.

  9. Major Transfusion Protocols for Children. • Major haemorrhage in children is a rare event. • Are children more susceptible to the hazard of Massive Transfusion? • The mortality rate in children of 8yrs. or less is 18% v 4% for older children and adults! (Iraq 2003-2008 NEJM April 16, 2009).

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