ILA 1: Management of bleeding

Question 1

Things to look for in A-E:

a) Airway
b) Breathing
c) Circulation

Answer 1

a) Signs of obstruction (apnoea, stridor, see-saw breathing)
b) RR, expansion, chest sounds
c) CRT, HR, BP

Question 2

You attend Mr Knowles in his side room to clerk him. His wife has left. He says hello, sits up and tells you he feels sick. He then vomits copious black granular fluid over you, the bed and the floor. There are blood clots in the vomit. He is now moribund on the bed.

a) Give 2 possible causes of hypoxia in this man

Answer 2

a) Hypovolaemic shock, aspiration pneumonia

Question 3

Goal-directed therapy in haemorrhage

Answer 3

Aim for SBP of ~ 100mmHg:

• high enough to perfuse vital organs
• not so high to break down clots and exacerbate bleeding

Question 4

Major bleeding: management

Answer 4

Replace: (ensure it is warmed first!)

• Red cells (request 4 units)
• Clotting factors (FFP)
• Fibrinogen (fibrinogen concentrate)
• Platelets (platelet transfusion)

Question 5

How much would you expect 1 unit of blood to raise Hb by?

Answer 5

10g/L

Question 6

How can we define “massive haemorrhage”

Answer 6

• Ongoing blood loss in patient with ongoing transfusion
• Loss of 50% total blood loss within 3 hours
• Replacement of entire blood volume over 24 hour period.

Question 7

What are the complications of massive transfusion?

Answer 7

• ABO incompatibility (never event)
• Minor transfusion reactions
• Transfusion associated lung injury (TrALI)
• Dilution of other blood products, etc.