Podcasts about tranexamic

Join us on the Anesthesia Patient Safety Podcast as we confront a critical patient safety issue: the recurring wrong drug, wrong route errors involving Tranexamic acid (TXA) and Bupivacaine. Elizabeth Rebello, an anesthesiologist at the University of Texas MD Anderson Cancer Center, sheds light on this alarming trend where lookalike vials lead to catastrophic outcomes, including paralysis and death. Learn why this issue demands urgent action and the steps that are essential for anesthesia professionals to prevent such devastating mistakes.We'll uncover real-world incidents and delve into the underlying challenges faced by anesthesia teams, from lack of standardization to high-pressure environments. Hear about the staggering 50% mortality rate associated with this error and revisit our previous coverage on a National Alert Network warning about similar TXA administration errors. This episode is a must-listen for those dedicated to advancing perioperative patient safety and mitigating the risks of medication administration errors in anesthesia care.For show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/209-preventing-catastrophic-medication-errors-the-dangers-of-txa-and-bupivacaine-mix-ups/© 2024, The Anesthesia Patient Safety Foundation

In this episode, Dr. David Bishop, a Specialist Anesthesiologist and Head of the Clinical Unit of Anaesthesia at Edendale Hospital in Pietermaritzburg talks about a vital topic and his recent publication, Tranexamic acid at cesarean delivery: drug-error deaths. Tranexamic acid at cesarean delivery: drug-error deaths https://pubmed.ncbi.nlm.nih.gov/36300729/ Spinal tranexamic acid – a new killer in town … Read More Read More

Discover the transformative skincare journey of Dr. Linder, the trailblazing founder of Linder Health, as she graces our podcast. With a career that artfully blends engineering, medicine, and a deep-seated passion for aesthetic medicine, Dr. Linder reveals the experiences that have shaped her innovative path in dermatology. From her early days as a curious child to the pivotal moments in her education and fellowships that guided her to revolutionize skincare practices, her story is a testament to the power of fusing art with science for the betterment of patient care.Embark on an exploration of entrepreneurial spirit and the relentless pursuit of skincare excellence as Dr. Linder takes us behind the scenes of building a skincare empire. She recollects the inception of PCA Skin and the evolution of her latest venture, Linder Health, amid the trials of a global pandemic. Delving into the nuances of skincare innovation, we discuss the parallels between maintaining healthy skin and dental hygiene, the necessity of evolving traditional skincare methodologies, and the joy of cultivating a family business anchored in a collective passion for science. Dr. Linder's commitment to longevity and health span in the industry is not just inspiring—it's reshaping how we approach our skincare routines.Join us as we dissect the science behind the latest advancements in skincare treatments and the importance of a holistic approach to wellness that encompasses mental and physical health. Dr. Linder shares her insights on revolutionary peel treatments, the science of ingredients like Tranexamic acid, and the critical role of daily sunscreen application across all skin tones. Moreover, we traverse the terrain of product compliance, the significance of a minimalist skincare routine, and the impact of a well-rounded wellness routine that includes not only top-notch skincare but also sleep, nutrition, and stress management. This episode isn't just a conversation; it's a masterclass in nurturing your skin and overall well-being, courtesy of a true skincare virtuoso.Visit linderhealth.com/anarchy or use code "Anarchy" to receive a free magnesium supplement, CALM!Support the Show.Follow The Show On All Socials Using The Tag @skincareanarchy

Episode 36! In this episode we talk about tranexamic acid in GI bleeds. We flip the script a little bit and talk about our OLD article first, HALT-IT or "Tranexamic acid in upper gastrointestinal bleed in patients with cirrhosis: A randomized controlled trial" published in Lancet in 2020. This sets the stage for our new trial "Tranexamic acid in upper gastrointestinal bleed in patients with cirrhosis" published in Kumar et al in Hepatology (a new journal for us!)HALT-IT: https://pubmed.ncbi.nlm.nih.gov/32563378/TXA and cirrhosis: https://pubmed.ncbi.nlm.nih.gov/38441903/If you enjoy the show be sure to like and subscribe, leave that 5 star review! Be sure to follow us on the social @icucast for the associated figures, comments, and other content not available in the audio format! Email us at icuedandtoddcast@gmail.com with any questions or suggestions! Thank you Mike Gannon for the intro and exit music!

Researchers in Zambia and Pakistan have shown that a drug which helps to stop bleeding in childbirth is safe to give by injection into a muscle - making it easier to save women's lives where skilled help isn't always close by. Tranexamic acid is usually given by a drip into a vein. But a new study by the London School of Hygiene and Tropical Medicine compared that method with giving an injection into the thigh and administering it as a drink in a solution. They found that the injection was just as effective as the drip – which doctors say will save time and lives. We hear from one of the first people in the world to be given blood grown in a laboratory – and the scientist who made it possible. People with conditions like sickle cell anaemia could eventually benefit from this technology with lab blood tailored to their needs. Overweight people with painful arthritic joints might be told it's due to “wear and tear”. But Dr Graham Easton explains how a new study shows that changes to cells within our joints cause inflammation – and it's not simply a case of extra weight putting pressure on our knees and hips. Producer: Paula McGrath

Kavita Varu is a lawyer from Sheffield and a single mother of two who hit rock bottom just as we went into lockdown three years ago. She decided to learn how to DJ, bought some decks and taught herself. She started doing live sessions on social media, has since played in Ibiza and Amsterdam and recently won the Inspiring Indian Women She Inspires Rising Star award. Scientists believe that they have found a new way to administer a drug to prevent post-natal haemorrhage, which is thought to cost the lives of seventy thousand women a year globally. This makes it one of leading causes of maternal deaths worldwide. Tranexamic acid, which is used to control bleeding after giving birth, is usually given intravenously. But after conducting trials in Pakistan and Zambia, researchers at the London School of Hygiene and Tropical Medicine found that it worked well if injected into the body via a muscle. Academic and former international footballer Professor Laura McAllister has made history as the first Welsh woman to be elected to UEFA's executive committee. With a background in sports governance, Laura McAllister says she's on a mission to use her seat at the table to modernise the game and reflect the growth of the sport. Iconic red-carpet looks from Lizzo and Phoebe Waller-Bridge go on display alongside the historic frocks that inspired them this spring. Crown to Couture at Kensington Palace gives audiences the exclusive chance to see Lizzo's spectacular 2022 Met Gala dress and Phoebe Waller-Bridge's Monique Lhuillier gown from the 2019 Emmys alongside original Georgian couture like the Silver Tissue Gown worn at the court of Charles II. We hear from Polly Putnam the curator of the exhibition. Romantic Comedy is the new novel from bestselling author Curtis Sittenfeld. Sally, a successful comedy writer in her own right meets Noah a global celebrity and she is thrown into turmoil. Can a 'normal' person date a superstar? It seems to work for her male colleagues who regularly step out with accomplished, beautiful women, so why is Sally so plagued with insecurities? Curtis Sittenfeld joins Anita. Presenter: Anita Rani Producer: Kirsty Starkey

In this episode, our team discusses the recent paper from JAMA Surgery Association of Whole Blood With Survival Among Patients Presenting With Severe Hemorrhage in US and Canadian Adult Civilian Trauma Centers. Join us as we explore some of the history of blood transfusions, how we got to where we are today, and the role whole blood transfusion may play going forward Hosts:  Elliott R. Haut, MD, PhD, a senior, nationally recognized name in trauma and acute care surgery at Johns Hopkins University. Dr. Haut is a past president of The Eastern Association for the Surgery of Trauma (EAST) and editor-in-chief of Trauma Surgery and Acute Care Open. Marcie Feinman, MD, MEHP, the current program director of General Surgery Residency at Sinai Hospital of Baltimore and editorial board member of SCORE. She received her Masters in Education in the Health Professions from Johns Hopkins.  David Sigmon, MD, MMEd, a PGY-7 resident at the University of Illinois at Chicago who will be a fellow at Lincoln Medical Center in the Bronx next year. He did two years of research in surgical education at the University of Pennsylvania where he also received his Master's in Medical Education.  LITERATURE Torres CM, Kent A, Scantling D, Joseph B, Haut ER, Sakran JV. Association of whole blood with survival among patients presenting with severe hemorrhage in US and Canadian adult civilian trauma centers. JAMA Surg. Published online January 18, 2023.  https://pubmed.ncbi.nlm.nih.gov/36652255/ Sperry JL, Guyette FX, Brown JB, et al. Prehospital plasma during air medical transport in trauma patients at risk for hemorrhagic shock. N Engl J Med. 2018;379(4):315-326. https://pubmed.ncbi.nlm.nih.gov/30044935/   Moore HB, Moore EE, Chapman MP, et al. Plasma-first resuscitation to treat haemorrhagic shock during emergency ground transportation in an urban area: a randomised trial. Lancet. 2018;392(10144):283-291. https://pubmed.ncbi.nlm.nih.gov/30032977/   Cannon JW, Khan MA, Raja AS, et al. Damage control resuscitation in patients with severe traumatic hemorrhage: A practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg. 2017;82(3):605-617. https://pubmed.ncbi.nlm.nih.gov/28225743/   Howley IW, Haut ER, Jacobs L, Morrison JJ, Scalea TM. Is thromboelastography (Teg)-based resuscitation better than empirical 1:1 transfusion? Trauma Surg Acute Care Open. 2018;3(1):e000140. https://pubmed.ncbi.nlm.nih.gov/29766129/   Guyette FX, Brown JB, Zenati MS, et al. Tranexamic acid during prehospital transport in patients at risk for hemorrhage after injury: a double-blind, placebo-controlled, randomized clinical trial. JAMA Surg. 2020;156(1):11-20. https://pubmed.ncbi.nlm.nih.gov/33016996/   Smart BJ, Haring RS, Zogg CK, et al. A faculty-student mentoring program to enhance collaboration in public health research in surgery. JAMA Surg. 2017;152(3):306-308. https://pubmed.ncbi.nlm.nih.gov/27973649/   National Academies of Sciences E. A National Trauma Care System: Integrating Military and Civilian Trauma Systems to Achieve Zero Preventable Deaths after Injury.; 2016. https://nap.nationalacademies.org/catalog/23511/a-national-trauma-care-system-integrating-military-and-civilian-trauma   Braverman MA, Smith A, Pokorny D, et al. Prehospital whole blood reduces early mortality in patients with hemorrhagic shock. Transfusion. 2021;61 Suppl 1:S15-S21.  https://pubmed.ncbi.nlm.nih.gov/34269467/ **Specialty team application link - https://forms.gle/DwrRcMYDaP3a3LaQA Please email hello@behindtheknife.org with any questions. Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out other trauma episodes here: https://behindtheknife.org/podcast-category/trauma/

Hello and welcome to season 3 of The Treatment Room! Today we're joined by celebrity Los Angeles esthetician Sarah Ford (behind faces like Ariana Grande + Jack Harlow.) She shares how she created a successful esthetician business built on raving referrals and word of mouth. We talk: Derm referrals Melasma Fungal acne Tranexamic acid Sarah's PCOS and wellness journey Being an introverted esthetician How to grow your business Follow Sarah on Instagram. MY SOCIAL MEDIA + SHOPS to order Colorescience, Jan Marini, iS Clinical, DermeHome, Seen + more with free shipping, please email me at tessaskinconsulting@gmail.com shop FSBT or follow along on instagram @freeskinbytessa. To shop Glymed Plus, register on the top right via my authorized store: https://glymedplus.com/store/tessaskin Now Booking Acne Bootcamp! Book a skin consultation or mentorship call with me: www.tessaskin.com Tess' Instagram @myestytessa Tess' YouTube: Tess Zolly Tess' TikTok: @myestytessa Music: Sweet by LiQWYD | https://www.instagram.com/liqwyd Music promoted by https://www.free-stock-music.com Creative Commons Attribution 3.0 Unported License https://creativecommons.org/licenses/by/3.0/deed.en_US

Welcome to Ask Stago, the Podcast dedicated to provide expert answers to your expert questions in coagulation. In today's episode, our guest François Depasse will help us to understand the hemostasis results obtained along pregnancy, what are the related difficulties for the lab and Link to previous podcasts: S1E15 Disseminated Intravascular Coagulation (DIC) and fibrin related markers: S2E1 Whole Blood Viscoelastic Testing (VET) Literature sources: Szecsi PB, Jørgensen M, Klajnbard A, Andresen MR, Colov NP, Stender S, Haemostatic reference intervals in pregnancy. Thromb Haemost 2010; 2013: 718-27 Kristoffersen AH, Peters PH, Bjørge L, Røraas T and Sandberg S. Concentration of fibrin monomer in pregnancy and during the postpartum period. Annals of Clinical Biochemistry 2019; 56(6): 692-700. Hellgren H. Hemostasis during normal prgenancy and puerperium. Semin Thromb Hemost. 2003; 29(2): 125-30. Leduc L, Wheeler JM, Kirshon B, Mitchell P, Cotton DB, Coagulation profile in severe preeclampsia, Obstet Gynecol 1992 79(1); 14-8 Gillissen A, van den Akker T, Caram-Deelder C, Henriquez DDCA, Bloemenkamp KWM, de Maat MPM, van Roosmalen JJM, Zwart JJ, Eikenboom J, van der Bom JG. Coagulation parameter during the course of severe postpartum hemorrhage: a nationwide retrospective cohort study. Blood Adv 2018; 2(19): 2433-42 Ducloy-Bouthors AS, Mercier FJ, Grouin JM, Bayoumey F, Corouge I, Le Goueze A, Rackelboom T, Broisin F, Vial F, Luzi A, Capronnier O, Huissoud C, Mignon A, Early and systematic administration of fibrinogen concentrate in post-partum haemorrhage following vaginal delivery: the FIDEL randomized controlled trial. BJOG 2021. 128:1814-23. Brenner A, Ker K, Shakur-Still H, Roberts I. Tranexamic acid for post-partum haemorrhage: what, who and when. Best Pract Res Clin Obstet Gynaecol. 2019; 1:66-74   Content is scientific and technical in nature. It is intended as an educational tool for laboratory professionals and topics discussed are not intended as recommendations or as commentary on appropriate clinical practice.

In this episode, we discuss coagulation cascade, the principles behind ROTEM and the pharmacology of Tranexamic acid.

SMA News Today's multimedia associate, Price Wooldridge discusses how a recent study found that Tranexamic acid effectively reduced blood loss by over 50% during surgery to correct scoliosis due to spinal muscular atrophy. Also, we all know that self-reflection can be challenging. In Brianna Albers' latest article, she reflects on a reality that requires her to make a change. DeAnn Runge discusses Brianna's column, “To Protect My Emotional Wellness, I'm Letting Myself Take a Break” on this audio news episode. Are you interested in learning more about spinal muscular atrophy? If so, please visit https://smanewstoday.com/

Dr. Martin Schreiber is a trauma and critical care surgeon at Oregon Health & Science University in Portland. He has had a major impact on our understanding of resuscitation in trauma, among many other topics. We talked to Dr. Schreiber about his experience with the military, his advocacy around trauma research, and trauma resuscitation. Links: 1. Trauma Center Association of America calls for NIH Trauma Institute. https://www.traumacenters.org/news/557958/TCAA-Chair-Calls-for-Creation-of-Trauma-Institute-in-the-NIH-.htm 2. Effect of Out-of-Hospital Tranexamic Acid vs Placebo on 6-Month Functional Neurologic Outcomes in Patients With Moderate or Severe Traumatic Brain Injury. https://pubmed.ncbi.nlm.nih.gov/32897344 3. Tranexamic acid in trauma. How should we use it? https://journals.lww.com/jtrauma/Citation/2013/06000/Tranexamic_acid_in_trauma__How_should_we_use_it_.30.aspx Bio (from https://www.ohsu.edu/people/martin-a-schreiber-md-facs-fccm) Dr. Schreiber's special areas of interest are trauma surgery and surgical critical care. He received his medical degree in 1988 from Case Western Reserve University in Cleveland, OH. Dr. Schreiber completed his internship at Madigan Army Medical Center in Fort Lewis, WA., and his residency training at the University of Washington in Seattle. His trauma and critical care fellowship was completed at the University of Washington.

Tranexamic acid is proven to lower mortality rates among women who have postpartum haemorrhage, but it's still rarely used. Professors Haleema Shakur-Still and Ian Roberts of LSHTM discuss their new documentary on the subject and their research, while Dr. Taissa Vila and Professor Wilson Savino discuss Brazil's struggles with COVID-19.

Earlier this year, clinical practice guidelines for the diagnosis and management of von Willebrand disease (VWD) were published in Blood Advances. The guidelines (https://bit.ly/2OIfKLE) are a collaborative effort from the American Society of Hematology, the International Society on Thrombosis and Haemostasis, the National Hemophilia Foundation, and the World Federation of Hemophilia. Guideline author Paula James, MD, of Queens University, Kingston, Ont., reviews some of the recommendations in these guidelines with host David H. Henry, MD, in this episode. Case discussion A patient presents with the complaint of heavy menstrual bleeding, which could indicate a bleeding disorder such as VWD. How does one diagnose or rule out VWD? Tests to order include CBC, prothrombin time (PT), and partial thromboplastin time (PTT). Results of CBC, PT, and PTT could be normal, which would necessitate special testing to specifically look at factor VIII and von Willebrand factor (VWF). A patient’s family history may be helpful, as most types of VWD are autosomal dominant, though two subtypes are recessive. Diagnostic evaluation of VWD VWF is the chaperone protein for factor VIII in the intrinsic pathway, which is measured by the PTT. In more severe forms of VWD, the PTT is prolonged because of factor VIII. VWF is measured separately because it is not reflected in the PT or PTT. The recommendation is to measure VWF antigen and employ a functional assay to see how well VWF binds platelets. The recommendation in the new guidelines is to use the GPIbM assay rather than the ristocetin cofactor assay. Many labs in the United States are still using the ristocetin cofactor assay. However, in Canada, Europe, and other parts of the world, many labs have moved to a newer assay that is automated. It has a much lower coefficient of variation and fewer issues with measurement of VWF in Black populations, which is a major issue with the cofactor assay. Types of VWD Type 1 VWD is characterized by a decreased amount of VWF. Type 1 patients have low VWF antigen and low platelet-dependent VWF function to a similar degree, with low or normal factor VIII. Type 2 VWD is characterized by aberrant VWF. The functional assay is a lot lower than VWF antigen. The platelet-dependent function to VWF antigen ratio cutoff is 0.7. Further testing is warranted to determine subtypes (2A, 2B, 2N, or 2M), including VWF multimers. Genetic testing can be helpful to further delineate subtypes. Type 3 VWD is characterized by the absence of VWF. The patient will have a VWF antigen level of 0, platelet-dependent VWF function of 0, and a reduced factor VIII level (usually less than 10%). Pregnant patients with VWD There is a protective adaptation in pregnancy, in which factors normalize in the third trimester, which works to prevent hemorrhage at delivery. This protective effect is because of the hormonal changes of pregnancy, and it is seen in patients with milder forms of VWD. WVF levels peak within 8-24 hours after delivery and then slowly return to baseline. There is a risk of delayed postpartum hemorrhage once VWF levels return to baseline, which tends to happen 7-14 days postpartum. Procedural planning: Desmopressin challenge test Desmopressin causes the release of VWF from the Weibel-Palade bodies of the endothelium, and it can be used as prophylaxis or treatment of bleeding in type 1 VWD. The desmopressin challenge test is used to check how the patient responds to desmopressin when well, to predict the patient’s response after an anticipated procedure. The test involves measuring VWF levels before desmopressin is given and at 1 hour, 2 hours, and 4 hours after desmopressin administration. The idea is to measure the magnitude of increase in VWF levels and observe how sustained that increase is to predict the patient’s response to desmopressin after future procedures. There is a subset of patients with type 1 VWD who have increased clearance of VWF that causes their decreased VWF levels. They may not have a sustained plateau in the VWF level after desmopressin, which emphasizes why testing as far as 4 hours after desmopressin administration is important. The dose of desmopressin given in this test is typically 0.3-0.4 mcg/kg. Recommendations for preprocedure prophylaxis for type 1 VWD Minor procedures (e.g., wisdom tooth extraction) The patient should receive an antifibrinolytic agent, such as tranexamic acid or aminocaproic acid, 2 hours before the procedure, followed by desmopressin 30-60 minutes prior to the procedure. After the procedure, the patient should continue to receive the antifibrinolytic agent for 3-4 days. Major procedures/surgeries (e.g., gallbladder removal) The guidelines do not recommend desmopressin for major procedures because patients need to be fluid-restricted for approximately 24 hours after administration because of the risk of hyponatremia. Desmopressin is a synthetic analog of vasopressin, which results in the accumulation of free water similarly to vasopressin. The guidelines do recommend giving VWF-containing concentrate to increase VWF and factor VIII to greater than 50% from baseline for at least 3 days. VWF concentrates can be given every 12 hours or as continuous intravenous infusions. Tranexamic acid should be given as an adjuvant both prior to the procedure and in the days following. Cryoprecipitate is not recommended because it can’t be virally inactivated.  Preprocedure prophylaxis in type 2 or 3 VWD Desmopressin does not work for most patients with type 2 or 3 VWD. So even for minor procedures, these patients will need to receive VWF concentrate coupled with antifibrinolytics. Show notes written by Sheila DeYoung, DO, a resident at Pennsylvania Hospital, Philadelphia. Disclosures Dr. Henry has no relevant disclosures. Dr. James disclosed relationships with Baxter/Baxalta/Shire, CSL Behring, Bayer, and Octapharma. *  *  * For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgehemonc David Henry on Twitter: @davidhenrymd

Chemists Gloria & Victoria realized that they spend so much time talking about AHAs glycolic and lactic acid, they've neglected all the other great acids of skincare. So in episode 18, they decided to put the spotlight on tranexamic and azelaic acid over a few beers.

Johns W, Walley KC, Seedat R, Jackson B, Boukhemis K, Gonzalez T. Tranexamic Acid Use in Foot and Ankle Surgery, Foot Ankle Ortho. 2020, 5(4):1-6. https://doi.org/10.1177/2473011420975419  

News from ASH 2020: No benefit from tranexamic acid prophylaxis in blood cancers: https://bit.ly/2K3Mah1 ‘Practice changing’: Ruxolitinib as second-line in chronic GVHD: https://bit.ly/3gT4kyg  Durable responses with anti-BCMA CAR T-cell for multiple myeloma: https://bit.ly/381f1ut Five-minute SC injection of daratumumab in RRMM: https://bit.ly/3gKuZgx Email Blood & Cancer at podcasts@mdedge.com  

Tranexamic acid could be skincare’s next big thing, but what is it? We’ve got answers. Plus, we discuss how the modeling industry is changing for the better, and share the latest beauty news: Sephora’s new president, cult-favorite The Ordinary foundations arrive in the U.S., hits and misses at TRESemmé, a new (vegan!) red makeup pigment, and details on how one U.K. salon’s search for a happy hairstylist went wrong. -- Want more of our beauty podcast? Episode Recaps & Notes: fatmascara.com/blog; Our Private Facebook Group: Fat Mascara / Raising a Wand; Instagram: @fatmascara, @jessicamatlin, @jenn_edit; Twitter: @fatmascara; Email: info@fatmascara.com; To Leave a Voicemail & Be Featured on a Future Episode: 646-481-8182. See acast.com/privacy for privacy and opt-out information.

Are you trying to keep up with the latest medical literature but your journals keep getting blown away by the industrial fan you've bought to try and survive this sweaty heat wave? Your ears are in the right place! In this months episode:...Tranexamic acid in UGI bleeding: more harm than good?...(04:35)HALT-IT Trial Collaborators. “Effects of a high-dose 24-h infusion of tranexamic acid on death and thromboembolic events in patients with acute gastrointestinal bleeding (HALT-IT): an international randomised, double-blind, placebo-controlled trial.” Lancet (London, England) vol. 395,10241 (2020): 1927-1936. doi:10.1016/S0140-6736(20)30848-5...Cocoa beans in acute ischaemic stroke?...(08:15) Modrau, Boris et al. “Theophylline as an Add-On to Thrombolytic Therapy in Acute Ischemic Stroke: A Randomized Placebo-Controlled Trial.” Stroke vol. 51,7 (2020): 1983-1990. ...Ticagrelor for stroke prevention?...(12:40) Johnston, S Claiborne et al. “Ticagrelor and Aspirin or Aspirin Alone in Acute Ischemic Stroke or TIA.” The New England journal of medicine vol. 383,3 (2020): 207-217. ...Probiotics for your mood?... (16:28)Noonan S, Zaveri M, Macaninch E, et al Food & mood: a review of supplementary prebiotic and probiotic interventions in the treatment of anxiety and depression in adults BMJ Nutrition, Prevention & Health 2020...Probiotics in care homes... (22:15)Butler, Christopher C et al. “Effect of Probiotic Use on Antibiotic Administration Among Care Home Residents: A Randomized Clinical Trial.” JAMA vol. 324,1 (2020): 47-56. ...Tofu to reduce mortality?... (25:11)Cai, Xiaoyan et al. “Association between prediabetes and risk of all cause mortality and cardiovascular disease: updated meta-analysis.” BMJ (Clinical research ed.) vol. 370 m2297. 15 Jul. 2020,...Coffee time: the facts and myths... (29:16)van Dam, Rob M et al. “Coffee, Caffeine, and Health.” The New England journal of medicine vol. 383,4 (2020): 369-378....Does MTX actually cause ILD?...(33:15)Juge, Pierre-Antoine et al. “Methotrexate and rheumatoid arthritis associated interstitial lung disease.” The European respiratory journal, 2000337. 9 Jul. 2020, JOURNALBITES (38:13)Vitamin D & diabetes preventionAn app for cardiac arrestNoradrenaline dysregulates the immune responseAI & Skin disease...Putting the Ash in hand wASH...(42:40)-------------------------------------Check out the awesome infographics on Twitter @JournalSpotting or our website

Tranexamic acid has been thought to be the wonder drug for stopping the active bleeding and has recently been proven life-saving in certain subgroups of patients. HALT_IT is another landmark trial that has evaluated the benefit of tranexamic acid in patients with acute GI bleeding. In this podcast, we discuss the implications of this landmark trial.

Tranexamic acid (2:50), IBSchek for irritable bowel syndrome (6:10), endometrial biopsy (8:10), megestrol for palliative care (11:30), migraines in children (14:00), chronic dyspnea (16:20), antibody testing for SARS-CoV-2 (19:00).

Tranexamic acid (TXA) is a synthetic lysine derivative that binds with the lysine site on plasminogen, inhibits fibrinolysis and stabilizes clot. While it has been around since the 1960's, its popularity for major trauma has gained a lot of steam in recent years. This has also resulted in creative emergency providers finding novel uses for it at the bedside. In this podcast, Dr. Tim Fallon discusses some of the more novel bedside uses of TXA including epistaxis, hemoptysis, post tonsillectomy bleeding, and dental trauma. Click Here for the Show Notes on Downeastem.org References Zahad, R. A new and rapid method for espistaxis treatmetn using injectable form of tranexamic acid topically: a randomized controlled trial. AJEM. 31 (2013)1389-1392.[Pubmed] Wand, O. Inhaled Tranexamic Acid for Hemoptysis Treatment. Chest. 2018; 154(6):1379-1384.[Pubmed] Schwarz, W. Nebulized tranexamic Acid Use for Pediatric Secondary Post-Tonsillectomy Hemorrhage. Annals of Emerg Med. in Press. [Pdf] Dietrich, S. Trick of the Trade: Topical Tranexamic Acid Paste for Hemostasis. ALiEM. https://www.aliem.com/category/clinical/tricks-of-the-trade/ Mason, J. Epistaxis TXA Pack. EMRAP HD. May 2018 Rezaie, S. TXA for Everyone: Inhaled TXA for Hemoptysis. RebelEM. Rezaie, S. Topical Tranexamic Acid for Epistaxis or Oral Bleeds. RebelEM

Tranexamic acid, which frustrates clot dissolution, has been shown to reduce death from intracranial bleeding in a large international placebo-controlled trial — “CRASH-3.” Ali Raja and Joe Elia host a lively chat with Ian Roberts, the co-chair of the trial’s writing committee, who, in addition to chastising the hosts’ seeming fascination with P-values, recounts a story […]

We’ve recently rolled out a new epistaxis treatment protocol here at MCHD. Join the podcast team as we discuss some nosebleed background information along with the classic and emerging treatment options. Did somebody say TXA?? Yep, we have TXA and this is a perfect opportunity introduce the MCHD epistaxis/TXA treatment protocol. It’s simple, cheap and minimally invasive. With rapidly accumulating evidence that we will improve patient centered outcomes using this treatment, this is an episode that you don’t want to miss. REFERENCES: 1. Klepfish A, Berrebi A, Schattner A. Intranasal tranexamic acid treatment for severe epistaxis in hereditary hemorrhagic telangi- ectasia. Arch Intern Med 2001; 161: 767. 2. Gaillard S, Dupuis-Girod S, Boutitie F, Rivi ere S, Morini ere S, Hatron PY, Manfredi G, Kaminsky P, Capitaine AL, Roy P, Gueyffier F, Plauchu H, for the ATERO Study Group. Tranexamic acid for epistaxis in hereditary hemorrhagic telangiectasia patients: a European cross-over controlled trial in a rare disease. J Thromb Haemost 2014; 12: 1494–502. 3. Zahed R, Moharamzadeh P, Alizadeharasi S, Ghasemi A, Saeedi M. A new and rapid method for epistaxis treatment using injectable form of tranexamic acid topically: a randomized controlled trial. Am J Emerg Med 2013;31:1389–92. 4. Birmingham AR, Mah ND, Ran R, et al. Topical tranexamic acid for the treatment of acute epistaxis in the emergency department. Am J Emerg Med. 2018;36:1242-1245. 5. Zahed R, Mousavi, Jazayeri MH,Nader iA,et al.Topical tranexamic acid compared with anterior nasal packing for treatment of epistaxis in patients taking antiplatelet drugs: randomized controlled trial. Acad Emerg Med. 2018;25:261-266. 6. Akkan, Sedat et al. Evaluating Effectiveness of Nasal Compression With Tranexamic Acid Compared With Simple Nasal Compression and Merocel Packing: A Randomized Controlled Trial. Annals of Emergency Medicine, Volume 74, Issue 1, 72 - 78 7. Min, H. J., Kang, H., Choi, G. J., & Kim, K. S. (2017). Association between Hypertension and Epistaxis: Systematic Review and Meta-analysis. Otolaryngology–Head and Neck Surgery, 157(6), 921–927. 8. Kikidis D, Tsioufis K, Papanikolaou V, Zerva K, Hantzakos A. Is epistaxis associated with arterial hypertension? A systemic review of the literature. Eur Arch Otorhinolaryngol. 2014; 271(2):237-243

Tranexamic acid use in Head Injury - it is worth reading this recent paper from the Lancet and some of the blogs that discuss it.   The Lancet paper (currently open access) - Crash-3 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)32233-0/fulltext The Crash- 2 Trial https://www.ncbi.nlm.nih.gov/pubmed/23477634 The Rebel EM Blog https://rebelem.com/crash-3-txa-for-ich/ EMLitOfNote Blog http://www.emlitofnote.com/?p=4538 PulmCrit (EMCrit) Blog https://emcrit.org/pulmcrit/crash3/ The BBC article https://www.bbc.com/news/health-49977827     www.rnzcuc.org.nz podcast@rnzcuc.org.nz https://www.facebook.com/rnzcuc https://twitter.com/rnzcuc   Music licensed from www.premiumbeat.com Full Grip by ScoreSquad   This podcast is intended to assist in ongoing medical education and peer discussion for qualified health professionals.  Please ensure you work within your scope of practice at all times.  For personal medical advice always consult your usual doctor

Professor Stephen Bernard: Tranexamic Acid. From CICM ASM PROGRAM 2019.  

The July 2019 supplement of the The Bone and Joint Journal consists of papers from The Knee Society. In this episode, Mr Iain Murray (Associate Editor for Knowledge Translation at the BJJ) interviews two authors of one of the prize papers published in the supplement: Dr Craig Della Valle and Dr Yale Fillingham. The article "A multicentre randomized clinical trial of tranexamic acid in revision total knee arthroplasty: does the dosing regimen matter?" was the recipient of the 2019 Mark Coventry award.Click here to read the articleClick here to view the table of contents for The Knee Society supplement

Tranexamic acid is an old drug with a new purpose, and is increasingly found in the drug kits of prehospital providers. Dr Dan Bodnar, Deputy Medical Director of Queensland Ambulance Service, joins Todd on the podcast to discuss the uses, evidence base and administration of Tranexamic acid. Dan is a Brisbane based Emergency Physician.  His work life between the Royal Brisbane and Women's Hospital, the Queensland Ambulance Service and the Queensland Children's Hospital.  

Flight Lieutenant James Kuht & Surgeon Lieutenant Matt Kain interview four exciting speakers at the Medical Innovation* 2018. We ask the Surgeon General whether the Defence Medical Services are still at the cutting edge of medical innovation, interview Colonel Nigel Tai immediately following an augmented-reality telemedicine surgery simulation, hear about the experiences of Surgeon Lt Cdr Will Sharp aboard HMS enterprise rescuing migrants from the Mediterranean, and discuss the innovative repurposing of auto-injectors for delivering Tranexamic acid (TXA)to save lives from trauma with Lt Col Harvey Pynn. *Medical Innovation is Europe's leading defence medical conference and exhibition delivered in partnership with the Defence Medical Services. The 2018 event delivered an outstanding speaker programme, and opportunity to see the latest innovations from leading medical companies, and an exclusive showcase of remote diagnostic technology from 'Expedition Ice Maiden', the first all-female team to ski coast-to-coast across Antarctica unsupported. The next edition of Medical Innovation will focus on 'Enhancing Resilience' and will take place on Tuesday 10 September 2019 at DSEI, ExCeL, London. Register today to secure your place. www.dsei.co.uk/register

In an exclusive interview with TheRightDoctors on Emcure AICOG tv, Dr. Dilip Dutta, director at gynecology institute of clinical excellence Kalyani in West Bengal, senior vice president of IMA bengal branch in 2016 and 17, dean at Indian Academy of obstetrics and gynecology in 2015, vice chairman of ISSAR, spoke about postpartum haemorrhage and how to treat it. This is what he said: ' PPH after normal delivery is more than the PPH following cesarean section. The reason is that in the normal delivery in the rural area where the placenta maybe retained or placenta maybe half partially removed and that causes the PPH. In a normal delivery, bleeding is 100-200 we say mild because during the pregnancy the bladder is diluted if you loss about 100 or 200 you maybe loss blood of 1 or 2 gram so does not mean, If it is more than 200 to 500 we call moderate and after 500, which leads to our problem like shock any other things than we definitely called that is severe PPH. Oxytocin we are using, it may be used by you given IM, intramuscular or intravenous, we may use any saline you can give it. It will make the control if it is not controlled then we have using the mesophosphorus drugs also, Tranexamic acid is a must is a must to tackle a case of bleeding following major degree placenta previa because placenta is below when you take the placenta friable vessels are there bleeds Tranexamic .' TheRightDoctors, a Google Launchpad Digital Health StartUp, is one of the leaders in production and dissemination of Medical Information. We bring Insights from the World's Best Medical Minds to digital audiences worldwide across leading digital and social media platforms. Subscribe for more videos: https: https://goo.gl/BDq1gL Our Social Media Links : Facebook - https://goo.gl/YO1oel Google + - https://goo.gl/ImMXq5 Twitter - https://goo.gl/J1gtvw LinkedIn - https://goo.gl/FClkyl

Tranexamic acid is ACOG endorsed for the treatment of established postpartum hemorrhage. Postpartum hemorrhage is now defined as greater or equal to 1000mls estimated blood loss regardless of mode of delivery. In this brief session, we will review the dosing regimen for TXA for established PPH.

(*Hypothetical Case) You are an obstetrician (or anaesthetist) and you work in a peripheral hospital in a metropolitan city. You are not on call but despite this you get woken by a phone call at 2am one night. It is a junior obstetric registrar who is very keen for you to come and give them some help. They tell you the on call obstetric consultant is already busy in theatre with an urgent caesarean for fetal distress and isn't currently available. They are on the labour ward with a women who has just had vaginal delivery of twins following a relatively long labour augmented with oxytocin. She now has an atonic uterus and despite oxytocin / ergometrine has bled about 2 litres - she has just reminded everyone that she is a jehovah's witness and reiterates that she will not accept blood under any circumstances. Unfortunately she never had any formal antenatal discussion about blood products - this is the first time she has mentioned it! The registrar sounds very scared and they want your advice about what to do next! What are you going to advise over the phone? What should have been done differently in the antenatal period? Join Graeme and I in this podcast. Thanks to Graeme for again being a good sport and agreeing to join in this podcast to make it more of a conversation and easier to listen to! He had to ad-lib, completely off the cuff, without any warning (I literally grabbed him in the corridor). - Tune in to find out where Wangkatjungka community is and why it is relevant to this topic! The Most Important Points to Consider: ANTENATAL Optimise the haemoglobin and iron stores before delivery Discuss and document what the patient will and won't accept - make sure you understand Decide on the best place for delivery - consider availability of theatre and resources to manage haemorrhage (cell salvage, surgical expertise, radiology etc) INTRAPARTUM stop any bleeding AS SOON AS POSSIBLE oxytocics - get control of tone rapidly Tranexamic acid - consider prophylactically or as soon as any bleeding occurs. theatre access immediately senior / experienced staff early hysterectomy early (not late). Manual aortic occlusion. Cell salvage - this can include vaginal bleeding and blood with amniotic fluid POSTPARTUM What is they have significant anaemia? ICU/HDU give oxygen give haematinics (iv iron / EPO) to rapidly replace the lost Hb minimise any further blood loss - including iatrogenic blood tests! paralysis & ventilation - usually needed around Hb 30-40g/L hyperbaric O2 - case series and reports of successful use polymerised Hb - can be accessed for compassionate use but manufactured in the US USEFUL RESOURCES Best Reference on this topic: Kidson-Gerber, G., Kerridge, I., Farmer, S., Stewart, C. L., Savoia, H. and Challis, D. (2016), Caring for pregnant women for whom transfusion is not an option. A national review to assist in patient care. Aust N Z J Obstet Gynaecol, 56: 127–136. doi:10.1111/ajo.12420 For a good explanation and diagram explaining the Jehovah's witnesses' basic position on blood and blood products : http://ajwrb.org/watchtower-approved-blood-transfusions Tranexamic Acid Tranexamic acid for prophylaxis in Caesarean https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5228660/ Tranexamic Acid for PPH WOMAN study Hyperbaric Oxygen to treat severe anaemia in a JW after abruption: https://www.ncbi.nlm.nih.gov/pubmed/23380087 Case report of use of hemopure for postpartum anaemia https://www.tandfonline.com/doi/pdf/10.1080/22201173.2009.10872581 Case report of the use of hemopure in severely anaemic JW trauma patient in Melbourne https://www.mja.com.au/journal/2011/194/9/synthetic-haemoglobin-based-oxygen-carrier-and-reversal-cardiac-hypoxia Vaginal Cell Salvage Cell salvage for postpartum haemorrhage during vaginal delivery: a case series http://www.bloodtransfusion.

According to a quote variably attributed to Niels Bohr, Yogi Berra, Albert Einstein, Mark Twain and others ‘prediction is difficult; especially about the future’. Nevertheless, in an era of evidence-based medicine, one might surmise that the future of management of GI bleeding in the ICU will be informed by large-scale high quality RCTs. There are a number of such trials on the horizon that give us a pretty good idea of what the future holds. Based on my best-guess of what these trials will show I predict that in the future we will: 1. Use more TXA in patients with GI bleeding. 2. Use less stress ulcer prophylaxis. The Haemorrhage ALleviation with Tranexamic acid (TXA) – InTestinal system trial (HALT-IT) is a pragmatic trial that will compare TXA to placebo in 8000 participants with clinically significant gastrointestinal bleeding. The rationale for this trial is that decreasing fibrinolysis with TXA will increase clot stability, improve haemostasis, and reduce rebleeding, leading to reduced mortality for patients presenting with GI bleeds. Additional information about the role of TXA will come from a second trial, the EXARHOSE trial, which will investigate the safety and efficacy of TXA in cirrhotic patients with acute upper GI bleeding. There are two large-scale RCTs comparing proton pump inhibitors to placebo coming soon. The first is the SUP-ICU trial, which is being run by the Scandinavian Critical Care Trials Group. This trial will enrol adult patients with one or more risk factors for upper GI bleeding and has a primary end point of day 90 mortality. The second is the REVISE trial which includes patients who are mechanically ventilated in ICU and expected to be ventilated the day after tomorrow. REVISE has a primary end point of ‘clinically significant GI bleeding’. Together SUP-ICU and REVISE have a combined sample size of over 8000 participants and will help us to better understand the effects of PPI use on mortality risk, GI bleeding risk, VAP risk, and C. diff infection risk. The results of these trials will be complemented by the PIC-UP trial which will investigate the role of stress ulcer prophylaxis in PICU patients and the PEPTIC trial which compares PPIs and H2RBs in mechanically ventilated adults. 

  The paper which we discuss in the interview is available open access here How does tranexamic acid work? Critical appraisal aids To understand more about hierachy of evidence and how a systematic review fits into this please have a look at these resources available from the Cochrane group. http://consumers.cochrane.org/levels-evidence http://training.cochrane.org/path/grade-approach-evaluating-quality-evidence-pathway The CASP checklist can … Continue reading Episode 26: Tranexamic Acid

Tranexamic acid (TXA) is an old drug, but one that we in emergency medicine have found love for once again.  In preparation for an upcoming talk at a conference, I realized I had not yet made a post regarding TXA.  This is a quick summary of TXA and links to a lot of great #FOAMed resources out there you can also check out regarding the same.  I have also included one bit that I have recently found very successful but with little evidence currently.  Listen to the podcast for more!

TXA. What if there was a drug that would stop bleeding early? What if that drug had been shown to be effective? What would it take for you to use the drug? Over 90 percent of hospitals have some kind of massive transfusion protocol, but only about two thirds of those hospitals carry Tranexamic acid, or TXA. What does TXA ... Read More The post MSM Podcast Episode 8- TXA appeared first on Medschoolmedic.

Simon Carley is on his own once more, talking through the highlights of the November 2016's EMJ. Here are links to the discussed highlights: Diagnostic accuracy of PAT-POPS and ManChEWS for admissions of children from the emergency department - http://emj.bmj.com/content/33/11/756.full Related editorial: Paediatric early warning systems (PEWS) in the ED - http://emj.bmj.com/content/33/11/754.extract Early warning scores: a health warning - http://emj.bmj.com/content/33/11/812.abstract Engaging the public in healthcare decision-making: results from a Citizens’ Jury on emergency care services - http://emj.bmj.com/content/33/11/782.full ED healthcare professionals and their notions of productivity - http://emj.bmj.com/content/33/11/789.abstract Soluble urokinase plasminogen activator receptor (suPAR) in acute care: a strong marker of disease presence and severity, readmission and mortality. A retrospective cohort study - http://emj.bmj.com/content/33/11/769.full Burden of emergency conditions and emergency care usage: new estimates from 40 countries - http://emj.bmj.com/content/33/11/794.abstract Best Bets: BET 1: Tranexamic acid in epistaxis: who bloody nose? - http://emj.bmj.com/content/33/11/823.2.full BET 2: Usefulness of IV lidocaine in the treatment of renal colic - http://emj.bmj.com/content/33/11/825.full Discussed blog articles: Nuances of Neurogenic Shock - http://blogs.bmj.com/emj/2016/11/04/nuances-of-neurogenic-shock/ The weekend effect. Part 1 - http://blogs.bmj.com/emj/2016/10/28/645/ The weekend effect: Part 2 – a traumatic time! - http://blogs.bmj.com/emj/2016/10/29/the-weekend-effect-part-2-a-traumatic-time/

A 5-year-old boy was playing with his older brother in front of their home when he was struck by a car. He sustained a femur fracture, splenic laceration, and blunt head trauma – the so-called Waddell’s triad. On arrival, he was in compensated shock, with tachycardia. He decompensates and needs blood. How do we manage his hemodynamics and when do we perform massive transfusion? Pediatric Massive Transfusion 40 mL/kg of blood products given at any time within the first 24 hours. Adolescents and Adult Massive Transfusion 6-8 units of packed red blood cells (PRBCs) Adults have about 5 L of circulating blood. Not including plasma, one could replace all circulating erythrocytes with about 10 units of PRBCS The best ratio of PRBCs:Plasma:Platelets is unknown, but consensus is 1:1:1. 1 unit of PRBCS is typically 300 mL of volume. The typical initial transfusion of PRBCs in children is 10 mL/kg. Massive transfusion in children is defined as 40 mL/kg of any blood product. Once you start to give a child with major trauma the second 10 mL/kg dose of PRBCs – start thinking about other blood components, and ask yourself whether you should initiate your massive transfusion protocol. The goal is to have the products ready to use in the case of the dynamic trauma patient. The Thromboelastogram (TEG) Direct measures the four components of clot formation. When there is endolethial damage and bleeding, the sequence that your body takes to address it is as follows:  Platelets migrate and form a plug Clotting factors aggregate and reinforce the platelets Fibrin arrives an acts like glue Other cells migrate and support the clot. R time – reaction time – the initial line in the tracing that shows time to beginning of clot formation. Treated with platelets K factor – kinetics of the clot –how much the clot allows the pin to move, or the amplitude. Treated with cryoprecipitate Alpha angle – the slope between the R and K measurements – reflects how quickly the fibrin glue is working. Treated with cryoprecipitate Ma – maximum amplitude – reflects the overall strength of the clot. Treated with platelets LY30 – the clot lysis at 30 min – is the decrease in strength of the clot’s amplitude at 30 min. Treated with an antifibrinolytics (tranexamic acid) Shape Recognition Red wine glass: a normal tracing with a normal reaction time and a normal amplitude. That patient just needs support and monitoring. Champagne glass: a coagulopathic TEG tracing – thinned out, with less amplitude. This patient needs specific blood products. Puffer fish or blob: a hyperfibrinolytic tracing. That patient will needs clot-stablizer. TEG – like the FAST – can be repeated as the clinical picture changes. The Trauma Death Spiral Lethal triad of hypothermia, acidosis, and coagulopathy. Keep the patient perfused and warm. Each unit of PRBCs contains 3 g citrate, which binds ionized calcium, causing hypotension. In massive transfusion, give 20 mg/kg of calcium chloride, up to 2 g, over 15 minutes. Calcium chloride is preferred, as it is ionically readily available – just use a larger-bore IV and watch for infiltration. Calcium gluconate could be used, but it requires metabolism into a bioavailable source of calcium. Prothrombin complex concentrate (PCC) Prothrombin complex concentrate (PCC) is derived from pooled human plasma and contains 25-30 times the concentration of clotting factors as FFP. Four-factor PCCs contain factors II, VII, IX and X, while 3-factor PCCs contain little or no factor VII. The typical dose of PCC is 20-50 units/kg In the severely hemorrhaging patient – you don’t have time to wait for the other blood products to thaw – PCC is a powder that is reconstituted instantly at the bedside. Tranexamic acid (TXA) Tranexamic acid (TXA), is an anti-fibrinolytic agent that functions by stopping the activation of plasminogen to plasmin, and the degradation of fibrin. The Clinical Randomisation of an Antifibrinolytic in Significant Hemorrhage (CRASH-2) investigators revealed a significant decrease in death secondary to bleeding when TXA was administered early following trauma. Based on the adult literature, one guideline is to give 15 mg/kg loading dose of TXA with a max 1 g over 10 minutes followed by 2 mg/kg/h for at least 8 h or until bleeding stops. Resuscitative Pearls Our goal here is damage control. Apply pressure whenever possible. Otherwise, resuscitate, identify the bleeding source, and slow or stop the bleeding with blood products or surgery. How Children are Different in Trauma In adults, we speak of “permissive hypotension” (also called “balanced resuscitation” or “damage control resuscitation”). The idea is that if we bring the adult patient’s blood pressure up to normal, we may be promoting clot rupture. To avoid this, we target a MAP of 65 and look for clinical signs of sufficient perfusion. Adults tolerate hypotension relatively well, and is sufficient until we send them to the OR or interventional radiology suite. In children, this is simply not the case. Hypotension in children is a sign of pre-arrest. Remember, they compensate with an increased systemic vascular resistance and tachycardia to maintain blood pressure. We should not allow children to become hypotensive – severe tachycardia alone should prompt us to resuscitate. In other words, permissive hypotension is not permissible for children. FAST is not sensitive enough to rule-out abdominal trauma. Fox et al in Academic Emergency Medicine found a sensitivity of 52%; with a 95% confidence interval [CI] = 31% to 73%. Often children even with high-grade splenic and liver lacerations can be managed non-operatively. If they are supported adequately, they are observed in the ICU and can avoid surgery in many cases. Unfortunately, a negative FAST cannot help with detecting or grading the laceration for non-operative management. In other words, feel free to use ultrasound – especially for things that we in the ED will react to and intervene on – but CT may help to manage the traumatized child non-operatively. General Guideline for Imaging in Pediatric Trauma CT Head and Neck, non-contrast: in concerning mechanisms of injury, patients that are difficult to assess (especially those under 3 months), those with a GCS of 13 or lower. CT Chest, IV contrast: for suspicion of vascular injury that needs exploration, especially in penetrating trauma. Otherwise, chest xray will tell you everything you need to know in children – especially in blunt trauma. Hemo or pneumothoraces are readily picked up by US or CXR. Rib fractures on CXR predict pulmonary contusions. If you are concerned about great vessel injury, then CT Chest may be helpful; otherwise consider omitting it. CT Abdomen and Pelvis, IV contrast: helpful in grading splenic and liver lacerations with goal to manage non-operatively. Abdominal tenderness to palpation, significant bruising, or a seat belt sign are concerning and would generally warrant a CT. Also, consider in liver function test abnormalities, or hematuria. Extremity injuries: in general can be evaluated with physical exam and plain films. However, some injuries in high-risk anatomically complex areas such as the hand and wrist, tibial plateau, and midfoot may be missed by plain films, and CT may be helpful here. Remember: you can help to mitigate post-traumatic stress and risk for adult healthcare aversion. Summary Massive transfusion in children is at 40 mL/kg of total blood products. Think about it if you are giving your second transfusion to the traumatized child. Do everything you can to support perfusion and avoid the death spiral of hypothermia, coagulopathy, and acidosis. Keep the child perfused with blood as needed, correct coagulopathy, avoid too much crystalloid, and make sure to use the least high-tech of all of these interventions – keep him dry and covered with warm blankets. Do a careful physical exam, and use CT selectively with an end-point in mind – the default is not the pan-scan – evaluate possible injuries depending on your suspicions from history, physical, and lab tests. Become familiar with the relatively new modalities in trauma such as TXA, cryoprecipitate and the emerging technology of thromboelestogram – red wine is good for you, champagne is weak, and a puffer fish is trouble. Selected References Dehmer JJ, Adamson WT. Massive transfusion and blood product use in the pediatric trauma patient. Semin Pediatr Surg. 2010 Nov;19(4):286-91. doi: 10.1053/j.sempedsurg.2010.07.002. Fox JC, Boysen M, Gharahbaghian L, Cusick S, Ahmed SS, Anderson CL, Lekawa M, Langdorf MI. Test characteristics of focused assessment of sonography for trauma for clinically significant abdominal free fluid in pediatric blunt abdominal trauma. Acad Emerg Med. 2011 May;18(5):477-82. Harvey V, Perrone J, Kim P. Does the use of tranexamic acid improve trauma mortality? Ann Emerg Med. 2014 Apr;63(4):460-2. Holscher CM, Faulk LW, Moore EE, Cothren Burlew C, Moore HB, Stewart CL, Pieracci FM, Barnett CC, Bensard DD. Chest computed tomography imaging for blunt pediatric trauma: not worth the radiation risk. J Surg Res. 2013 Sep;184(1):352-7. Nosanov L, Inaba K, Okoye O, Resnick S, Upperman J, Shulman I, Rhee P, Demetriades D. The impact of blood product ratios in massively transfused pediatric trauma patients. Am J Surg. 2013 Nov;206(5):655-60. Ryan ML, Van Haren RM, Thorson CM, Andrews DM, Perez EA, Neville HL, Sola JE, Proctor KG. Trauma induced hypercoagulablity in pediatric patients. J Pediatr Surg. 2014 Aug;49(8):1295-9. Scaife ER, Rollins MD, Barnhart DC, Downey EC, Black RE, Meyers RL, Stevens MH, Gordon S, Prince JS, Battaglia D, Fenton SJ, Plumb J, Metzger RR. The role of focused abdominal sonography for trauma (FAST) in pediatric trauma evaluation. J Pediatr Surg. 2013 Jun;48(6):1377-83. This post and podcast are dedicated to Larry Mellick, MS, MD, FAAP, FACEP. Thank you for your dedication to medical education, and sharing your warm bedside manner, extensive knowledge and talents, and your patient interactions with the world. Powered by #FOAMed — Tim Horeczko, MD, MSCR, FACEP, FAAP

Associate Professor Nikola Sprigg is the Principal Investigator of randomised controlled trial 'Tranexamic acid in Intracerebral Haemorrhage' (TICH). Carmen Lahiff-Jenkins, Managing Editor of the International Journal of Stroke spoke to Assoc. Prof. Sprigg at the World Stroke Conference in Brasilia, Brazil.

In this episode we talk about the results of the CRASH-2 trial published in Lancet.  This trial showed that the EARLY use of Tranexamic acid may improve survivial, but delayed use may be associated with an increased mortality.  

Audio Journal of Global Health Issues Can Road-Side Tranexamic Acid Therapy Reduce Mortality and Blood Transfusions after Trauma? The CRASH Trial. JAIME MIRANDA, London School of Hygiene and Tropical Medicine, Lima An antifibrinolytic agent, tranexamic acid (commonly used to reduce bleeding during surgery) is being investigated as first-aid to cut mortality and the need for blood transfusion immediately after trauma or injury. The CRASH trial, still in its early phases in a worldwide adult population, aims to bring particular benefit to developing countries, many of which are blighted by trauma with few measures, if any, having been available up to now to reduce the death toll. In Lima, Peru, Jaime Miranda discussed his group's ongoing investigation with Peter Goodwin.