NBME Step 2 CK Form 7 Transfusion of group O, Rh-negative packed red blood cells (NBME Answers)

Retired NBME Step 2 CK Form 7 Answers

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A 27-year-old man is brought to the emergency ...
Transfusion of group O, Rh-negative packed red blood cells 🔍 / 📺 / 🌳 / 📖
tags: surgery inc

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submitted by ∗yotsubato(1208)

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The indications for blood transfusion for pelvic fracture patients are systolic blood pressure of <90 mmHg, heart frequency >130 bpm and clinical symptoms of shock. In an emergency, combined transfusion of red blood cells, plasma and platelets (6-4-1) is preferred (19).

So...... This question is bullshit?

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study_dude_guy I spent way too long trying to find this paper. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5394148/ The flow chart is the first figure In major trauma, you give 1-2 L of fluid and check for response, if they are still hypotensive you give blood products. +1

seagull This is a question of elimination. A) Epinephrine would increase his heart rate which is already at 130 B) No idea what this is- cross it off C) Recombinant factor 8 - tx hemophilia A D) reverse anticoagulation but not commonly used. PCT is used now. E) PT is hypotensive and actively bleeding in chest - makes most sense +4

prasadnadendla We can eliminate epinephrine as an answer because the patient is not having anaphylaxis or septic shock. The patient's hypotension and tachycardia are due to hypovolemia. Because they have already received a significant amount of crystalloids the next step is a blood transfusion. If too much crystalloids are infused the patient can get a coagulopathy including DIC due to dilutional thrombocytopenia. +1

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submitted by ∗step_prep5(246)

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Key idea: Patient has active bleed into chest (right hemopneumothorax with negative FAST) that is not responding to fluids (remains tachycardic and hypotensive after 3L crystalloid), and therefore should be managed with blood product resuscitation + surgical intervention
Key idea: Group O, Rh-negative blood can be given to patients of all ABO and Rh blood types

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submitted by dreamyyn(10)

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Just regarding Seagull's subcomment, hetastarch is a colloid solution (in contrast to normal saline or lactate ringer's which is crystalloids) and is the second-line treatment to expand the volume in patients with non-hemorrhagic shock (the first line is crystalloids). Blood transfusion should be given to hemorrhagic shock.

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