Question

Steps of massive transfusion protocol (MTP) utilized in adult poly-trauma victims in ER/ICU.

Hint:

The 1:1:1 ratio for blood product replacement (PRBC: plasma: platelets) is essential in MTP to manage trauma patients effectively.

Answer 1

Step 1: Understanding Massive Transfusion Protocol (MTP).
Massive Transfusion Protocol (MTP) is implemented when a trauma patient requires large volumes of blood products to restore circulatory volume and oxygen-carrying capacity. The goal of MTP is to replace lost blood and clotting factors rapidly while maintaining blood pressure and tissue perfusion.

Step 2: Key steps of MTP.
1. Activation: MTP is triggered by clinical signs of severe hemorrhage (e.g., massive blood loss, shock). A protocol is activated, and the hospital blood bank is notified.
2. Initial blood products administration: The patient receives an initial bolus of packed red blood cells (PRBC), plasma, and platelets, following a 1:1:1 ratio (PRBC: plasma: platelets). This ratio is commonly used to prevent coagulopathy and replenish blood volume.
3. Monitoring and reassessment: Continuous monitoring of vital signs, laboratory values (e.g., hemoglobin, lactate, coagulation parameters), and clinical status is done to adjust blood product administration.
4. Ongoing blood product support: Additional blood products are administered as needed to maintain adequate oxygenation and circulation. This includes further PRBC, plasma, platelets, and clotting factor concentrates.

Step 3: Conclusion.
The MTP ensures rapid and appropriate blood product replacement in trauma patients, especially those in hemorrhagic shock. The goal is to restore normal hemostasis and prevent complications from massive blood loss.