- Guideline - massive haemorrhage
Link:www.aagbi.org/sites/default/files/massive_haemorrhage_2010_0.pdf
- Summary points
- Hospitals must have massive haemorrhage protocol in place
- Immediate control of bleeding is of paramount importance
- The protocol must be mobilised immediately
- Fibrinogen <1 or PT and APTT of > 1.5x normal represents haemostasis failure. Early use of FFP (15ml/kg) may prevent this occurring
- Established coagulopathy may require more FFP to correct
- Fibrinogen replacement should be by cryo or fibrinogen concentrate
- 1:1:1 red cell:FFP:platelets should be considered
- A minimum target platelet count of 75 should be considered
- Comsider group specific blood, with O-ve for only if blood is needed immediately
- Locally developed shock packs should be considered
- Standard VTE prophylaxis should be commenced as soon as possible as a prothrombotic state occurs following massive haemorrhage
- Organisational aspects
- Need for team leader
- Communication
- Collection of blood products
- Securing IV access and central access
- Switchboard to alert
- Transfusion lab
- Haematologist
- ICU doctor
- Surgical senior on site
- Radiologist on call
- Logistics of blood supply
- Identification
- Standard issue
- Emergency issue
- Blood storage and transfer
- Traceability
- Stock management
- Treatment of haemostasis failure
- Treat hypocalcaemia and hypomagnesaemia
- Tranexamic acid
- RFVIIa
- Aprotinin
- Vitamin K/octaplex
- Lethal triad: Acidosis, hypothermia, coagulopathy
- Initial treatment
- Control obvious bleeding points
- High FiO₂
- IV access
- Bloods
- FBC, U&E, PT, APTT, fibrinogen, x-match, TEG
- Warm fluid/blood resuscitation
- Rapid access to imaging
- Alert theatre for cell salvage
- Try to avoid vasopressors if possible