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🩺 Should You Give Tranexamic Acid During ABCD in PLAB 2?

Today’s blog addresses a high-yield, practical question asked by a candidates today:

"Can I give tranexamic acid (TXA) during ABCD resuscitation?"

Let’s explore the clinical reasoning and best practice based on current guidelines and how to apply it effectively in the PLAB 2 exam.



✅ What is Tranexamic Acid (TXA)?

Tranexamic acid is an antifibrinolytic medication that helps to reduce bleeding by preventing the breakdown of blood clots. It's been shown to reduce mortality when administered early (within 3 hours) in cases of major traumatic bleeding.

🧠 Key point: This benefit does not extend to gastrointestinal bleeds, based on current evidence (e.g., HALT-IT trial).



🩹 ABC Comes First

During emergency management, especially in PLAB 2, you follow the ABCD approach:

  • Airway

  • Breathing

  • Circulation

  • Disability

💡 In haemodynamically unstable patients, securing the airway, ensuring oxygenation, and stabilising circulation is always your top priority.

Even if you know TXA can save lives, administering it while the airway is still blocked or the patient is hypoxic won't help—oxygen delivery is essential for any drug to work effectively.


📘 What Do Guidelines Say?

According to the latest clinical guidelines and trauma protocols:

"TXA should be administered after initial resuscitation steps have stabilised the patient."Administer 1g IV over 10 minutes, followed by 1g over 8 hours.

💬 In trauma: Early use (within 3 hours) saves lives.❌ In GI bleeds: TXA is not recommended due to lack of benefit and increased side effects.



🧑‍⚕️ How Should You Handle This in PLAB 2? (Except for GI bleeding)

Here’s what a model candidate might say in a PLAB 2 station:

“Once the airway, breathing, and circulation are stabilised, I would administer 1 gram of tranexamic acid intravenously as part of ongoing management for major bleeding.”

By doing this, you:

  • Demonstrate clinical safety

  • Show guideline awareness

  • Prioritise life-saving actions

🎯 Remember: In PLAB 2, being safe and systematic matters more than showing off advanced interventions.



📝 Summary — Key Takeaways

  • TXA reduces mortality in major trauma when given within 3 hours

  • Never give TXA before stabilising ABCs

  • Not useful in GI bleeds

  • In PLAB 2, state that TXA will be given after ABCD resuscitation



🎓 Final Words

PLAB 2 is not just about what you know—it's about how you prioritise. This question reflects exactly that.

Be safe. Be logical. And practice clearly stating your plan in the right order.

🌟 You’ve got this.


📚 Reference

Bezati, S., Ventoulis, I., Verras, C., et al. (2025). Major Bleeding in the Emergency Department: A Practical Guide for Optimal Management. Journal of Clinical Medicine, 14(784). https://doi.org/10.3390/jcm14030784

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