Page 19 - 2026 SMOG

BLOOD AND COMPONENT USE
IMMEDIATE Indications in Trauma Patients With Serious Injury
• Systolic BP <100 or weak/absent radial pulse
• Tachycardia >100
• Amputation(s), penetrating chest/abdomen injury, truncal/junctional injury
Clinical Indications
• Significant trauma
• Evidence of hemorrhagic shock
• Altered mental status in the absence of brain injury
• Severe hypothermia associated with blood loss
• Clinical signs of coagulopathy (tachycardia, tachypnea, fever, altered mentation, hypoxemia)
• Positive FAST exam (especially if two or more regions are positive)
• Lactate >4mmol/L, base deficit >6mEq/L (base excess <–6mEq/L), pH <7.25, INR ≥1.5
Treatment
• Maximize hemorrhage control, treatment of suspected tension pneumothorax, patent airway or
airway control, IV/IO access, hypothermia prevented and/or treated
• Blood Product Order of Precedence
˚ Whole Blood
˚ Plasma, RBCs, Platelets in a 1:1:1 Ratio (no particular order)
˚ Plasma and RBCs in a 1:1 Ratio
Plasma (thawed, liquid, reconstituted) alone or RBCs alone
˚
• Document all items on the SF 518 (the only authorized document for blood products aboard
Army aeromedical evacuation platforms)
˚ Two-person verification of patient and blood products given matching SF 518
• Examine units of blood (look for gas, discoloration, clots, and sediment) and verify that the
Safe-T-Vue is white
• Initiate large-bore IV (18Gmin, 14G preferred) or IO access (Lidocaine 2% (2–3mL) flush in
IO site provides analgesia and increases compliance)
• Blood and blood products must be administered through a Y-tubing with a filter, flushed with
NS prior to use
• Transfuse blood through an approved fluid warming device if available
˚ Achieve rapid transfusion via pressure bag up to 300mmHg; use a 60mL syringe or manual
pressure in the event a pressure infuser is not available
• Consider slowing all other concurrent infusions unless they are TXA or RFVIIa
• Resuscitation Goal: until palpable radial pulse, improved mental status, or SBP >100
(>110 with head injury) and MAP >60mmHg
• 30mL of 10% Calcium Gluconate or 10mL of 10% Calcium Chloride IV/IO should be given to
patients in hemorrhagic shock during or immediately after transfusion of the first unit of blood
product and with ongoing resuscitation after every 4 units of blood product. Monitor ionized
calcium, and administer calcium if ionized calcium levels are less than 1mmol/L
• Monitor the patient q5min and document any patient signs and symptoms consistent with
transfusion reaction (monitor core temperature)
˚ If a transfusion reaction occurs, see the TRANSFUSION REACTION PROTOCOL.
Reference: CPG ID #18 (Damage Control Resuscitation), CPG ID #26 (Frozen and Deglycerolized Red Blood
Cells), CPG ID #73 (Damage Control Resuscitation – Prolonged Field Care), CPG ID #82 (Prehospital Blood
Transfusion)

2026 Standard Medical Operating Guidelines (SMOG) • 11