Anaes Vivas · Trauma and massive haemorrhage
Trauma and massive haemorrhage — Viva
Viva on CRASH-2/CRASH-3 TXA, PROPPR ratios with NS mortality, Brohi mechanism, guideline scope.
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Prompt
Trauma and massive haemorrhage
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Viva Stems
- CRASH-2: how many patients, hospitals, countries, what regimen, what two mortality pairs with RRs? Was enrolment within 3 or 8 hours? [1]
- Where does the "within 3 hours" rule actually come from? (Taught: time-to-treatment analysis, not enrolment.)
- PROPPR: 680 of whom, what arms, what were the 24-hour, 30-day, exsanguination, and haemostasis numbers — and was mortality significant? [2]
- Brohi: 208 of whom, drawn when, what did hypoperfusion track with? [5]
- What does Spahn's 5th edition own — and what pack timings does its abstract not pin? [3]
- CRASH-3: how many randomised, how many within 3 h, overall versus mild-to-moderate versus severe results? [6]
- Head-injured hypotensive bleeder — why is permissive hypotension wrong here? (Taught.)
- Eight units in, hypotensive with long QT — what electrolyte, why, and what do you monitor? (Taught: ionised calcium.)
References5ShowHide
- [1]Shakur H, Roberts I, Bautista R, et al. Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial Lancet, 2010.PMID 20554319
- [2]Holcomb JB, Tilley BC, Baraniuk S, et al. Transfusion of plasma, platelets, and red blood cells in a 1:1:1 vs a 1:1:2 ratio and mortality in patients with severe trauma: the PROPPR randomized clinical trial JAMA, 2015.PMID 25647203
- [3]Spahn DR, Bouillon B, Cerny V, et al. The European guideline on management of major bleeding and coagulopathy following trauma: fifth edition Crit Care, 2019.PMID 30917843
- [5]Brohi K, Cohen MJ, Ganter MT, et al. Acute traumatic coagulopathy: initiated by hypoperfusion: modulated through the protein C pathway? Ann Surg, 2007.PMID 17457176
- [6]CRASH-3 trial collaborators. Effects of tranexamic acid on death, disability, vascular occlusive events and other morbidities in patients with acute traumatic brain injury (CRASH-3): a randomised, placebo-controlled trial Lancet, 2019.PMID 31623894