IT’S TRAUMA TUESDAY

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For nurses and other clinicians practicing anywhere

along the trauma care spectrum

Take a quick test of your trauma care knowledge

Article of the Week

What you need to know about DOACs

Direct oral anticoagulants (DOACs), such as apixaban, rivaroxaban, edoxaban, and dabigatran, are widely used due to their fixed dosing, fewer interactions, and reduced need for routine monitoring. However, in trauma settings—especially during major bleeding, urgent surgery, or stroke intervention—knowing the actual DOAC level may help guide critical decisions, including the use of reversal agents.

Mithoowani S, Tan CW, Siegal DM. Measuring Direct Oral Anticoagulant (DOAC) Levels: Applications, Limitations, and Future Directions. Int J Lab Hematol. Apr 22 2025.

Trauma Happenings

Evidence-Based Guidance on Post-Acute mTBI Care

Access key recommendations and best practice statements from the latest VA/DoD Clinical Practice Guideline for the Management and Rehabilitation of Post-Acute Mild Traumatic Brain Injury. This free resource, offered through Lippincott NursingCenter^®, provides practical, evidence-informed strategies to support patient recovery and optimize outcomes. Download your free copy today.

What if I Fail the TCAR/PCAR Posttest?

Learners who do not achieve a passing score of 80% on the TCAR or PCAR posttest will be provided an opportunity to retake the assessment. Prior to attempting the retest, you will need to complete a mandatory practice test designed to support learning and reinforce key concepts. To improve performance on the retest, learners are strongly encouraged to:

  -Carefully review the practice test questions and their corresponding rationales.
  -Revisit the Time to Review questions embedded throughout the course.
  -Study the Summary of Key Points at the end of each module in the manual.

You can reveal a letter or the entire word if you get stuck

Is it Base Deficit or Base Excess?

Base deficit (BD), a negative number, and base excess (BE), a positive number, are both terms used in blood gas analysis to assess a patient’s metabolic acid-base status. They reflect the amount of acid or base that must be added to a blood sample to return the pH to a normal value (typically 7.40). In trauma patient care, patients rarely experience a base excess (metabolic alkalosis). However, a deficit of base (metabolic acidosis) is a common occurrence and is a valuable metric because it isolates the metabolic component of acid-base balance, independent of respiratory influence.

A normal BD/BE is -2 to +2 mmoL/L (or mEq/L). This makes sense because, at baseline, patients should have neither an excess nor a deficit; the number should be pretty close to zero. A BD of -6 is commonly used to define shock in injured patients, and a BD of -8 correlates with a 50% mortality! So, don’t underestimate the value of this lab test.

The confusion arises from how we speak about BD, because the values refer to the degree of DEFICIT. A BD that goes UP (e.g., from -5 to -3) is actually an improvement, even though the number got smaller. Likewise, a BD that goes DOWN (becomes more negative) reflects a worsening situation as the number gets larger. To avoid confusion, instead of saying BD is “increasing” or “decreasing,” it’s clearer to say BD is “improving” or “worsening.” 
 

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