Massive transfusion and coagulopathy

^{[3] [17] [5] [4] [6] [13] [2] [12]}

Meet the patient

A 28-year-old motorcyclist arrives in the trauma bay: BP 76/40, HR 128, distended abdomen, FAST positive. He is cold at 35.2C, his pH is 7.18, his INR is 1.8. Forty-five minutes since injury. The three things that will save him are already decided: tranexamic acid now (1 g over 10 min then 1 g over 8 h, within 3 h of injury), blood in balanced ratios between 1:1:1 and 1:1:2, and early definitive haemorrhage control.^[4][6][1][3]

The lethal triad is already established — hypothermia, acidosis, coagulopathy — and it carries a high mortality rate. The window is the first hour: warm toward normothermia (core 36-37C), give TXA within 3 hours (protocols should consider the first dose en route, without awaiting viscoelastic results), transfuse in balanced ratios, and get to damage control surgery in deep haemorrhagic shock with ongoing bleeding and coagulopathy. Everything else is a refinement.^[3][13][17]

References17ShowHide

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