Trauma Transfer Protocols
Warfarin reversal for intracranial hemorrhage
These steps are to be completed while waiting for transport, do not let them delay transfer
FFP reversal: ( If prothrombin concentrate and rFVIIa not immediately available)
·Transfuse 2 units AB FFP immediately
·Transfuse additional 2 units type-specific FFP
·10mg Vitamin K IVPB
Profilnine/Factor VIIa reversal
·Profilnine® 4000 units
(50 units/kg for patients under 80 kg)
·1 mg of rfVIIa
·10 mg vitamin K slow IV infusion
· INR check after infusions
If still > 1.5 repeat with 2000 units Profilnine dosing
Stabilization of pelvic fractures
·Place the sling beneath the patient at buttocks level centered over the greater trochanters
·Close and fasten the sling securely per sling instructions
·Fold sheet smoothly and place under patient's pelvis so it is centered over the greater trochanters
·Wrap and twist the two running ends of the sheet around the patient's pelvis.
·Once tightened, cross the running ends and tie or clamp them to maintain tension.
Suspected Aortic Injury Protocol
·Strongly consider critical care transport by the fastest mode available.
·If unable to perform the following steps, take measures to keep patient calm with sedation and pain control until specialty transport arrives.
·Consider intubation with deep sedation and neuromuscular blockade to minimize catecholamine release during transport. Intubation should be performed using only rapid sequence intubation protocols.
·Initiate esmolol drip to lower double product. The goals are a HR <80 and SBP between 90 and 110.
a. Initial load: 500 mcg/kg/min over 1 min.
b. Maintenance drip: 50mcg/kg/min.
c. If unable to reach desired HR and SBP goals after 4 min then rebolus with 500 mcg/kg/min over1 min and increase maintenance drip rate to100 mcg/kg/min.
d. If still unable to reach desired goals: may rebolus with 500 mg/kg/min and increase drip to 150mcg/kg/min.
·If unable to reach goals: may titrate without a rebolus to300 mcg/kg/min.
·If patient becomes hypotensive or HR < 50 then stop esmolol drip.
·If maximum dose of esmolol reached and patient still has SBP >120 or if patient's HR< 60, and SBP still > 120, then initiate nitroprusside to manage BP.
a. Initial dose 0.5mcg/kg/min.
b. Titrate every 3-5minutes to target BP or max dose of 10 mcg/kg/min.
c. Stop drip immediately if patient becomes hypotensive.
Traumatic brain injury
For patients with GCS <9, age 15 or older with traumatic brain injury
·Arrange transport by fastest mode available
·Institute supportive measures
·Elevate HOB > 30 degrees (unless contraindicated)
·Appropriate sedation/ analgesia
·Ventilation -Goal end tidal CO2 35-40
·If SBP ≥ 100 mmHg, bolus 0.5 g/kg Mannitol (if available) and reassess.This applies to patients with suspected intracranial hypertension ie. blown pupil
·If SBP < 100 bolus with 250cc 3% hypertonic saline (if available) and repeat if needed.