Major Haemorrhage Flashcards
What are the steps of a major haemorrhage?
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
What indicates activating the major haemorrhage protocol?
Shock
Tachycardia
Low blood pressure
Where do you look for blood?
On the floor and four more
Which system scenarios are associated with the major haemorrhage pathway?
Obstetric Vascular GI upper GI lower Gynae In surgery Trauma Cardiac
What is the telephone number for major haemorrhage in Manchester?
4444
Who should be in the team?
ED doctors Consultant (team leader) Surgeons Anaesthetics Radiologist for emergency radiology Nursing support and ODP
What roles are in the team?
Leader (consultant) Resuscitation lead (ABCDE) Communication lead Emergency runner Scribe
How to stop the bleeding?
Pressure/tourniquets
Early intervention in surgery
Reverse anticoags with Vit K and Prothrombin complex concentrate
Tranexamic acid (within 1 hr) - stabilises blood clotting
Which blood samples do we need to take during a major haemorrhage?
FBC, UE, LFT, Calcium, PT, APTT
Which type of blood do you give?
Red cells (O neg if v necessary, group specific - 15mins or crossmatched - 45/60mins)
FFP
Platelets
What are the potential issue with O neg and group specific?
They can cause reactions if the patient has antibodies
What is very important about the blood sample in an emergency situation?
LABEL THE FUCK OUT OF THEM
What is in “pack 1” of the major haemorrhage pack?
4 units of red cells
4 units FFP
What is in “pack 2” of the major haemorrhage pack?
4 units of red cells
4 units FFP
1 dose of platelets
2 doses of cryoprecipitate
Why does the haemorrhage come in packs?
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
What do you aim for for the fibrinogen, PT ratio, APTT ratio, Hb and plts when monitoring coagulation?
Fibrinogen >1.5g/L PT ratio <1.5 APTT ratio <1.5 Hb 80-100g/L Plts >75x10^9/L
What is stand down?
Don’t forget to tell the lab that the major haemorrhage is stable so they can prioritise others
What is cell salvage?
When the cells of a patient’s own blood are recycled
When can you not use cell salvage?
When there are signs of infection
Why does the patient need to be monitored closely post control of the haemorrhage?
They might be at risk of thrombosis so counter-intuition and give them thromboprophylaxis
What is defined as a massive transfusion?
More than 10 units in 24hrs
More than 4 units in 1hr
What is ALI?
Acute lung injury
This is caused by circulating toxins when tissues are ischaemic in blood loss
What injuries can the various organs pick up when they aren’t perfused?
ALI Renal failure Gut failure Sepsis DIC ACoTs
What is DIC?
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
