Page 111 - ATP-P 11th Ed

container must be rejected. Administer intravenously using sterile, filter-
type administration set.”
®
(e) If mannitol 20% (Osmitrol ) is unavailable or does not produce di-
®
uresis, administer furosemide (Lasix ) 40–80mg initially and titrate later SECTION 1
doses to maintain urine output of 100–200mL/hr.
(f) However, if urine output is not obtained within 2–3hr of administration
of fluid, consider the development of acute renal failure and discontinue
further fluids.
®
(g) Consider using acetaminophen (Tylenol ) 1g PO, PR, or IV q6hr to
treat discomfort associated with fevers. (Avoid the use of aspirin or other
NSAIDs).
®
(h) Administer 25–50mg of diphenhydramine Benadryl ) IM or IV to
treat the associated histamine release from AHTR and help manage the
chills and rigor.
Antihistamine (IV administration) must never be mixed with blood or
blood products in the same transfusion lines.
iii. SAVE the rest of the donor blood and any typing information available and
evacuate with the patient. This will allow for ABO and further diagnostic test-
ing at the medical treatment facility.
c. Febrile Nonhemolytic Reactions
i. Treat with antipyretics. Acetaminophen (Tylenol ) 1g PO, PR, or IV (avoid
®
the use of aspirin and other NSAIDs). For ease of administration, consider the
use of rapid release acetaminophen through a nasogastric (NG) tube. Rapid
release acetaminophen can be dissolved
in water within 5 minutes and then deliv-
ered through the NG tube.
ii. If symptoms abate and there is no evi-
dence of an acute hemolytic reaction,
consider restarting the transfusion.
iii. Pretreatment with antipyretics and anti-
histamines is not recommended in this Acetaminophen rapid release
protocol. Although it is commonly done (Retrieved from
there is no evidence that is decreases the http://www.drugs.com/imprints/l-5-10933.html)
incidence of fever and urticaria associated with transfusions. It could also mask
the symptoms of a hemolytic reaction. 28-35
d. Urticarial Reactions
®
i. Treat with 25–50mg diphenhydramine (Benadryl ) IM or PO.
ii. If symptoms abate and there is no evidence of an acute hemolytic reaction con-
sider restarting the transfusion.

100 SECTION 1 TACTICAL TRAUMA PROTOCOLS (TTPs) ATP-P Handbook 11th Edition 101