Page 239 - 2023 SMOG Digital

calcium should be monitored and calcium should be given for ionized calcium less
than 1.2mmol/L.
• Monitor patient every 5 minutes and document any patient signs and symptoms
consistent with a transfusion reaction. These include: chills, back/chest pain, rash,
fever, hives, and/ or wheezing.
Document procedure, results, and vital signs on the SF 518.
CLINICAL PEARLS AND CONSIDERATIONS:
• Febrile Reaction- Temperature increase (1°C or 2°F) from baseline, chills, flushing,
headache and rapid pulse
• Allergic/Anaphylaxis Reaction- itching, chills, flushing, nausea/vomiting, coughing
and/or wheezing, or laryngeal edema
o Treat with Diphenhydramine 50mg IVP or IM. Have Epinephrine standing by.
• Acute Hemolytic Reaction- rapid onset of dyspnea, hypotension, hemoglobinuria, rise
in venous pressure, distended neck veins, cough and/or crackles at the bases of the
lungs. Treatment is to stop the transfusion, titrate O 2 saturations above 94%, and
increase IV fluid hydration to 100-200mL/hr to support a urine output above
100-200mL/hr.
• Circulatory Overload- onset of shortness of breath, tachycardia, hypertension, jugular
vein distention, pulmonary rates, and hypoxia. This condition may be difficult to
distinguish from a hemolytic reaction.
• If a casualty with an altered mental status due to suspected TBI has a weak or absent
peripheral pulse, resuscitate as necessary to restore and maintain a normal radial
pulse. If BP monitoring is available, maintain a target systolic BP goal of at least
110mmHg.
• Blood is very viscous, use the largest line available to infuse.
*** Blood component therapy is location specific and is not standard for all missions OCONUS
and CONUS.

239