Page 238 - 2023 SMOG Digital

ORDER OF PRECEDENCE:
• Resuscitate with 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
PROCEDURE:
• Document all items on the SF 518 (only authorized document for blood products
aboard Army Aeromedical Evacuation platforms).
o Two person verification of patient and blood products given matching SF 518.
• Observe units of blood
o Look for gas, discoloration, clots, and sediment
o Safe-T-Vue must remain white on color indicator. Red coloration indicates
that temperature has been exceeded and is no longer acceptable for use.
• Initiate large bore IV (18ga minimun, 14ga preferred) or IO access.
o IO access via sternum or humerus is preferred. Tibia site can be utilized as
alternate, but attempt should be made to gain another access point.
o Lidocaine 2% (2-3mL) flush in IO sites provides analgesia and increases
compliance.
• All blood and blood products will be administered through a dedicated line of NS
using Y-tubing with filter.
• Transfuse blood through an approved fluid warming device if available.
• Rapid transfusion can be achieved by using an approved pressure infusion device.
o Inflate pressure bag to at least 300mmHg
o 60cc syringe or manual pressure can also be utilized in the event a pressure
infuser is not available.
• Slow all other concurrent infusions unless they are TXA or RFVIIa.
• Resuscitation Goal:
o until palpable radial pulse, improved mental status or SBP 100 (SBP >110 w/
head injury) and MAP >60mmHg.
• Addition of Calcium when administering any amount blood will be given. Citrate
binding can adversely affect serum Calcium levels. 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 products. Ideally, ionized

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