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Module 3: The Body's Response to Injury

Segment 13: Postoperative Care Concerns

References labeled PEDS contain a pediatric element or primary focus.

Topic: Postoperative care concerns

  • Shandaliy Y, Busey K, Scaturo N. Impact of a calcium replacement protocol during massive transfusion in trauma patients at a level 2 trauma center. Am J Health Syst Pharm. 2024;81(Supplement_4):S160-s165. doi: 10.1093/ajhp/zxae099 https://pubmed.ncbi.nlm.nih.gov/38578328/.

Topic: Transfusion-related concerns

  • Brandt MD, Liccardi C, Heidle J, et al. Prevalence of trauma-induced hypocalcemia in the prehospital setting. J Spec Oper Med. 2023;23(2):44-48. doi: 10.55460/wyej-1m3j https://pubmed.ncbi.nlm.nih.gov/37094288/.
  • Byerly S, Inaba K, Biswas S, et al. Transfusion-related hypocalcemia after trauma. World J Surg. 2020;44(11):3743-3750. doi: 10.1007/s00268-020-05712-x https://pubmed.ncbi.nlm.nih.gov/32734451/.
  • Ciaraglia A, Lumbard D, DeLeon M, et al. Retrospective analysis of the effects of hypocalcemia in severely injured trauma patients. Injury. 2024;55(5):111386. doi: 10.1016/j.injury.2024.111386 https://pubmed.ncbi.nlm.nih.gov/38310003/.
  • Dandan Z, Yiting W, Shengqiang Z, et al. Systematic review of prediction models for post-traumatic hypothermia risk. Injury. 2025;56(12):112883. doi: 10.1016/j.injury.2025.112883 https://pubmed.ncbi.nlm.nih.gov/41240776/.
  • Davids R, Robinson G, Van Tonder C, et al. Jehovah’s Witness needing critical care: A narrative review on the expanding arsenal. Crit Care Res Pract. 2024;2024(1):1913237. doi: 10.1155/2024/1913237 https://pubmed.ncbi.nlm.nih.gov/38813134/.
  • DeBot M, Sauaia A, Schaid T, et al. Trauma-induced hypocalcemia. Transfusion. 2022;62 Suppl 1:S274-s280. doi: 10.1111/trf.16959 https://pubmed.ncbi.nlm.nih.gov/35748689/.
  • DiFrancesco NR, Gaffney TP, Lashley JL, et al. Hypocalcemia and massive blood transfusions: A pilot study in a Level I trauma center. J Trauma Nurs. 2019;26(4):186-192. doi: 10.1097/jtn.0000000000000447 https://pubmed.ncbi.nlm.nih.gov/31283747/.
  • Ditzel RM, Jr., Anderson JL, Eisenhart WJ, et al. A review of transfusion- and trauma-induced hypocalcemia: Is it time to change the lethal triad to the lethal diamond? J Trauma Acute Care Surg. 2020;88(3):434-439. doi: 10.1097/ta.0000000000002570 https://pubmed.ncbi.nlm.nih.gov/31876689/.
  • Dupuy C, Martinez T, Duranteau O, et al. Comparison of the lethal triad and the lethal diamond in severe trauma patients: a multicenter cohort. World J Emerg Surg. 2025;20(1):2. doi: 10.1186/s13017-024-00572-5 https://pubmed.ncbi.nlm.nih.gov/39773274/.
  • Fang X, Mo C, Zheng L, et al. Transfusion-related acute lung injury: From mechanistic insights to therapeutic strategies. Adv Sci (Weinh). 2025;12(11):e2413364. doi: 10.1002/advs.202413364 https://pubmed.ncbi.nlm.nih.gov/39836498/.
  • Hewgley WP, Griffin RL, Baird E, et al. Early calcium replacement after minimal blood transfusion is associated with adverse outcomes. Eur J Trauma Emerg Surg. 2026;52(1) doi: 10.1007/s00068-026-03282-6 https://pubmed.ncbi.nlm.nih.gov/42565997/.
  • Kuriri FA. Transfusion-related acute lung injury (TRALI): Current understanding, challenges, and future directions. Saudi Med J. 2025;46(8):865-877. doi: 10.15537/smj.2025.46.8.20250233 https://pubmed.ncbi.nlm.nih.gov/40840955/.
  • Laing ML, Burtch K, Storrer A, et al. Standardized calcium replacement in massive transfusion: A quality improvement project. J Trauma Nurs. 2023;30(5):290-295. doi: 10.1097/jtn.0000000000000743 https://pubmed.ncbi.nlm.nih.gov/37702732/.
  • Liaud-Laval G, Libert N, Pissot M, et al. Severe hypocalcemia at admission is associated with increased transfusion requirements: A retrospective study in a level 1 trauma center. Injury. 2024;55(1):111168. doi: 10.1016/j.injury.2023.111168 https://pubmed.ncbi.nlm.nih.gov/37926665/.
  • Metcalf A, Kitchens D, Reddic J, et al. Impact of transfusing packed red blood cells through a rapid infuser on potassium levels. J Trauma Nurs. 2023;30(1):14-19. doi: 10.1097/jtn.0000000000000694 https://pubmed.ncbi.nlm.nih.gov/36633340/.
  • Mills JD. Trauma diamond of death: Adding calcium to the lethal triad. J Emerg Nurs. 2024;50(3):330-335. doi: 10.1016/j.jen.2023.12.011 https://pubmed.ncbi.nlm.nih.gov/38705704/.
  • Calcium supplementation during massive transfusion. Web Page. https://pharmertoxguy.files.wordpress.com/2018/05/hypocalcemia-with-massive-transfusion.png.
  • Palitnonkiat V, Thampongsa T, Sirikun J, et al. Association between hypocalcemia and mortality in trauma patients: a systematic review and meta-analysis. Trauma Surg Acute Care Open. 2025;10(4):e001800. doi: 10.1136/tsaco-2025-001800 https://pubmed.ncbi.nlm.nih.gov/41180256/.
  • Quintana-Díaz M, Garay-Fernández M, Ariza-Cadena F. Advancing in the understanding of coagulopathy during hemorrhagic shock: From the triad to the deadly pentad. Colombian J Anaesthesiol. 2022;50(4) doi: 10.5554/22562087.e1038 https://www.revcolanest.com.co/index.php/rca/article/view/1038.
  • Rajesh A, Barry L, Limon D, et al. Aggressive calcium chloride dosing reduces early mortality in trauma patients receiving whole blood resuscitation. J Trauma Acute Care Surg. 2026;doi: 10.1097/ta.0000000000005009 https://pubmed.ncbi.nlm.nih.gov/41995161/.
  • Rushton TJ, Tian DH, Baron A, et al. Hypocalcaemia upon arrival (HUA) in trauma patients who did and did not receive prehospital blood products: a systematic review and meta-analysis. Eur J Trauma Emerg Surg. 2024;doi: 10.1007/s00068-024-02454-6 https://pubmed.ncbi.nlm.nih.gov/38319350/.
  • Schriner JB, Van Gent JM, Meledeo MA, et al. Impact of transfused citrate on pathophysiology in massive transfusion. Crit Care Explor. 2023;5(6):e0925. doi: 10.1097/cce.0000000000000925 https://pubmed.ncbi.nlm.nih.gov/37275654/.
  • Selki K, Demir MC, Şengüldür E. Prognostic value of severe hypocalcemia in predicting mortality and transfusion in moderate-to-severe trauma. BMC Emerg Med. 2026;26(1) doi: 10.1186/s12873-026-01476-0 https://pubmed.ncbi.nlm.nih.gov/41923194/.
  • Shandaliy Y, Busey K, Scaturo N. Impact of a calcium replacement protocol during massive transfusion in trauma patients at a level 2 trauma center. Am J Health Syst Pharm. 2024;doi: 10.1093/ajhp/zxae099 https://pubmed.ncbi.nlm.nih.gov/38578328/.
  • Vasudeva M, Mathew JK, Groombridge C, et al. Hypocalcemia in trauma patients: A systematic review. J Trauma Acute Care Surg. 2021;90(2):396-402. doi: 10.1097/ta.0000000000003027 https://pubmed.ncbi.nlm.nih.gov/33196630/.
  • Wolf J, Geneen LJ, Meli A, et al. Hyperkalaemia following blood transfusion: A systematic review assessing evidence and risks. Transfus Med Rev. 2022;doi: 10.1016/j.tmrv.2022.04.003 https://pubmed.ncbi.nlm.nih.gov/35534372/.
  • Wray JP, Bridwell RE, Schauer SG, et al. The diamond of death: Hypocalcemia in trauma and resuscitation. Am J Emerg Med. 2021;41:104-109. doi: 10.1016/j.ajem.2020.12.065 https://pubmed.ncbi.nlm.nih.gov/33421674/.