FTE™ — Fluid & Transfusion Engine

Decision support only. Does not replace clinical judgment.

Case Header

IDNew Case

Patient Name *

MRN / Hospital No. *

Hospital

Procedure / Operation

Controlled vocabulary — type to search 200+ procedures

Surgeon

OR / Theatre

Default Bag Volume

Demographics

Age

Age Unit Affects age-group classification and pediatric/neonate rules.

Age Group

Physiologic Profile * Affects EBV, blood product thresholds, OB-specific guidance

Sex

Actual Body Weight (kg) *

Height (cm)

IBW (kg) — auto from height Reference only — fluid/blood calculations use Actual BW

Adjusted BW (kg, optional) For obese; if empty → Actual BW used

ASA Class Used for: documentation / risk stratification

Fluid and blood calculations use Actual Body Weight only. IBW is for reference.

Personnel

REQUIRED

Anesthesiologist Name *

Technician Name *

Required for documentation and audit trail.

Baseline Labs

LAB

Hb (g/dL) * Used for: ABL calculation · transfusion trigger comparison

Hct (%) optional Used for: ABL calculation (Hct method — configure in Settings)

Platelets (×10⁹/L) optional Used for: platelet transfusion alert (<50 general; <100 OB/neuro)

INR optional Used for: FFP/plasma indication (threshold: INR >1.5)

Fibrinogen (g/L) optional Used for: cryoprecipitate indication (threshold: <1.5 g/L)

Operation

OR

Surgery Class *

Expected Duration (hr) *

NPO / Fasting Hours *

Urgency *

Operation Name

Controlled vocabulary — type to search 200+ procedures

Surgical Loss Rate: — mL/kg/hr

9

Major: 8–10 mL/kg/hr (default 9)

Hemorrhage Risk Tags

RISK

Pre-Op Vitals (optional)

VITALS

HR (bpm)Used for: tachycardia/bradycardia flag

SBP (mmHg)Used for: hypotension/hypertension flag; shock index

DBP (mmHg)Used for: BP documentation (SBP/DBP display)

SpO₂ (%)Used for: hypoxia flag (<94%)

Temp (°C)Used for: hypothermia/fever flags

Vomiting vol (mL)Used for: total pre-op fluid loss estimate

NG Output (mL)Used for: total pre-op fluid loss estimate

Comorbidities

✓CHF / Fluid Sens. ✓CKD / Renal ✓IHD / ACS Risk ✓Neurocritical ✓OB Risk (auto if Profile=Obstetric)

Comorbidities used for: fluid restriction warnings · PLT thresholds · MHP early-cryo advice

Blood Product Availability

Used for: MHP cycle product selection · resource conflict detection

Blood Volume Estimation

BV

Blood Volume (mL/kg): — (auto-set by age/sex)

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

PLAN

Comorbidity Warnings

Compute to see warnings

Cumulative Balance

—

Blood Volume

—

mL

Hb Trigger

—

g/dL

Allowable Blood Loss

—

mL

Allowable Blood Loss (ABL)

ABL

Compute to see ABL.

RBC Transfusion Triggers

TX

Compute to see triggers

Component Dosing

—

Transfusion Milieu

—

MHP Activation Triggers

MHP

Trigger MHP if ANY checked. No labs required.

✓Shock physiology with ongoing bleeding ✓Very high bleeding rate ✓Pelvic trauma instability ✓PPH >1000 mL with ongoing bleeding ✓Rapid transfusion pace

MHP Strategy Cycles

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

Crystalloid mL

Colloid mL

EBL mL

Urine mL

MAP (opt)

Lactate (opt)

PRBC units

FFP units

Platelets units

Cryo units

Whole Blood units

✓Crackles / Overload

Event Log

No events.

Anesthesia Chart Summary

DOC

Compute & run OR session to generate.

Research Case Log

LOG0 cases

Search (Name, MRN, Procedure)

From Date

To Date

Recent Cases (last 10)

REC

No recent cases.

All Cases

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Appendix A — Pre-Induction Resuscitation & Salvage Scenarios

SAFETY

Prepared by Dr. Amir Fadhel, MBChB, FICMS-AIC

Intestinal Obstruction / Dehydration

Third-space losses may exceed 5–10 mL/kg/hr in established obstruction
Assess volume status: tachycardia, orthostatic changes, urine output, skin turgor
NG output + vomiting = measurable loss — replace volume-for-volume with isotonic crystalloid
Check K⁺, Cl⁻, HCO₃⁻ — metabolic alkalosis common in upper GI obstruction
Target: HR < 100, MAP > 65, UO > 0.5 mL/kg/hr before induction
💡 Pearl: A "stable" HR of 110 in a young patient may mask 1–1.5 L deficit

Trauma / Fracture Hemorrhage Risk

Estimated blood loss by fracture site:
Pelvis: 1500–3000 mL | Femur: 1000–1500 mL | Tibia: 500–1000 mL
Multiple fractures → cumulative loss may be catastrophic
Blood availability must be confirmed BEFORE induction
Consider MHP activation criteria proactively
💡 Pearl: Do not wait for lab Hb — clinical shock overrides lab values

Elderly Hypotension + Induction Risk

Geriatric patients have reduced cardiac reserve and blunted baroreceptor reflex
Baseline SBP 100 in elderly may represent compensated shock
Induction agents cause further vasodilation → cardiovascular collapse
Reduce induction dose by 30–50%; titrate slowly
Pre-load with small bolus (250 mL) and vasopressor available
💡 Pearl: "Normotensive" elderly + tachycardia = resuscitate first

Sepsis Physiology

Warm shock: vasodilation, high CO, low SVR → fluids + vasopressors early
Cold shock: vasoconstriction, low CO → fluids + inotropes
Initial bolus: 30 mL/kg crystalloid (reassess after each 500 mL)
If MAP < 65 despite 2 L crystalloid → start norepinephrine
Lactate > 4 mmol/L indicates tissue hypoperfusion — guide resuscitation
💡 Pearl: Induction in unresuscitated sepsis → peri-arrest. Always optimize first.

Massive Hemorrhage Preparation

Ensure 2 large-bore IVs (16G minimum) and crossmatched blood available
Activate MHP early — do not wait for catastrophic bleeding
Blood bank notification: group + screen, O-neg for emergency
Calcium replacement: 10 mL CaGluconate per 3–4 units blood
TXA 1 g IV within 3 hours of injury onset
💡 Pearl: "Anticipate, prepare, communicate" — the MHP triad

⛔ Pause Induction and Resuscitate First

MAP < 65 or SBP < 90 → do NOT induce
HR > 110 with hypotension → active hemorrhage or hypovolemia
Lactate > 4 or base deficit > 6 → ongoing shock
Active uncontrolled bleeding → surgical control first
Exception: Life-threatening airway or imminent maternal/fetal demise
💡 Pearl: "Induction of anesthesia is the second insult. Don't deliver it to an unresuscitated patient."

🆘 When to Call Senior Help

Any hemodynamic instability not responding to initial resuscitation
MHP activation or anticipated > 4 units blood
ASA IV–V patient for emergency surgery
Difficult airway + hemodynamic compromise
Any situation where you feel uncertain — ask early, not late
💡 Pearl: "The best anesthetic decision is sometimes to delay and call for help."

Educational support only. Does not replace clinical judgment or institutional protocols.

⚙️ Settings

Configure clinical parameters for your practice

Transfusion Target Configuration

REQUIRED

⚠️

Important: Configure your transfusion target based on your hospital's protocol. This setting is required for accurate blood loss calculations and automated transfusion alerts.

Target Hb (g/dL):

Typical: 7 (general surgery), 8 (neuro/elderly), 9 (cardiac/IHD)

OR use Target Hct (%):

Hct ≈ Hb × 3 (approximate conversion)

Calculation Method:

ℹ️

Why configure this?
• Calculates Allowable Blood Loss (ABL) accurately
• Triggers automatic warnings when Hb drops below target
• Helps plan transfusion timing during surgery
• Personalizes recommendations to your patient's needs

Massive Hemorrhage Protocol

OPTIONAL

ℹ️

The MHP panel shows evidence-based reference protocols. You can customize these to match your hospital's specific MHP if desired.

Current Status: Loading...
Customize if your hospital uses different MHP cycles

Field Purpose Map

TRACEABILITY

Every input field and its downstream effect. Confirms no orphaned inputs.

App Updates

FTE™ checks for updates automatically every 60 seconds when active.

Data Management

All data stored locally on this device. Never sent to servers.

FTE™ — Fluid & Transfusion Engine

Offline clinical decision-support tool for perioperative fluids and transfusion guidance.
ENKI-CLINICAL Suite

v1.6.4

Decision support only. Does not replace clinical judgment.

Contact

Dr. Amir Fadhel, MBChB, FICMS-AIC

Anesthesiology & Critical Care — Iraq

WhatsApp: +964 781 984 2914 Email: dr.amiralshimmarii@gmail.com

How to Use This App

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

How Calculations Work

4-2-1 Maintenance Rule

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

Fasting Deficit (mL) = Maintenance Rate × NPO Hours

Example: 110 mL/hr × 8 hours = 880 mL

50/25/25 Deficit Replacement

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

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

⛔

TRANSFUSION TARGET NOT CONFIGURED
Configure your target Hb in Settings → Transfusion Target for automated alerts.

Pediatric mL/kg Dosing

⛔

PEDIATRIC DOSING NOT CONFIGURED
Use your local pediatric protocol for blood product dosing (mL/kg).

Massive Hemorrhage Protocol Cycles

⛔

MHP PROTOCOL NOT CONFIGURED
Configure your local MHP template in Settings → Massive Hemorrhage Protocol.