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(PT/INR, PTT, platelets). Some centers are now trialing the use of cold-stored
whole blood for the resuscitation of bleeding children. Controversy remains
regarding the role of tranexamic acid (TXA), an antifibrinolytic agent, as an
adjunct for the treatment of hemorrhagic shock. In bleeding adults, administration
of TXA within 3 hours after injury was associated with a survival advantage.
There is minimal data available in children, but it seems reasonable to treat
hemodynamically unstable victims of penetrating trauma with TXA, as well as
those with laboratory evidence of fibrinolysis (on viscoelastic testing). Large-bore
intravenous catheters are preferable, whether in the upper or lower extremities, to
allow rapid infusion of large volumes of fluid during resuscitation. Ideally, the
blood should be given through a warming device, to avoid significant
hypothermia from refrigerated blood products. Accessing the femoral vein is
acceptable and in fact is a preferred site in children in the rare instances when
central access is needed.