Page 110 - ATP-P 11th Ed

(j) Seizures
(k) Bradycardia
SECTION 1 g. Mild Toxicity – Slow or stop transfusion until symptoms subside. Ensure proper
iii. Treatment
mixture and concentration of citrate
h. Severe Toxicity – Give 0.45mEq elemental calcium or approximately 1mL of a
10% calcium gluconate (100mg/mL) for each 100mL citrated blood infused. Infuse
over 10–20min for each 1–2g of calcium gluconate. Diluted prior to administration
(D5W or NS 100–250mL).
Note: 10% calcium gluconate solution (100mg/mL): 1mL = 0.46 mEq elemental Ca = 9mg
elemental Ca
i. Can be repeated every 4–6hr depending on symptoms.
Use a 0.22 micron filter for administration.
Do not rapidly infuse calcium or give more than one dose without the ability to
monitor electrolytes. This may lead to cardiac arrhythmias and could cause necrosis
of the vein.
5. Treatment of Immunologic Blood Transfusions Reactions.
The first step in treating ALL transfusion related issues is to STOP the transfusion
and save all of the blood products and equipment used for administration and typing for
follow-up testing.
a. Anaphylactic Reactions
i. Epinephrine 0.5mL of 1:1000 IM
ii. Airway maintenance and oxygenation
iii. Resuscitate hypotensive patients with IV fluids.
b. Acute Hemolytic Transfusion Reaction (AHTR)
i. Immediately STOP the transfusion
ii. Initial Treatment
(a) Secure and maintain airway
(b) Begin an IV infusion of lactated Ringer’s (LR).
DO NOT run any fluid through the line that was carrying blood.
(c) The goal of fluid resuscitation is to maintain a urine output of 100–200mL/
hr until the urine is clear of hemolyzed RBCs.
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(d) Administer mannitol 20% (Osmitrol ) 20g IV over 5min using a 0.22
micron filter to prevent infusion of mannitol crystals. If diuresis does not
occur, repeat the 20g dose once. The patient should receive a Foley catheter
to monitor urine output.
If crystals are observed, the container should be warmed by appropriate
means to not greater than 60° C, shaken, then cooled to body temperature
before administering. If all crystals cannot be completely redissolved, the
100 SECTION 1 TACTICAL TRAUMA PROTOCOLS (TTPs) ATP-P Handbook 11th Edition 101