Massive Haemorrhage

Question 1

Definition of massive haemorrhage by blood volume and rate of loss (4)

Answer 1

One blood volume in 24 hours,
50% blood volume in 3 hours,
Blood loss of 150 ml/minute,
Obstetrics: Minor-500-1000ml & Major>1000ml

Question 2

Definition of massive haemorrhage by clinical situation (2)

Answer 2

bleeding which leads to a heart rate of >110 beats per minute and/or systolic blood pressure less than 90mmHg,
bleeding which has already prompted use of emergency O Rh(D) negative red cells.

Question 3

First step of massive haemorrhage protocol

Answer 3

call blood bank and state major haemorrhage

Question 4

What urgent bloods should be sent in massive haemorrhage

Answer 4

FBC,
coagulation screen, 
fibrinogen, 
crosshatch, 
U&Es, 
calcium

Question 5

What is initial management in massive haemorrhage

Answer 5

ABCDE, 
large bore iv access, 
IV fluids, 
call for help, 
transfuse red cells/FFP/platelets

Question 6

Red cells are infused to

Answer 6

maintain tissue oxygenation

Question 7

FFP is infused to

Answer 7

replace coagulation factors

Question 8

Cryoprecipitate can be infused to

Answer 8

replace fibrinogen

Question 9

If ongoing bleeding after initial transfusion in massive haemorrhage, what is management?

Answer 9

repeat blood samples,

transfuse further RBC and FFP,