Question

Case Introduction An ambulance emergency response team notifies an emergency room (ER) that they are 4 minutes away, with two females, ages 31 and 32, and a 32-year-old male, who have just been in an accident and have life-threatening injuries. They request a flight team to pick the patients up from the ER and take them to the nearest level 1 trauma center immediately. They also ask that a code response team be ready with as many units of blood as possible. The physician on staff orders all O negative units to be taken to the ER STAT. The hospital has only 3 0 negative units on hand, but they have 15 O positive units, all of which are taken to the ER. The type and screens that were drawn in the ambulance are given to the phlebotomists as soon as the ambulance arrives at the hospital. The physician orders that the female who has the most life- threatening injuries should be given all of the O negative units, and the other female, who seems stable at the moment, is to be given two units of O positive red blood cells. The male has less-serious injuries, so the physician orders that he is to be emergency screened for blood and Rh type before being given any units of blood. The females have lost so much blood that the physician orders that each of them should be given an additional four o positive units before the flight team can get there to pick them up

1. Did the physician handle this situation correctly? Why or why not? Support your argument. (8pts)

2. If the second female was typed O negative and was given 2 units of O Positive blood, what can be done to remedy the situation? (6pts)

Answer 1

QUESTION 1-

In the case given above, The hospital is clearly in the shortage of resources i.e. O negative blood. In such cases a medical triage should be used to determine who gets the treatment based on the degree of injury.

Hence, The physician has handled the case correctly by giving all of the O negative blood to the woman who had sustained life-threatening injuries.

A medical triage is mostly used in cases of natural disasters were there are too many casualities and shortage of resources. It can also be used in situations such as these. The one sustaining more life threatening injuries should be treated efficiently as early as possible, within the golden hour. Thus, increasing her chances of survival.

QUESTION 2-

O negative blood is a universal donor but can receive blood only from O negative. Unfortunately, O negative blood is also highly rare and much in demand

Many a times, O positive is given in emergency situations when O negative blood is unavailable and there is no time for cross-matching, Justlike in the scenario described above. In such situations, if the male patient receives O positive blood, the body could produce antibodies against the blood which is being transfused and cause some serious complications such as Acute immune hemolytic reaction or a delayed hemoytic reaction. In eaither of the cases the following steps can be used-

• stop the transfusion immediately
• monitor the patients blood pressure and temperature
• monitor the kidney function
• trasfuse compatible blood to the receiver