Something I have been preaching for a decade has finally gotten the attention and research it deserves. On this episode, I get two of the authors from the Lethal Diamond Paper to discuss hypocalcemia in the bleeding patient.
Ricky Ditzel
Prior Special Operations Combat Medic and current Premed Postbacc Student at Columbia trying to go to medical school
Jeffrey Siegler
EM Doc & EMS Physician at Wash U in St. Louis
Read the Lethal Diamond Paper

* Official JTACS Lethal Diamond

Here is a powerpoint from Ricky
The Lethal Triad Should be the Lethal Diamond
Calcium is an independent part of the death spiral, but it is also intertwined with the other three factors as this diagram demonstrates:

Calcium in Clotting
 

from @MikeEMPharmD  data from: Giancarelli A, Birrer K, Alban R, Hobbs B, Liu-DeRyke X. Hypocalcemia in trauma patients receiving massive transfusion. J Surg Res. 2016;202(1):182-187. [PubMed]
What to Do

* Give calcium with your first unit of blood in trauma (and TXA)
* Consider giving 1g for every 2-4 products you administer during large transfusion
* Send and Respond to Icals

Read these Papers

* MilMed
* Citrate in Cirrhotics
* Hypocalcemia during MTP
* mass trans
* Ionised-calcium-levels-in-major-trauma-patients-who-received-blood-in-the-emergency-department
* Howland WS, Schweizer O, Carlon GC, Goldiner PL. The cardiovascular effects of low levels of ionized calcium during massive transfusion. Surg Gynecol Obstet 1977; 145:581.
* Hypocalcemia in trauma patients receiving massive transfusion. J Surg Res. 2016;202(1):182-187.

Related EMCrit Stuff

* Hypocalcemia
* EMCrit 278 – Labors of Trauma – Blunt Edition (Part 1)
* EMCrit Podcast 13 – Trauma Resus II: Massive Transfusion
* Massive Transfusion Protocol (MTP)

Now on to the Podcast...