AEMT/PARAMEDIC Standing Order:

Adult:

INDICATIONS:

• Evidence of significant blunt or penetrating trauma (e.g. ejection from automobile, fall > 20 feet, pedestrian struck, penetrating injury to neck, torso, etc.)
• Evidence or concern for severe external and/or internal haemorrhage (bleeding requiring tourniquet, amputation proximal to wrist or ankle, unstable pelvis, two or more long bone fractures, concern for significant intra-thoracic or intra-abdominal injury, etc.)
• Presence of one or more markers of hemodynamic instability:
  • Sustained BP < 90
  • Sustained HR > 110 after pain adequately treated.
• Injury must have occurred within the past 3 hours.

CONTRAINDICATION:

• < 15 years old • Previous allergic reaction to TXA
• Isolated head injury
• Injury > 3 hours’ old
• Patients who have received or will receive prothrombin complex concentrate (PCCs), factor VIIa, or factor IX complex concentrates
• Women who are known or suspected to be pregnant with a fetus of viable gestational age. ( > 24 weeks).

PROCEDURE:

Mix 1 g of TXA in 100 mL of 0.9% NaCl or LR. Infuse via wide-open IV/IO bolus over approximately 10 minutes. Notify the receiving facility of TXA administration prior to arriving OUR PROTOCOL IS TO MIX 1g/100ml.

PEARLS:

• The greatest benefit is seen when TXA is administered to patients within 1 hour of injury.
• Rapid IV push may cause hypotension.
• If there is a new onset of hypotension, slow the TXA infusion.
• Protect patients from extremes in temperatures.
• Do not administer in the same line as blood products, or PCN (penicillin).
• Good documentation of time of injury, and time of TXA administration is necessary.