Tranexamic Acid

Hello all,

I wonder if someone out there in RAMC land would be willing to help me out with something? I'm a student paramedic (and serving sTAb, but Gunner cap badged, please don't hold that against me...) and I'm writing a paper on the feasibility of introducing Tranexamic acid into ambulance service use. I think I've managed to find most of the information I need, but I haven't yet been able to find anything on how the RAMC is currently using Tranexamic acid in the field. For example, do you guys have a 'JRCALC' style aide memoire detailing indications, contraindications, cautions, dosages etc???

Any help would be much appreciated.

Many thanks,

Our trust is rolling it out to all paramedics.
I have just signed the pgd .
It was just for the critical care paramedics but now all paras are getting it.
We also now have activated charcoal and getting iv paracetamol too.
Yeah, have just this afternoon discovered the SWAS PGD for it, which probably gives me everything I was looking for. However this seems quite forward thinking so am not expecting my own service to be following anytime soon, and I think my paper should stand for at least a few years yet!

Activated charcoal and IV parac make a lot of sense too, and would do for my own service given some of the transfer to hospital times we incur. Can't imagine there are too many contraindications for the lovely charcoal beverage!
Bizzarely we received charcoal before paracetamol. Jrcalc have just agreed to iv paracetamol. All we have is entonox and morphine/oramorph. So iv paracetamol will be useful in treating pain and pyrexia

We are still using 2006 guidelines. Apparently there is some bunfight as to owns the rights to Jrcalc guidelines and pocket aid memoirs. So we won't see the 2012 guidelines soon?
TXA has been part of the obsteric arsenal for some time - non compressable bleeds an'all that. It's available to me in my particular practice for the same reason but in relation to trauma.

IV Parrots'eatumall, Midaz, Oramorph, Fent, Ket and a few other bits as well. Not sure if this will roll out to NHS ambo service any time this century though.

As for JRCALC. What a complete clusterfuck. The whole fuckin lot of'um should be sacked. It would be quicker to start again, and end up with the document we need, rather than suffer the delays and nonsence that bunch of self serving, over importantant tools.

Mind you, Dr Joanna from JRCALC is/was a bit of a looker (if it's the same one that I met), so all is not lost.

Wonder if Rohypnol will make it onto the list?
Have you heard of the BNF?

Unfortunately BNF doesn't give me the nice easy-peasy dosage info I was looking for. It's all well and good if I want to sit down, take the patient's weight and then calculate an exact dosage based on BNF's 25-50mg/kg (over 24 hours), but I was looking for the much more punchy, "feck, this bugger's bleeding out, quick whack in a cannulla and give TXA *now*" typey answer. SWAS's PGD gave me exactly that: for adults, 1gm IV (or IO) administered over 10 minutes:


Nope, not 266. A tad further North than that.

Once upon a time, I used to routinely give 1g of tranexamic acid i.v. to patients at the end of a TURP (clearly this is elective civvy work, not mil or pre-hospital).

Don't bother anymore. There's a theoretical risk of stroke, but I had none in my small cohort (and they were arguably a higher-risk group).
Clearly I work for a forward thinking outfit, we already deploy TXA & IV Paracetemol, Actvated Charcoal is a bit of new one but I think it was carried years ago, funny how things go in and out of favour. Wonder if I just took some BBQ briquettes in to work and got punters to chew on them that would help ?
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