Rollover at 02:15, SBP 78, GCS 7, positive FAST — activated MTP at triage before labs because waiting felt unsafe; I stand by it. Do you hold for shock index/lactate, or call it on mechanism + mentation when seconds matter?
In that scenario — rollover at 02:15, ‘SBP 78’, positive FAST — I pull MTP at the door and have the clerk pre-alert the blood bank so a 4/4/1 cooler is rolling before the patient hits CT. Do you bundle TXA with your first cooler or keep it separate? Only caveat: we set a 10–15 minute checkpoint to reassess and de-escalate if the first units turn the BP around, so we don’t overshoot.
I’m with you; my tweak is placing a verbal ‘1 g CaCl2 with the first unit’ order when I pull MTP to blunt the citrate drop and keep the pressure from cratering… I still ‘call early, cancel fast’ once the A-line trends settle — do you bundle calcium into your packs?