New Jersey, Flight Programs don’t administer blood products in the prehospital setting, but do administer TXA. The administration of TXA is based on specific vital signs for blunt trauma, who do not present with an isolated head injury etc. (e.g. HR >120, BP <90). Shock Index appears to be a much better indicator for the administration of TXA in blunt trauma. After all the following article was presented in 2012 from research >5 years ago.

This article was posted by Lauren Westafer, MD Emergency Medicine Chief Resident, Northampton, Massachusetts.

Shock Index – A Better Vital Sign in Trauma

The gist:  Don’t rely on a trauma patient’s normal vital signs to assume they’re hemodynamically stable. Rather, use the shock index (HR/SBP) to predict a patient’s need for massive transfusion.

The Shock Index (SI) is Heart Rate divided by Systolic Blood Pressure (HR/SBP)

  • Heart rate and blood pressure are often poor predictors of a patient’s perfusion status.  Patients notoriously crash, even if they never really become hypotensive or tachycardic (especially in the elderly!).  In trauma patients, a better assessment of a patient’s vital signs is the SI.

Normal SI = 0.5-0.7

  • SI > 0.9 then approach the patient as though they are actively bleeding
  • SI increases more than 0.3 at any point in care (prehospital to ED), then treat this as though the patient is actively exsanguinating
  • Don’t rule out bleeding if SI is within normal limits
  • Elderly patient multiply their age by the SI (Age x SI)
The Vandromme, et al paper in the Journal of Trauma in 2011 posited that the following holds true…
  • SI > 0.9  predicts twice the risk of massive transfusion
  • SI > 1.1 predicts four times the risk of massive transfusion
  • SI > 1.3 predicts nine times the risk of massive transfusion!
So, in trauma patients who come in with normal appearing vital signs, calculate the SI (and hopefully get a lactate and base deficit) before determining the patient is stable.

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