Top Tweets for #tgded
…and it makes sense doesn’t it? If your problem is hyperfibrinolysis, then an anti-fibrinolytic like TXA makes complete and utter sense.
If your patient is even remotely bleedy then use it. #TGDed
Another reminder about tranexamic acid (TXA).
There is now a lot of evidence - not just in trauma - that TXA works, and reduces bleeding.
It’s cheap, easy to give, and easily forgotten because it’s not glamorous. Don’t worry, it doesn’t increase thrombosis. #TGDed
30% of our severe trauma patients arrive in hospital with a coagulopathy. Mainly hyperfibrinolysis.
This is why we resuscitate not only with packed red cells, but with plasma and platelets too.
PROMMTT trial showed early adoption of this strategy saves lives. #TGDed
Damage control surgery is doing the minimum needed to stop bleeding and make the patient safe.
This gives us time to correct coagulopathy, hypothermia and acidosis. #TGDed
Good morning Twitter, a bit of trauma education for a Saturday morning at @IcsmTrauma’s student conference.
As Una Walsh tells us about damage control surgery.
The communication between the anaesthetic team and surgical team here is vital! #TGDed
Transfusion is not without risk, so use it sensibly and sparingly. Viruses, allergic reactions, antibodies. And with the current blood shortage think really carefully whether your patient needs it. #TGDed
Remember your alternatives to transfusion. Intravenous iron will work within a couple of days, and the newer preparations are much less likely to cause adverse reactions. #TGDed
All the evidence for transfusion suggests that as long as you don’t have acute cardiac disease, you’ll be fine transfusing to a haemoglobin of around 70-80g/l.
If you end up with an Hb of 120 you’ve given too much. #TGDed
While we’re on squeezing blood in, it’s very easy to over-transfuse. Give a small bolus fast, see its effect, and stop as soon as the BP (or radial pulse) is up.
Then when your surgeon has controlled the bleeding you can transfuse up nicely in leisure. #TGDed.
When resuscitating someone who’s bleeding, it’s very tempting to squeeze a load of cold blood in. Use a warmer whenever you can. It’s so easy to develop hypothermia, which disrupts your coagulation and makes you bleed more. #TGDed
If your patient is even looking just a little bit bleedy, think about giving them Tranexamic acid. It’s cheap, there’s a lot of evidence of its effectiveness, and don’t worry, it doesn’t make you more likely to get thromboembolism.
1g IV. You won’t regret it. #TGDed
Haemoglobin is a very late indicator of bleeding:
If you have five litres of blood in your body, and deposit two of those litres on the kitchen floor, then the haemoglobin of the remaining three litres is still the same.
It takes hours for the Hb to drop. #TGDed
The national shortage of blood made me think about what we can do to conserve supplies, so I thought I’d revive an old tradition and do a few #TGDed tips on good management of bleeding. (Feel free to add your own tips below too.
https://t.co/Iqx7trG3Ea
Something that happened today (not GI related) made me think about local anaesthesia, and how to make procedures (such as epidurals/spinals/LPs), but also bone marrows etcetc) non-painful, so I thought I’d share some top tips: 🧵
(#TGDed for old times’ sake)
Something that happened today (not GI related) made me think about local anaesthesia, and how to make procedures (such as epidurals/spinals/LPs), but also bone marrows etcetc) non-painful, so I thought I’d share some top tips: 🧵
(#TGDed for old times’ sake)
@medicluke @chandna_hum I think I did a #tgded hashtag on it, so if you search for that and cannulation or something like that you should get it.
Cricoid pressure I find just gets in the way, and in any case you’re supposed to let it go if any regurgitation occurs. Especially in emergency situations and trauma it simply makes airway management harder. #rapidsequence #TGDed
The colleague currently sitting next to me thinks the person who described the head-up ramped position should be given the Nobel prize.
Airway management is *so* much easier with your patient head-up. #rapidsequence #TGDed
I think the biggest risk for aspiration is bowel obstruction. High luminal pressure, high gastric and gut volume.
Get a nasogastric down, drain and decompress before induction. #rapidsequence #TGDed
When someone says there is “no evidence” for something it can mean two things:
- the trials have been done and the results show no difference (but some of these trials could be rubbish and underpowered)
- no one has done a trial, or trials are too difficult
#TGDed
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