Massive Haemorrhage Flashcards
Who can activate the Massive Haemorrhage Protocol?
Acitvation of the protocol should be based on the clinical judgement of the most senior doctor at the scene.
Standard definitions of massive blood loss are usually restrospective.
What definition is most applicable to acute situation?
Bleeding which leads to…
- a HR of more than 110bpm
- and/or systolic B.P of less than 90mmHg
also note, clinical experience of the attending doctor is important in determing the need for MHP activation.
Most importantly: avoid delay; if in doubt, activate the MHP
Principles of managing massive blood loss in adults should be broadly applied to the care of children but what is different?
Blood components transfused should be prescribed in mls/kg body weight of children <50kg and not as units.
What 3 steps comprise the initial management of any patient with massive blood loss?
- Begin activation of the patient
- Activae the Massive Haemorrhage Protocol
- Take blood samples and send urgently
How would you begin resuscitation of the patient as part of your initial management?
- Insert wide bore cannulae or central venous cannula
- Give prewarmed colloid and/or crystalloid
- consider giving O-neg blood
- follow appropriate Resus Protocols from Resuscitation Council (UK) and local guidelines
What should be avoided to reduce risk of DIC (disseminated intravascular coagulation)?
Hypotension
Hypothermia
When should transexamic acid be given?
When should it be considered?
TRANSEXAMIC ACID:
- should be given within first 3 hours of major haemorrhage due to trauma or postpartum haemorrhage
- it should be considered for all other causes of major haemorrhage
Seeing as its an emergency, do you still need the second blood sample (in relation to policy re. blood transfusion)?
The second sample policy will never delay the provision of blood products in an emergency
When necessary, O-neg blood or group specific blood based on a single test will be supplied in an emergency situation
BUT a single sample is still desirable and should be taken at the earliest opportunity if required.
What steps must be taken by the most senior doctor attending to activate the MHP?
- Begin resus of the patient
- Identify member of the team to be bedside MHP co-ordinator or Named Contact
- Identify a member of the team to take urgent blood samples from the patient and transport to the lab
- FBC, full coag screen (PT, APTT, fibrinogen)
- U&Es plus any other biochemical test indicated
- Transfusion sample (ensure adequate labelling on bottle and form)
- The named contact will dial 2222 to contact the FVRH switchboard who will activate the protocol
What would be your role/responsibility if you were to find yourself as the doctor activating the MHP?
- Activate the MHP
- Provide initial clinical leadership to the clnical team attending to the patient
- Co-ordinate resus, monitoring and management of the patient
- Identify the named contact
- Decide on urgency with which blood and the number of blood products required and communicate this to the named contact
- Ensure blood samples are taken and transported urgently to the lab
- Communicate with and involve more senior clinicians/ other specialities as required
If you were to find yourself the named contact during activatiion of MHP, what would your roles and responsibilities be?
- Dial 2222 to contact switchboard and activate
- indicate duty specialist middle grade doctor and senior responsible clinician to be contacted
- Communicate with Biomedical Scientist and the Hospital Transfusion Lab
- Liaise with senior responsible clinician and other speciality doctors when they have been informed of the MHP activation
- Take delivery of blood components from porter
- Ensure blood samples taken are transported urgently to lab by porter
- Receive results of lab tests and communicate these to the relevant medical staff
- Act as single point of contact between the attending clinical team, the HTL biomedical scientist and others as necessary, including consultant haematologist
- Advise the HTL if any O-neg emergency uncross-matched blood stock has been used including no. of units
- Maintain an accurate log of events including records of lab results and all labels from blood bags transfused for completion and return to HTL
- Inform lab and switchboard when MHP stood down
What is the role of the senior responsible clinician?
- to provide clinical leadership to the clinical team
- assist with resuscitation
- consider need for endoscopic, surgical or radiological intervention
- assess the need for transfer to a critical care bed
What is the role of the duty speciality middle grade doctor?
immediately attend and assist with resuscitation of the patient and liaise with senior responsible clinician and other speciality teams as neccessary, including duty consultant anaesthetist if required
Where will the Adult Emergency Team attend and not attend?
They will attend major haemorrhages in ward areas
They will not attend MHP activations in theatre, Obstetrics, paediatrics or Emergency Department routinely
Discuss decisions around requesting more blood components
- wherever possible should be guided by blood tests
- Recombinant Vlla (NovoSeven) is not recommended for use in MHP
- Discuss early on with duty haematologist
