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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. Provide a brief overview of transfusion reactions Provide a definition of TRALI

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Becky Piper , MN RN Pierce College Nursing Program

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  1. Transfusion Related Acute Lung Injury: A Simulation Case Experience For Nurse Educators Becky Piper, MN RN Pierce College Nursing Program

  2. Objectives • Provide a brief overview of transfusion reactions • Provide a definition of TRALI • Describe the steps used to build the TRALI SCE

  3. 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

  4. TRALI Fatalities

  5. Recent Trends TRALI Deaths

  6. TRALI vs. TACO

  7. TRALI vs. Normal Lung

  8. 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.

  9. Knowledge Gaps • Lack of information on TRALI for nurses and transfusionists in peer review journals • Few nursing text books mention it!

  10. 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

  11. 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.

  12. 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.

  13. 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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