Quickhits: Whole Blood In Trauma, Triple Negative Breast Cancer, and the Linear Probe for IUP

TraumaUltrasoundOBGYN
Written By Dillon Warr

Hello Team,

Several things from last night. 

Whole Blood for Trauma?

  • In regard to the MTP trauma case last night, here is an article hot off the press from NEJM. This is one of the first major RCTs on whole blood (a lot of other observational studies have informed our care previously).

  • This pragmatic, multicenter RCT (SWiFT trial) compared prehospital whole blood vs. standard component therapy in traumatic hemorrhage and found no difference in the primary outcome of death or massive transfusion at 24 hours (48.7% vs. 47.7%). Safety profiles were comparable.

  • Limitations include the pragmatic prehospital design with heterogeneity in patient selection and treatment delivery, potential inclusion of patients without true life-threatening hemorrhage, and missing data from registry disruptions. Additionally, the intervention dose (only up to 2 units) may have been insufficient to detect a benefit.

  • Implication: Whole blood appears safe and logistically attractive, but this trial does not support clear clinical superiority over balanced component therapy in civilian prehospital trauma care.

Triple Negative Breast Cancer

  • Although we are not in charge of treating this condition, we do need to understand the basics, as patients may come in for adverse effects from the less targeted chemotherapeutic agents (like carboplatin, paclitaxel), and family may have some questions that you could help (broadly) answer .

  • Here's a long review on the topic, if you are feeling bold.

  • Big picture:  Triple-negative breast cancer is characterized by the absence of estrogen receptors (ER), progesterone receptors (PR), and human epidermal growth factor receptor 2 (HER2) on tumor cells. This lack of receptor expression results in limited treatment options, as conventional hormone therapies and HER2-targeted therapies are ineffective. It is associated with a more aggressive clinical course, poorer prognosis, and higher rates of metastasis and recurrence compared to other breast cancer subtypes.

Linear Ultrasound Probe for IUP Identification

  • See this "Trick of the Trade" from AliEM

  • The linear probe has a higher frequency, and may be able to visualize that fetal pole and yolk sac in the uterus when you think you might see something with the curvilinear probe. This could spare you a trip to radiology for a TVUS or taking the time to do one yourself.

References

Dillon Warr
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