Monday, May 24, 2021

Hypocalcaemia, Trauma and Transfusion

St Emlyn’s - By Iain Beardsell - May 22th, 2021
I’m writing this blog post after listening to the ever excellent Scott Weingart on the EMCrit podcast in discussion with the authors of this paper, to which I highly recommend you listen. Why bother to write about hypocalcaemia on St Emlyn’s when it’s already in the FOAMed forum I hear you ask. Well, I thought it would be worth considering in the UK context (as well as getting the discussion going as widely as possible). I also wanted to combine this with a critique of this paper, published in the same journal and on the same topic a few months later…
I think the time has come for us to consider giving a bolus of calcium chloride alongside the first unit of blood in the patient with traumatic haemorrhage. This intervention is low cost, easy to administer, already present in the drug packs of prehospital teams, and, although not directly studied yet, the potential benefits far outweigh the potential harm. In fact, I would recommend a minijet of 10% calcium choride is added to the kit bags containing blood products to make this even easier to remember. 
I would love to hear your thoughts on this. Will you be adding the administration of calcium early in the patient’s management when looking after those with major haemorrhage?