FTE™ Engine

Fluid & Transfusion · ENKI-CLINICAL
v1.0
Decision support only. Does not replace clinical judgment.

Demographics

For obese; if empty → Actual BW used

Baseline Labs

LAB

Operation

OR
9
Major: 8–10 mL/kg/hr (default 9)

Hemorrhage Risk Tags

RISK

Comorbidities

Blood Product Availability

Blood Volume Estimation

BV
70
Adult male default: 70 mL/kg · Female: 65 · Neonate: 80–100

Available Crystalloids

Maintenance
—
mL/hr
Fasting Deficit
—
mL
Surg Loss Rate
—
mL/hr
Hour 1 Total
—
mL

Hourly Plan (Doctrine §D5)

PLAN

Comorbidity Warnings (Doctrine §E3)

Compute to see warnings

Cumulative Balance

—
Blood Volume
—
mL
Hb Trigger
—
g/dL

RBC Transfusion Triggers (Doctrine §F1/F2)

TX
Compute to see triggers

Component Dosing (Doctrine §F3–F6)

—

Transfusion Milieu (Doctrine §F6)

—

MHP Activation Triggers (Doctrine §G1)

MHP
Trigger MHP if ANY checked. No labs required.

MHP Strategy Cycles (Doctrine §G2)

Evaluate MHP to see cycles
00:00:00
Elapsed OR Time
▶ Next Recommended Action
Start timer & compute patient data for guidance.
Crystalloid
0
mL
Colloid
0
mL
Blood Products
0
units
EBL
0
mL
Urine Output
0
mL
Fluid Balance *
0
mL
* ~300 mL/unit approx.

Quick Log

Event Log

No events.

Anesthesia Chart Summary

DOC
Compute & run OR session to generate.
FTE™ — Fluid & Transfusion Engine
Offline clinical decision-support tool for perioperative fluids and transfusion guidance.
ENKI-CLINICAL Suite · Doctrine v1.0
Decision support only. Does not replace clinical judgment.

Contact

Dr. Amir Fadhel
MBChB, FICMS-AIC — Iraq
Anesthesiology & Critical Care
Email: dr.amiralshimmarii@gmail.com

How to Use This App

  1. Enter patient demographics (age, sex, weight, ASA)
  2. Enter baseline labs (Hb required; Hct, PLT, INR, fibrinogen optional)
  3. Select surgery type, duration, NPO hours, and surgical loss rate
  4. Tap COMPUTE ENGINE and review the hourly fluid plan
  5. Use the OR Dashboard during surgery: start timer, log fluids, EBL, and urine output
  6. Follow real-time alerts for transfusion triggers, low UO, and MHP activation
  7. Generate and export the anesthesia chart summary at end of case

How Calculations Work

4-2-1 Maintenance Rule (Doctrine §D1)
Maintenance fluid rate is calculated by weight:
• First 10 kg: 4 mL/kg/hr
• Next 10 kg (11–20 kg): 2 mL/kg/hr
• Each kg above 20: 1 mL/kg/hr

Example: 70 kg adult = 40 + 20 + 50 = 110 mL/hr
Fasting Deficit (Doctrine §D2)
Fasting Deficit (mL) = Maintenance Rate × NPO Hours

Example: 110 mL/hr × 8 hours = 880 mL
50/25/25 Deficit Replacement (Doctrine §D3)
The fasting deficit is replaced over the first 3 hours of surgery:
• Hour 1: 50% of deficit
• Hour 2: 25% of deficit
• Hour 3: 25% of deficit
• Hour 4+: 0 deficit component
Surgical Loss Bands (Doctrine §D4)
Surgical loss rate varies by case classification:
• Minor: 2–4 mL/kg/hr (default 3)
• Moderate: 4–6 mL/kg/hr (default 5)
• Major: 8–10 mL/kg/hr (default 9)

Surgical Loss (mL/hr) = Selected Rate × Weight (kg)
Transfusion Thresholds (Doctrine §F1–F2)
Adult RBC triggers:
• Stable, non-bleeding: Hb < 7 g/dL
• Active hemorrhage/shock: Hb < 8 or symptomatic
• IHD/ACS: Hb < 9 g/dL
• Neurocritical: target 8–9 range
• Pregnancy/PPH: Hb < 7; unstable ≥8

Pediatric (≥1 month):
• Stable Hb < 7: PRBC 10–15 mL/kg
• Active bleed Hb < 8: PRBC 15 mL/kg + FFP 10–15 mL/kg
• Cardiac Hb < 9: PRBC 10–15 mL/kg
Pediatric mL/kg Dosing (Doctrine §F2–F5)
All pediatric blood product dosing is weight-based:
• PRBC: 10–15 mL/kg
• FFP: 10–15 mL/kg
• Cryoprecipitate: 1 unit per 10 kg
• Platelets: dose per local protocol (not specified in doctrine)
Massive Hemorrhage Protocol Cycles (Doctrine §G2)
If Whole Blood available (Cycle A):
1 WB → 1 FFP → 1 WB → 1 FFP (repeat)

If PRBC + FFP only (Cycle B):
PRBC:FFP = 1:1 until bleeding slows; add cryo early if available

Pediatric MHP:
PRBC 10–15 mL/kg alternating with FFP 10–15 mL/kg
Early cryo: 1 unit per 10 kg

OB emphasis: Fibrinogen falls early → cryo upfront if available