Which transfusion strategy should the nurse anticipate during initial resuscitation?
1Large-volume crystalloid first, followed by red blood cells after the blood pressure returns to normal
2Red blood cells alone until hemoglobin normalizes, with plasma and platelets delayed until bleeding stops
3Red blood cells, plasma, and platelets near a 1:1:1 ratio, followed by laboratory-guided adjustment✓ Correct answer
4Ten units of red blood cells for each unit of plasma and platelets to avoid early coagulation-factor exposure
Explanation
Massive transfusion protocols provide rapid balanced hemostatic resuscitation during life-threatening hemorrhage. Early red blood cells, plasma, and platelets are commonly delivered near a 1:1:1 ratio under the institutional protocol, limiting dilutional coagulopathy and excessive crystalloid exposure. After hemorrhage control or when laboratory or viscoelastic results are available, component therapy is adjusted to the client's needs. Red-cell-only or 10:1:1 strategies neglect coagulation factors and platelets.
Clinical reasoning Severe hemorrhage removes oxygen-carrying cells, clotting factors, platelets, calcium, and heat. Replacing red cells without hemostatic components worsens trauma-associated and dilutional coagulopathy.
Decision rule Activate the local massive transfusion protocol early, deliver balanced blood components rapidly, warm products as appropriate, monitor calcium and temperature, and transition to goal-directed replacement when feasible.
Scenario A trauma client has ongoing life-threatening hemorrhage, and the hospital's massive transfusion protocol has been activated.
Massive transfusion protocol — A predefined system for rapid delivery of balanced blood components during life-threatening hemorrhage.
Damage-control resuscitation — A hemorrhage strategy emphasizing rapid bleeding control, balanced blood products, limited crystalloid, temperature control, and correction of coagulopathy.
Tranexamic acid (TXA) — Antifibrinolytic; reduces mortality if given within 3 hours of trauma.