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Tranexamic Acid update

red_blood_cellsSince the CRASH2 trial was published in 2010, there has been a huge amount of work to ascertain how best to deliver tranexamic acid practically, particularly in the prehospital environment.

The benefits of tranexamic acid almost seemed too good to be true.  It’s cheap, easy to carry, has been used for decades within hospital and GP settings – and seems to offer absolute benefits in promoting haemostasis, with no side effects.  It also fits very well into the ‘damage limitation’ approach that has changed much of prehospital trauma care over the last few years.  In addition, military experience, particularly from Afghanistan, has accelerated the availability of high quality practical data on its use in challenging environments.

Now, there is some solid and pragmatic advice on the administration of tranexamic acid, including a Cochrane review which has been published in December last year:

>> Blood-clot promoting drugs for acute traumatic injury

It appears that it is now at a point that many practitioners can and should be considering its use.  Especially for areas where transfer to a surgical or major trauma unit is likely to be delayed – such as rural and remote areas of Scotland – it could offer vital life-saving benefits of reduced blood loss and extended survival times in the context of major trauma.

Administration is relatively straightforward.  Where there is evidence of a ‘positive primary survey’ – i.e. where pulse, blood pressure/capillary refill time or respiration rate are impaired due to suspected haemorrhage, resulting from trauma in the last 3 hours, the following treatment is suggested:

  • Inject two 500mg vials (1g) of tranexamic acid into a 100mL bag of normal saline.  Give this IV over 10-20 minutes (loading dose).
  • Inject two 500mg vials (1g) of tranexamic acid into a 500mL bag of normal saline.  Give this IV over 8 hours (maintenance dose).

Commonly, where transfer to hospital or extrication takes less than 30 minutes, the maintenance dose can be more safely given once the patient is in a facility that can provide an IV pump to give this over a more exact time.

httpv://www.youtube.com/watch?v=7oekncvAXGs

 

Crash 3 Trial

The investigators are now busy conducting the Crash 3 trial which will look at the effects of tranexamic acid specifically on traumatic brain injury.  They’ve produced a video explaining the new trial procedure – which also highlights some of the key points of using tranexamic acid above.

httpv://www.youtube.com/watch?v=7jdjSAiiCmc

 

 

 

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Helicopter Safety

Courtesy of defenceimages.mod.uk.

For anyone who is likely to come across a search and rescue helicopter, this comprehensive guide may be of interest.  Just published by Duncan Tripp, winchman/paramedic with RAF Lossiemouth, it offers advice and information about many relevant aspects of helicopter search and rescue – from BASICS Responders who may require casualty evacuation, to mountain rescue teams needing search assistance.

The 31 page document describes considerations for approaching helicopters (which of course is generally don’t, until the pilot indicates that it is safe), emergency ditching procedures and functions of the search tools on board.  There is also a guide on winching people, dogs and stretchers, and the command/control structure that develops for aircraft during a major incident.

You can download the document (PDF, 9.5MB) from the link below.

Click to download the guide (PDF).

 

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