Pearls
- When approaching a major hemorrhage scenario, there are several considerations before even contemplating the use of blood products:
- IV access (including intraosseus lines)
- Source control (involving interventionists, including surgeons, early)
- Anti-coagulant antidotes/reversal agents
- The optimal transfusion “ratio” is not presently known, if there is one. The 1:1:1 RBC/plasma/platelet ratio has not been shown to be superior for overall survival to the 2:1:1 strategy in any patient population, including that of trauma. Recent data actually suggest that non-trauma patients, especially “medical” patients, have lower survival rates with a 1:1 RBC:plasma ratio as compared to a 2:1 or 3:1 ratio.
- Additional considerations when attempting to correct hemorrhage are: temperature, pH, and ionized calcium levels. Pay attention to these, especially when transfusing large quantities of blood products in a short period of time, and intervene accordingly!
Dr Nielsen obtained his medical degree from the Duke University School of Medicine in Durham, North Carolina. During medical school, he also earned a Masters of Science in Control of Infectious Diseases from the London School of Hygiene and Tropical Medicine. Dr Nielsen completed an Internship and Residency in Internal Medicine at the Oregon Health and Science University in Portland, Oregon, where he later went on to complete a fellowship in Critical Care Medicine. He joined the Tulane faculty as an Assistant Professor in 2009.
Dr Nielsen is a member of the Society of Critical Care Medicine, the European Society of Intensive Care, and the American Thoracic Society. His primary research interests are the effects of critical illness on red blood cell behavior and the effects of transfused red blood cells on the microcirculation of recipients. Clinical projects include developing an innovative analgesia and sedation protocol for the Tulane Medical Intensive Care Unit, and improving the teaching of invasive procedures to residents using the Tulane Simulation Center.