[size=20px]A 6 year-old boy presents to the Emergency Department unconscious and hypotensive following a motor vehicle collision. The patient receives a 20 ml/kg bolus of normal saline but remains hypotensive. What is the next best step?

 

A Administer 10 ml/kg of O-negative packed red blood cells

 

B Administer another 20 ml/kg bolus of normal saline

 

C Start a dopamine infusion at 10 mcg/kg/min​

 

D Administer 10ml/kg of platelets

 

E Administer 250ml of 5% albumin[/size]

B

correct answer

A Administer 10 ml/kg of O-negative packed red blood cells

 

In this scenario, the patient remains hypotensive after initial attempts at fluid resuscitation. Based on previous guidelines, the correct answer would be to administer another 20 ml/kg bolus of normal saline. However, recent studies have shown an increase in hospital stay and need for ventilation after multiple crystalloid boluses. Newer guidelines state that the patient should receive an early transfusion of pRBC, which should be O-negative or type-matched if that information is available.