Pediatric emergency medicine trisk 3181 3181

(PT/INR, PTT, platelets) Some centers are now trialing the use of cold-stored whole blood for the resuscitation of bleeding children Controversy remains regarding the role of tranexamic acid (TXA), an antifibrinolytic agent, as an adjunct for the treatment of hemorrhagic shock In bleeding adults, administration of TXA within hours after injury was associated with a survival advantage There is minimal data available in children, but it seems reasonable to treat hemodynamically unstable victims of penetrating trauma with TXA, as well as those with laboratory evidence of fibrinolysis (on viscoelastic testing) Large-bore intravenous catheters are preferable, whether in the upper or lower extremities, to allow rapid infusion of large volumes of fluid during resuscitation Ideally, the blood should be given through a warming device, to avoid significant hypothermia from refrigerated blood products Accessing the femoral vein is acceptable and in fact is a preferred site in children in the rare instances when central access is needed