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The Use Of Blood Products In The Critically Ill Patient: Indications And Risks
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Publication Date

January/February 2014 (Volume 4, Number 1)

CME

This issue includes 3 AMA PRA Category 1 CreditsTM and 3 AOA Category 2A or 2B CME credits.

Authors

Kevin Scott, MD
Department of Emergency Medicine, University of Pennsylvania Health System, Philadelphia, PA

Colin Greineder, MD, PhD
Instructor, Department of Emergency Medicine, Post-doctoral Research Fellow, Institute of Translational Medicine and Therapeutics, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, PA

Lauren Weinberger Conlon, MD
Associate Residency Director, Department of Emergency Medicine, Assistant Professor, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, PA

Peer Reviewers

Ryan Knight, MD
Faculty, Womack Army Medical Center, Emergency Medicine, Ft. Bragg, NC

Chris Palmer, MD
Critical Care Medicine Fellow, Barnes Jewish Hospital, St. Louis, MO

Abstract

It is imperative that emergency physicians have a basic understanding of blood products and the indications and risks associated with their use. Evidence-based, restricted use of blood components in critically ill patients can lead to decreased mortality while avoiding unnecessary morbidity and complications. Recognition of the need for irradiated or leukoreduced components in special populations further reduces adverse events. This issue reviews the preparation of blood components and indications for their use, infusion of products, and the determination of stability after infusion. Infectious and immunologic risks associated with transfusion are reviewed, with special attention given to pulmonary complications, as well as guidelines for comprehensive informed consent. Massive transfusion protocols and the use of oxygen-carrying substitutes are also discussed.
 
Excerpt From This Issue

No sooner have you hung up your coat in the ED than an announcement comes on: “Attention ED staff, medic 19 is en route with a trauma. A 78-year-old male, victim of a MVC…vital signs unstable…” Your team quickly gathers to receive a report from EMS:

“Mr. Smith is a 78-year-old male who was the restrained front-seat driver involved in a roll-over motor vehicle crash. The vehicle slid on ice and collided with the median. We noted significant damage to the vehicle with intrusion of 14 inches into the compartment. The patient was extricated from the car and immediately placed on a backboard with cervical-spine immobilization. Vital signs en route were notable for a heart rate of 110 and a systolic blood pressure of 100.”

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