TXA v2

Today we're going to talk about TXA, tranexamic acid. This is a new medication per the 2023 PBCFR patient care protocols. So let's go ahead and talk about what this drug is indicated for, how it's used, and how we're going to dose this and the patients that are going to get it and are not going to get it. Let's start off by talking about what tranexamic acid actually is. So first thing that we need to remember is we got to remove a misconception. This is not a pro coagulant. It doesn't actually create clots in the body. What it does is it prevents the breakdown of clots that are already forming. The instant there's an injury, a broken vessel of any type, the clotting process begins, that cascade starts to take effect immediately. What TXA does is it prevents the body from breaking that down. So what brought about txa, especially in the types of patients that we're going to be giving it to? There was a study that was done called the Crash2study. In the Crash2study, they found out that TXA was helpful in patients that have bleeding. They also found that there was a subsection of patients that were that benefited from this. And they did a further study called the Crash 3 study. And in this study they found that patients that actually had head injuries secondary to trauma, those patients additionally benefited from txa. So we're going to talk about the three different protocols that we're going to give this drug. We're going to talk about some tips on how to administer the drug, and then obviously the contraindications at the end of this. So let's talk about the patients who are going to benefit from txa. So trauma, hemorrhagic shock. In those types of patients, they're going to benefit from txa. A lot of times in our patients that have extremity injuries, you know, we can put a tourniquet on them, we can apply direct pressure, we can elevate the limb, we can use all sorts of means to help slow, control, compress the bleeding. But you got to think about a lot of our patients have what we call non compressible bleeds. Whether it's inside their head, whether it's inside their chest or abdomen, or even in the junctional areas. It's very difficult for us to truly compress those. You can't put a tourniquet on those types of injuries. So TXA is going to help especially, especially in those types of patients with non compressible bleeds, but it's very beneficial for anybody that is bleeding out secondary to trauma. So it's going to be indicated for patients in traumatic hemorrhagic shock with or without whole blood. If you have whole blood available, that's the drug of choice. First and foremost, get the whole blood into the patient and then follow it up with txa. If you don't have whole blood available, they can still get txa. It's still going to be beneficial. Another patient that would benefit greatly from this is patients that have head injuries. In traumatic injuries, patients that have a GCS equal to or less than 12. Those patients have been shown, based on that crash 3 study that we referenced earlier, those patients have been shown to benefit from the administration of txa. Think about this. They got a bleed inside their head we cannot compress. So if we do something to assist in that clotting process, these patients have better outcomes. Here's the criteria for that head injury though. The injury has to have taken place within three hours. If it's outside that three hour window, we are not going to be administering txa. It is not going to be helpful. The earlier TXA is administered after the injury, the more, the more benefit you get from this medication. So those are some of the outlines of who's going to get the drug and how it's going to benefit them. Let's talk about contraindications. Already said this, but time of injury is greater than three hours. We are not administering txa. And then for medical hemorrhagic shock, there are patients that would benefit from a whole blood transfusion. Let's say they've got an esophageal varices rupture. Let's say they've got some sort of GI bleed and those patients would benefit from whole blood. We are not going to administer tranexamic acid to those patients. So if the reason they're bleeding out is secondary to a medical issue, no txa. If the reason they're bleeding out is secondary to trauma, we will be administering TXA to that person. Or if the reason that we're administering TXA is secondary to a head injury, that's another indication for this medication. Let's talk about dosing. So the dose is going to be for the standard adult, it's going to be 2 grams. Now if you look at the medication, the medication actually comes packages. A thousand milligrams in 10 mls or one gram in 10 mls. We're going to need two of these in order to get the actual to get the correct dose into the patient. So you'll need two vials. The best way to accomplish that will be with a 20cc syringe. That way we can draw the whole amount up at once. What we're going to do is we're going to admit it. We're going to add this medication to a 50cc bag. Use your blunt tip needle. Remember, the blunt tip needle is only to be used for medication, for transferring medications from a vial to a syringe or from a syringe to a bag. It's never intended to be used as an IM shot. That's not nice. Okay, so we're going to put the medication into the. Into the medication bag. Always label your bags. The best practice, label your bag. And then what we're going to do is we're going to spike this with a 60 drop set. We're going to run this wide open. Now, if I have to choose between administering whole blood or txa, you got to get blood in first. After the blood goes in, go ahead and give the TXA afterwards. Those two in conjunction is going to do an awful lot to help these patients who are bleeding out and are losing those clots, clotting factors actively through the bleed. So for adult patients, 2 grams 50cc bag, 60 drop set, run wide open. Let's talk about pediatrics. If any of these indications for TXA apply to that particular patient, whether it's a head injury or traumatic hemorrhagic shock, we are going to be administering tranexamic acid to these patients up until the age of 5, 5 years old, any younger than 5. We are not administering TXA to those patients. And if you reference the hand tevy app, it'll tell you exactly the amount of MLS to add to the 50cc bag. The administration process is exactly the same. 50cc bag, 60 drop set. Label your medication bag, run it wide open. Lastly, who's going to be carrying this drug? This is going to be on every EMS captain's truck in the county and it's also going to be on trauma Hawk. So if this patient, let's say you're at a battalion, that does not have the ability to administer whole blood because you don't have access to it, you would still want to call out that EMS captain to come out and administer tranexamic acid to that patient. It's going to be a benefit to that patient, even though we don't have blood to give them. Now, obviously, if there is blood available, get the blood into the patient, then we'll administer the tranexamic acid. And the flight crews, they have blood as well, so anytime they show up on scene, if they're administering blood or for traumatic hemorrhagic shock, they'll be administering tranexamic acid. If you have any questions regarding this drug, please reach out to your EMS captains or the medical services division. We'll be happy to answer any questions you have on this. Thank you very much. Stay safe.