TXA – Nor-Cal EMS

Tranexamic Acid – TXA

The number of attempts remaining is 4

1 / 14

All ALS organizations are required to conduct a 100% review of all prehospital TXA administrations.

True

False

2 / 14

In the CRASH 2 study there was an increase in the mortality rate for patients who received TXA greater than 3 hours after the traumatic event.

True

False

3 / 14

TXA leads to the formation of fibrin which is the ‘mesh’ that impedes blood flow for the formation of a clot.

True

False

4 / 14

TXA is a synthetic amino acid (lysine) that blocks plasminogen from being converted to the enzyme plasmin (the enzyme that halts the clotting process)?

True

False

5 / 14

Which of the following is a possible side effect of TXA:

Acute gastrointestinal disturbances

Visual disturbances

Thromboembolic events (DVT, PE, etc.)

All of the above

6 / 14

Which of the following is the correct procedure for administration of TXA

IV/IO push as rapidly as possible

IV/IO push over 2 minutes

Mix appropriate dose of TXA with 100 mL or 250 ml bag D5W or NS and infuse over 10 minutes

Mix appropriate dose of TXA with 1000 mL NS or LR and run wide open

7 / 14

What is the correct dose of TXA:

0.5gm

1 gm

100 gm

8 / 14

Which one of the following is not a contraindication for administration of TXA:

Time since injury > 3 hours

Isolated traumatic brain injury

Thromboembolic event (i.e. stroke, MI, PE, DVT) within the past 24 hours

Traumatic arrest with > 5 minutes of CPR without ROSC

Patient has no visible bleeding

9 / 14

Which of the following is an indication for administration of TXA under Nor-Cal EMS standing order treatment protocol:

Blunt or penetrating traumatic injury with signs and symptoms of hemorrhagic shock (including SBP < 90)

Hemorrhage not controlled with direct pressure, hemostatic agents, or commercial tourniquet application

both a and b

10 / 14

What is the minimum patient age for administration of TXA under Nor-Cal EMS standing order treatment protocol?

none

12 years old

15 years old

18 years old

11 / 14

Which one of the following describes the mechanism of action of TXA

Synthetic derivative of lysine that inhibits fibrinolysis by blocking the lysine binding sites on plasminogen

Inhibits both plasminogen activation and Plasmin activity thus preventing clot breakdown

Catalyzes the conversion of plasminogen to plasmin

Both a and b

12 / 14

Which one of the following is not a contributing factor to trauma-associated hyperfibrinolysis:

Vasodilation

Blood loss

Dysfunction of coagulation factors due to hypothermia and acidosis

13 / 14

The coagulation process is sometimes described as a ‘cascade’ because chemicals called clotting factors prompt reactions that activate additional clotting factors

True

False

14 / 14

Which of the following is not one of the three steps/items needed to achieve hemostasis:

Vascular spasm

Platelet plug formation

Administration of crystalloid IV fluid boluses

Coagulation

Your score is

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