Unique Plan Description: Massive Blood Transfusion Protocol (MH WH)
Plan Selection Display: Massive Blood Transfusion Protocol (MH WH)
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2023-01-03 09:47:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2024-01-17 09:25:35
Available at all facilities: Yes

Massive Blood Transfusion Protocol (MH WH)
Laboratory
		Physician to notify or delegate a specific person to call blood bank to initiate and with termination of MTP procedure(NOTE)*
	Type and Screen (No Product on hold)
		T;N, Stat, spec type = Blood
	.Crossmatch electronic
		T;N, Stat, Need by STAT-Massive Txn, # to GIVE 4, No Requirements, # to HOLD 4, Emergency Release
	Comprehensive Metabolic Panel
		T;N, Stat, spec type = Blood
	CBC with Diff
		T;N, Stat, spec type = Blood
	Prothrombin Time - MH/WH/JE
		T;N, Stat, spec type = Blood
	Partial Thromboplastin Time - MH/WH/JE
		T;N, Stat, spec type = Blood
	Fibrinogen Level - MH/WH/JE
		T;N, Stat, spec type = Blood
	Ionized Calcium
		T;N, Stat, spec type = Blood
	Magnesium Level
		T;N, Stat, spec type = Blood
	Blood Gases Arterial (ABG) - MH/WH/JE
		T;N, Stat, spec type = Blood
	CBC with Diff
		T;N+60, Timed, spec type = Blood
	Prothrombin Time - MH/WH/JE
		T;N+60, Timed, spec type = Blood
	Ionized Calcium
		T;N+60, Timed, spec type = Blood
	Fibrinogen Level - MH/WH/JE
		T;N+60, Timed, spec type = Blood
	Magnesium Level
		T;N+60, Timed, spec type = Blood
	Basic Metabolic Panel
		T;N+60, Timed, spec type = Blood
	CBC with Diff
		T;N+120, Timed, spec type = Blood
	Prothrombin Time - MH/WH/JE
		T;N+120, Timed, spec type = Blood
	Partial Thromboplastin Time - MH/WH/JE
		T;N+120, Timed, spec type = Blood
	Ionized Calcium
		T;N+120, Timed, spec type = Blood
	Fibrinogen Level - MH/WH/JE
		T;N+120, Timed, spec type = Blood
	Magnesium Level
		T;N+120, Timed, spec type = Blood
	Basic Metabolic Panel
		T;N+120, Timed, spec type = Blood
	Partial Thromboplastin Time - MH/WH/JE
		T;N+240, Timed, spec type = Blood
Diagnostic Tests
	ECG
		T;N, Stat, Indication: Arrhythmia
IV Solutions
	Sodium Chloride 0.9%
		500 mL, IV, STAT, T;N, 1 Dose(s)/Time(s), T+1;N, 20 ml/hr
			Comment: To Run w/ Blood
Medications
	calcium gluconate IVPB
		3,000 mg, INT, IVPB, Once, PRN see comment, 200 ml/hr
			Comment: Give after the 4th unit of blood. Send to Bedside
	desmopressin
		0.3 mcg/kg, INT, IVPB, Once, STAT
			Comment: Consider in renal failure, thrombocytopenia, or antiplatelet drugs
	magnesium sulfate 4gm in 100mL water
		4 gm, IVPB, Once, 200 ml/hr
			Comment: 4 gm in 100 mL water, infuse over 30 minutes
	tranexamic acid IVPB
		1,000 mg, INT, IVPB, Once, STAT
			Comment: Hemorrhage management
	Vitamin K IVPB
		1 mg, INT, IVPB, Once, STAT
		2.5 mg, INT, IVPB, Once, STAT
		5 mg, INT, IVPB, Once, STAT
		10 mg, INT, IVPB, Once, STAT
Patient Care
	Peripheral Lock-Insert
		T;N, Once, Insert Two
	Cardiac Telemetry Monitoring
		T;N, Telemetry Indications: Electrolyte disorder
			Comment: Verify rhythm on initiation. Constant Indicator
	Foley Catheter
		T;N, Foley, Insert, Critically ill requiring accurate output
			Comment: Use temperature sensing catheter
	Continuous Pulse Oximetry Monitoring Check
		
	Notify
		Physician to notify or delegate a specific person to call blood bank to initiate and with termination of MTP procedure

*Report Legend:
DEF - This order sentence is the default for the selected order
GOAL - This component is a goal
IND - This component is an indicator
INT - This component is an intervention
IVS - This component is an IV Set
NOTE - This component is a note
Rx - This component is a prescription
SUB - This component is a sub phase