Haemorrhagic Hypovolaemia

Question 1

What are the 3 care objectives in Haemorrhagic Hypovolaemia?

Answer 1

1. Identify and control major haemorrhage
2. Ensure vital organ perfusion while minimising the development of coagulopathy, acidosis and hypothermia.
3. Rapid transport to a facility capable of definitive haemorrhage control.

Question 2

Patients with a BP of less than _____ will often present with absent radial pulses and decreased alertness.
Due to the unreliability of BP’s below this number, it may be appropriate to…?

Answer 2

<70.

Combine the assessments and consider radial pulse, BP and alertness holistically.

Question 3

Where the pt is not alert but has BP of ≥ 70 with a present radial pulse, consider…?

Answer 3

Other causes - TBI, ETOH, OD, hypoglycaemia, dementia.

Question 4

When may it be appropriate to consult for fluids, vasopressors and/or blood products?

Answer 4

When an adequate BP cannot be achieve and there are other signs of unacceptably poor perfusion or deterioration.

Question 5

What is the preferred resuscitation fluid?

Answer 5

Blood products.

Question 6

When should TPT be considered?

Answer 6

Always, especially in the pt with the chest injury with IPPV or persistent hypotension despite fluid therapy.

Question 7

Should transport be delayed to obtain IV access?

Answer 7

No, do not delay transport for any reason, especially in the setting of penetrating trauma, or amputation.

Question 8

Which patients does the Haemorrhagic Hypovolaemia guideline apply to?

Answer 8

Suspected ruptured AAA, massive GIT haemorrhage and pregnant trauma patients.

Question 9

Which patients does the Haemorrhagic Hypovolaemia guideline specifically NOT apply to?

Answer 9

TBI, isolated SCI, APH, PPH.

Question 10

For APH associated with major trauma, call…?

Answer 10

PIPER.

Question 11

What is the absolute priority in suspected haemorrhagic hypovolaemia?

Answer 11

Control of major haemorrhage.

Question 12

What are potential mimics of hypovolaemia?

Answer 12

1. TPT
2. Significant pain (concurrent with Tx where required)
3. Environmental exposure

Question 13

What blood pressure is considered “tolerable hypotension” and for how long is it tolerated?

Answer 13

≥70 mmHg.

Tolerated without fluid replacement for up to 2 hours.

Question 14

If tolerating hypotension, what are the other considerations?

Answer 14

1. Prepare for deterioration.
2. Consult with the clinician or receiving hospital for Mx if: long prehospital times, prolonged extrication, elderly/frail pts

Question 15

What blood pressure requires active management? Outline the management.

Answer 15

<70mmHg.
Prioritise transport.
Normal Saline 250mL IV
Rpt. 250mL (max. 2000mL) as required.
Titrating to BP  ≥70 mmHg.
Consult for further Mx, consider blood products.