Estoy cansada.

Massive transfusion is arbitrarily defined as the replacement of a patient's total blood volume in less than 24 hours, or as the acute administration of more than half the patient's estimated blood volume per hour.

But that's just a definition. In an ideal reality, once the Massive Transfusion Protocol (MTP) has been activated the first container of blood and blood products is sent in a matter of minutes and the second is being prepared.  There is a designated courier to run back and forth from the blood bank and the location under the thralls of the MTP.  And he/she keeps running back and forth until for one reason or another the MTP is cancelled. But that's just how it would work ideally.

You can guess what I'm leading up to.

We had a patient come to the Trauma ICU last night directly from the OR. Blood was pouring out of the drains.  Oozing from the orifices.  The patient was hypotensive, acidotic and hypothermic; the deadly triad. We set to work.  The MTP was activated and, as the intern, I spent the next 6-7 hours running back and forth through the hospital in between the Blood Bank and the TICU.  We spent those 6-7 hours flirting with the oh-so-stoic line between life and death. Raising the patient's core body temperature to a point where the blood would theoretically start to clot again.  Keeping the blood pressure to a level that would maintain perfusion to the patient's organs. But what we poured in just came out again even faster.

I lost track of how many trips I made over the course of those hours of hypervigilance. But one thing is an understatement... "replacement of a patient's total blood volume in less than 24 hours."  We had complete replacement of the patient's total blood volume hourly, at the least. At the end, the floor was cluttered with the numerous canisters filled with the hemorrhage that just never stopped.  Even with the hypothermia finally corrected, it just never stopped. 

Much Love.