[size=20px]A 6-year-old boy arrives in the trauma bay after a high-speed motor vehicle collisions (MVC). his pulse is 150 b/m and blood pressure 60/30. Which of the following is the most appropriate initial approach to volume resuscitation?

 

A Activate massive transfusion protocol (MTP) only after transfusion volume exceeds 20 ml/kg in 60 minutes

 

B Whole blood should be avoided

 

C crystalloid should be prioritized over Blood products​ resuscitation

 

D Viscoelastic testing should be done only if there is clinical evidence for a coagulopathy​[/size]

C

A

but ideally the Massive haemorrhage protocol should be activated before arrival to prepare this patient who is already in sever shock

currently we avoid crystaloid for the resuscitation unless we don’t have any blood or the patient is not that sick

whole blood can be given as it avoid over load in recent papers but not yet authenticated as we mostly still use the 1:1:1 formula

ideally you should use the vesicoelastic testing soon after trauma to guide the type of fluid given and avoid the coagulopathy earlier rather than treating it after it is set in

A

A

A

A

A

A

C

C

A

correct answer

A Activate massive transfusion protocol (MTP) only after transfusion volume exceeds 20 ml/kg in 60 minutes

 

Studies have shown an increased likelihood for mechanical ventilation, more intensive care unit days and longer hospital stays in pediatric trauma patients given primarily crystalloid during the initial stages of resuscitation as opposed to blood products. Waiting until 40 ml/kg of blood has been transfused to initiate a massive transfusion protocol (MTP) would be inappropriate as a threshold of 20ml/kg in 60 minutes has been found to be the critical administration threshold in children. Whole blood administration has not been associated with increased morbidity in pediatric trauma patients and may provide a survival advantage. Viscoelastic testing during resuscitation results in reduced blood product use and less coagulopathy at 24 hours. Testing should be initiated at the onset of an MTP before there is clinical evidence for coagulopathy.