Massive Hemorrhage

A 25-year old tricycle driver without co-morbidities presents in the operating room after a traumatic amputation below his right knee. Upon hooking to the cardiac monitor vitals were noted to be: BP 120/70, HR 100, RR 19, Temp 36.5C, O2sat at room air 97%. Norepinephrine was note to be hooked to patient. A torniquet is also observed to be applied to the right thigh. Unfortunately, there is ongoing blood loss, which is estimated to be 1,500ml. Patient is for control of bleeders. What urgency code is the patient currently in?

• IV

• III

• II

• I

In correlation with situation in question #1 . What type of pRBCs are you permitted to transfuse?

• Cross-matched identical

• Uncross-matched identical

• Uncross-matched compatible, non-identifical

• All of the choices

During the surgery in the situation in question #1, bleeding was noted to be controlled. A point of care testing revealed values of Hgb: <6g/dl, PT-INR: <1.5 and Platelet count of >50,000/mm3. How should you go about the situation?

• Transfuse 1:1:1 ratio of blood components then do repeat testing

• Transfuse 1-2 units of pRBC then do repeat testing

• Transfuse 6 units of WB-derived platelets and 2 units of FFP then do repeat testing

• Transfuse 1-2 units of pRBC, 2 units of FFP and 1 apheresis unit of platelets then do repeat testing

When should platelets be transfused during massive hemorrhage?

• When platelet count <100,000/mm3

• When blood loss exceeds x 1.5 blood volume

• When PT-INR > 2.0

• In a 1:1:1 ratio with plasma and RBC

As the surgery went on with bleeding noted to be controlled at this point. a Point of care platelet count testing result indicated a count of 48,000/mm3. If you are going to transfuse platelet concentrates, what should your target values be?

• >75,000/mm3

• >100,000/mm3

• 150,000/mm3

• >150,000/mm3

How much platelet concentrate should you transfuse with regards to the result obtained in question #5?

• 4 units of WB-derived platelets

• 8 units of WB-derived platelets

• 1 apheresis unit

• 2 apheresis unit

During the surgical event, you are noted to have transfused multiple number of packed RBCs. A point of care testing revealed: aPTT>1.5x the controlled value. How much FFP should you transfuse to the patient?

• 1-5 units

• 1-4 units

• 2-8 units

• 4-10 units

How is massive hemorrhage defined in the context of blood loss?

• Exceeding circulating blood volume within a 48-hour period

• 50% of circulating blood volume loss within a 3-hour period

• Blood loss exceeding 100ml/minute

• Blood loss necessitating massive plasma and platelet transfusion (>/= 3 units of WB or RBC in 24 hours)

What is the recommended threshold for hemoglobin levels in healthy individuals acoording to the ASA?

• 4g/dl

• 6g/dl

• 8g/dl

• 10g/dl

In the context of hypothermia during massive transfusion, what is a potential consequence of rapid transfusion of miultiple units of chilled blood?

• Acidosis

• Decreased clotting factors concentrations

• Prevention of platelet activation

• Reduces concentrations of generated thrombin