Emergencies Flashcards
What is the definition of a major haemorrhage?
50% blood loss within 3 hours
> 150mls per minute
Full circulatory volume lost in 24 hours
What should the management be during a major haemorrhage?
- Assess if this is a major haemorrhage
- put out major haemorrhage protocol - Restore circulating volume
- IV access
- Fluids - warm if possible - Stop bleeding
- Send samples
- emergency cross match
- FBC
- Clotting studies
- ROTEM
- U&;Es
- ABGs - Give blood products
What is made available following a major haemorrhage protocol?
6 units of RBCs
- O negative will be provided until a 2nd cross matched sample is received
If there is trauma, obstetric or risk of DIC what should also be requested upon the major haemorrhage protocol?
FFP
Platelets may also need to be requested
How long does a group specific, cross match take?
- where can O neg blood be found?
Group and save: 25 mins
Cross match: 60 mins
O Neg can be found in:
- Blood bank
- Satellite fridges
What haemoglobin should be aimed for in Major haemorrhage?
Hb> 80g/L
How much time for products do you need to leave during a major haemorrhage?
20mins thawing time for FFP
25 mins for group specific RBCs
60 mins for crossmatch
Transport time
What drug can be given during a major haemorrhage to help control bleeding?
Tranexamic acid
IV infusion - slowly initially.
then transfusion over 24 hours
What is the ideal blood product use for DIC?
Cryoprecipitate - contains fibrinogen
What are the different types of shock?
Cardiogenic shock Hypovolemic shock Septic shock Neurogenic shock Anaphylactic Obstructive
What are the classifications of shock?
Type I: <750ml 15% <100bpm BP normal slight anxious
Type II: 750-1500ml 15-30% 100-120bpm BP normal Mildly anxious
Type III: 1500-2000 30-40% 120-140 BP lowered Anxious confused
Type IV: >2000 >140 BP lowered RR>35 Confused lethargic
How do you manage a haemorrhage causing shock?
- Assess if this is a major haemorrhage
- put out major haemorrhage protocol - Restore circulating volume
- IV access
- Fluids - warm if possible - Stop bleeding
- active haemorrhage control
- direct compression
- pelvic binder - Send samples
- emergency cross match**
- FBC
- Clotting studies
- ROTEM (assesses haemostasis in patients)
- U&Es
- ABGs - Give blood products
- give O neg blood initially then move to group specific when able
How much and how quickly should a fluid bolus be given in an emergency situation?
500ml saline over 15 mins
or
250ml in heart failure over 15mins
List some causes of cardiogenic shock:
M.I
Mitral regurgitation
Subarachnoid inducing catecholamine release causing cardiogenic stunning
Name some causes of obstructive shock
P.E
Cardiac tamponade
Tension Pneumothorax
List some causes of neurogenic shock, and explain the underlying pathological mechanisms:
High cervical cord trauma
Major brainstem or spinal injury
Guillain Barre syndrome
Loss of vasomotor control induces mass peripheral dilation.
Also damage to sympathetic nerves system can induce severe bradycardia
What are some clinical features of septic shock?
Warm peripheries
Bounding pulse
Large pulse pressure (120/ 50)
What are some clinical features of Anaphylactic shock?
Wheeze Stridor Angioedema - especially facial and laryngeal Itch Urticaria Bounding pulse warm peripheries Large pulse pressure
What are some mimics of anaphylaxis?
Carcinoid syndrome
Pheochromocytoma
Angioedema
Mastocytosis
What should be measured to confirm anaphylactic reaction and when?
Tryptase
1 - 6 hours following onset