Major bleed

Question 1

What is the definition of a major bleed?

Answer 1

• Loss of more than one blood volume within 24 hours or
• 50% of total blood volume lost in less than 3 hours
• Bleeding in excess of 150mL/min

Question 2

What is included in a major haemorrhage pack?

Answer 2

• 6U of PRC
• 4U of FFP
• 1 pooled platelets

Question 3

What is the management of major bleed?

Answer 3

• Team approach
• ABC
• Oxygen
• Monitoring
• IV access with wide bore
• Bloods: FBC, coagulation, fibrinogen, UEs, LFTs, Ca2+
• Tranexamic acid if trauma within 3 hours ago
• Keep the patient warm
• Give blood early (o neg until matching)

Question 4

What are the complications of major haemorrhage?

Answer 4

• Coagulopathy
• Hyperkalaemia
• Hypocalcaemia
• Acidosis
• Volume overload
• Hypothermia