As discussed in previous pearls, massive transfusion (MT) is defined as the transfusion of at least 10 U of packed red blood cells (PRBCs) within 24 hours.
While the optimal ratio of PRBCs, FFP, and platelets is not known, most use a 1:1:1 ratio.
Though scoring systems have been published to identify patients who may benefit from MT (ABC, TASH, McLaughlin), they have not been shown to be superior to clinical judgment.
A few pearls when implementing massive transfusion for the patient with traumatic shock:
Monitor temperature and aggressively treat hypothermia.
Monitor fibrinogen levels and replace with cryoprecipitate if needed.
Monitor calcium and potassium. MT can induce hypocalcemia and hyperkalemia.
References
Elmer J, et al. Massive transfusion in traumatic shock. J Emerg Med 2013; 44:829-838.
