Code Red Trauma Call

Only a senior member of the Trauma Team who has undergone induction training can trigger Code Red Trauma.

Tranexamic acid

Tranexamic acid is an antifibrinolytic agent that inhibits activation of plasminogen to plasmin; a bolus of Tranexamic acid (1g, iv over 10 min) should be started within 3 hours of injury.  Check whether this has already been given pre-hospital.  Consider a second dose if massive bleeding has led to loss of the patient’s circulating volume.

Blood Transfusion

Emergency Group O Stock Group O Neg (use in females) and O Pos (use in males) blood available in blood track fridge for CODE RED use.
MUST INFORM Blood Bank when units used so that stocks can be replaced Switch from Group O to patient’s group as soon as possible.
CODE RED PACK A contains: 4units FFP.
CODE RED PACK B contains: 4units FFP; 1 pool Platelets; and 1 pool cryoprecipitate.

Fresh Frozen Plasma

FFP needs defrosting before issue – this takes around 30mins (allow time for transit) Each dose should contain ~15ml/kg of FFP – around 4units for average adult.

Cryoprecipitate

Cryoprecipitate needs defrosting before issue – this takes around 30mins (plus allow for time transit) Do not put cryo in fridge after defrosting since can precipitate.
Each dose should contain 2 pools cryoprecipitate for average adult.

Platelets

Stored at ambient temperature DO NOT REFRIGERATE.
Since platelets have short shelf life of 5 days only the blood bank has limited supplies of platelets and has to order additional units from the Blood centre as needed.

Laboratory testing

Must request fibrinogen as well as coagulation screen and Full Blood count for all patients with massive haemorrhage.
Repeat testing of Coagulation screen including fibrinogen and platelet count needed after transfusion of components to guide further replacement.  ROTEM testing is available to further guide you.

Recombinant FVIIa

Discuss with Haemophilia Registrar (Bleep 1155 or via switchboard on call) regarding use of rFVIIa in patient who continues to bleed despite replacement therapy with FFP, platelets and cryoprecipitate

Simulated Code Red

Follow this link to a YouTube video of a simulated Code Red produced by the RLH Trauma Anaesthetic Group, directed by Billy English.  Billy would be very grateful for feedback, which you can provide here.