OHSU

Trauma Transfers

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:

• 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

 

Kcentra reversal
• If INR 2-4 – 25 units/kg (not to exceed 2500 units)
• If INR 4-6 – 35 units/kg (not to exceed 3500 units)
• If INR > 6 – 50 units/kg (not to exceed 5000 units)

 

Stabilization of pelvic fractures
Pelvic Sling
• Place the sling beneath the patient at buttocks level centered over the greater trochanters
• Close and fasten the sling securely per sling instructions
Pelvic Sheet
• 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.