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Transfusion Related Acute Lung Injury: A Simulation Case Experience For Nurse Educators. Becky Piper , MN RN Pierce College Nursing Program. Objectives. Provide a brief overview of transfusion reactions Provide a definition of TRALI

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becky piper mn rn pierce college nursing program

Transfusion Related Acute Lung Injury: A Simulation Case Experience For Nurse Educators

Becky Piper, MN RN

Pierce College

Nursing Program

objectives
Objectives
  • Provide a brief overview of transfusion reactions
  • Provide a definition of TRALI
  • Describe the steps used to build the TRALI SCE
trali
TRALI
  • TRALI defined
  • Pathophysiology

4 primary causes

  • HNA/HLA antibodies
  • Multiparous donors (>3pregnancies)
  • Lipid priming agents from older PRBC products
  • First hit-second hit model
treatment
Treatment
  • Symptoms may be mild to severe
    • If severe may need intubation to support respiratory system - treatment in ICU
    • Use of steroids
    • Lasix (Furosimide) is NOT appropriate
  • Symptoms may subside within 96 hrs.
knowledge gaps
Knowledge Gaps
  • Lack of information on TRALI for nurses and transfusionists in peer review journals
  • Few nursing text books mention it!
building the trali simulation
Building the TRALI Simulation
  • Research – TRALI and Simulation in Nursing
  • Writing the simulation using UWSON template
  • First review by Simulation experts at UWSON
  • Review by two Medical Directors

Dr. Tom Baker, Cascade Regional Blood Services – Tacoma

Dr. Bob Ranlett, Inland Blood Centers - Spokane

  • Trial runs for debugging
trali case study
TRALI Case Study

Case Description:

Your patient is Lucy Leardal, a 72 yr old female who tripped over her cat and was subsequently admitted in the evening through the Emergency Room with a left hip fracture. Lucy has a history of A-Fib and takes 5 mg of Coumadin daily.

trali case study1
TRALI Case study
  • You have just come out of shift report. Your patient is scheduled for hip surgery tomorrow

(ORIF). She is receiving the first of three units of FFP ordered to reverse the effects of Coumadin prior to the surgery. She has received approximately 50 ml of the first unit of FFP.

references
References
  • Fatalities reported to FDA , Annual summary for fiscal years 2005 and 2006

http://www.fda.gov/cber/blood/fatal0506.htm

  • Bradley, P. (2006). The history of simulation in medical education and possible future directions. Medical Education, (40), 254-262.
  • Issenberg, S.B., McGaghie, W., Petrusa, E., Gordon, D. & Scalese, R. , (2005). Features and uses of high fidelity medical simulation that lead to effective learning: a BEME systematic review. Medical Teacher,(27) 1, 10 - 28.
  • Jeffries, P.R., (Ed.), (2007). Simulation in Nursing Education, New York: National League for Nursing.
  • Perkins, G. (2007). Simulation in resuscitation training. Resuscitation, (73), 202-211.
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