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Emergency > Major Haemorrhage > Flashcards

Major Haemorrhage Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

What are the steps of a major haemorrhage?

A 
Recognise blood loss
Resuscitate
Stop the bleeding
Get a team together
Emergency runner
Nominate a communication lead w/lab
Find O negative blood
Massive haemorrhage packs 1 and 2
Monitor coag tests
Stand down
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2
Q

What indicates activating the major haemorrhage protocol?

A

Shock
Tachycardia
Low blood pressure

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3
Q

Where do you look for blood?

A

On the floor and four more

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4
Q

Which system scenarios are associated with the major haemorrhage pathway?

A 
Obstetric
Vascular
GI upper
GI lower
Gynae
In surgery
Trauma
Cardiac
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5
Q

What is the telephone number for major haemorrhage in Manchester?

A

4444

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6
Q

Who should be in the team?

A 
ED doctors
Consultant (team leader)
Surgeons
Anaesthetics
Radiologist for emergency radiology
Nursing support and ODP
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7
Q

What roles are in the team?

A 
Leader (consultant)
Resuscitation lead (ABCDE)
Communication lead
Emergency runner
Scribe
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8
Q

How to stop the bleeding?

A

Pressure/tourniquets
Early intervention in surgery
Reverse anticoags with Vit K and Prothrombin complex concentrate
Tranexamic acid (within 1 hr) - stabilises blood clotting

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9
Q

Which blood samples do we need to take during a major haemorrhage?

A

FBC, UE, LFT, Calcium, PT, APTT

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10
Q

Which type of blood do you give?

A

Red cells (O neg if v necessary, group specific - 15mins or crossmatched - 45/60mins)
FFP
Platelets

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11
Q

What are the potential issue with O neg and group specific?

A

They can cause reactions if the patient has antibodies

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12
Q

What is very important about the blood sample in an emergency situation?

A

LABEL THE FUCK OUT OF THEM

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13
Q

What is in “pack 1” of the major haemorrhage pack?

A

4 units of red cells

4 units FFP

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14
Q

What is in “pack 2” of the major haemorrhage pack?

A

4 units of red cells
4 units FFP
1 dose of platelets
2 doses of cryoprecipitate

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15
Q

Why does the haemorrhage come in packs?

A

Major Haemorrhages are associated with coagulopathy so, since red cells alone don’t provide coagulation or platelets, so the packs ensure appropriate management of coagulopathy

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16
Q

What do you aim for for the fibrinogen, PT ratio, APTT ratio, Hb and plts when monitoring coagulation?

A 
Fibrinogen >1.5g/L
PT ratio <1.5
APTT ratio <1.5
Hb 80-100g/L
Plts >75x10^9/L
17
Q

What is stand down?

A

Don’t forget to tell the lab that the major haemorrhage is stable so they can prioritise others

18
Q

What is cell salvage?

A

When the cells of a patient’s own blood are recycled

19
Q

When can you not use cell salvage?

A

When there are signs of infection

20
Q

Why does the patient need to be monitored closely post control of the haemorrhage?

A

They might be at risk of thrombosis so counter-intuition and give them thromboprophylaxis

21
Q

What is defined as a massive transfusion?

A

More than 10 units in 24hrs

More than 4 units in 1hr

22
Q

What is ALI?

A

Acute lung injury

This is caused by circulating toxins when tissues are ischaemic in blood loss

23
Q

What injuries can the various organs pick up when they aren’t perfused?

A 
ALI
Renal failure
Gut failure
Sepsis
DIC
ACoTs
24
Q

What is DIC?

A

Disseminated intravascular coagulation - Generalised blood coagulation and excessive consumption of coagulation factors a result of over stimulation of the blood-clotting mechanisms in response to disease or injury.
This ultimately results in deficiency of factors and spontaneous bleeding. Giving FFP, Plts and cryoprecipitate is essential

25
Q

What is ACoTS?

A

Acute coagulopathy of trauma shock

26
Q

What are complications to look out for of a massive blood transfusion?

A 
Haemolytic reactions (by rhesus antibody)
TRALI
Dilutional coagulopathy
Hypocalcaemia
Hypothermia

Emergency (9 decks)

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