UMEM Educational Pearls - By Caleb Chan

Category: Critical Care

Title: Critical Care Pearls for Blood Transfusions

Posted: 10/1/2019 by Caleb Chan, MD (Updated: 4/30/2024)
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Blood Transfusion Thresholds in Specific Populations

Sepsis - 7 g/dL

non-inferior to 9 g/dL (which was previously recommended in early goal-directed therapy and early Surviving Sepsis guidelines)

Acute Coronary Syndrome - no current specific recommendations pending further studies

recent MINT pilot study showed unexpected trend toward higher combined mortality and major cardiac events in restrictive transfusion arm (8 g/dL) vs. liberal arm (10 g/dL)

Stable Cardiovascular Disease - 8 g/dL

no difference in 30-day mortality compared to 10 g/dL, excluding those who have undergone cardiac surgery

Gastrointestinal Bleeds

UGIB - 7 g/dL (unless intravascularly volume depleted or h/o CAD)
- better 6 week-survival, less re-bleeding compared to 9 g/dL
LGIB - 7 g/dL, limited evidence, but based on UGIB data

Acute Neurologic Injury - Traumatic Brain Injury - 7 g/dL

no significant difference in neurologic recovery at 6 weeks or mortality vs. 10 g/dL, although there were more brain tissue hypoxia events in restrictive arm
anemia and transfusions both associated with worse outcomes in TBI

Postpartum Hemorrhage - 1:1:1 ratio strategy

Category: Critical Care

Posted: 8/14/2019 by Caleb Chan, MD
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The Kidney Transplant Patient in Your ED

Acute bacterial graft pyelonephritis is the most frequent type of sepis (bacterial pneumonia is the second most common source)
Obtain renal transplant imaging to evaluate for sources of infection (i.e. urinary tract obstruction, renal abscess, or urine leakage)
BK polyomavirus may reactivate and lead to nephritis, ureteral stenosis, or hemorrhagic cystitis
Pneumocystis pneumonia is the most common fungal infection in patients without prophylaxis and after prophylaxis discontinuation (adjunctive steroids for treatment is controversial)
Vascular access may be challenging. Avoid subclavian lines or femoral venous acess on the side of the graft
Cardiovascular disease is the leading cause of mortality (accounts for 40-50% of deaths after the first year following renal transplant)