Massive haemorrhage protocol

Question 1

Define massive haemorrhage based on volume and rate of blood loss

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

How may massive haemorrhage also be defined based on the clinical situation ?

Answer 2

• Bleeding which leads to a heart rate of >110 beats per minute and/or systolic BP < 90mmHg
• Bleeding which has already prompted use of emergency O Rh(D) neg. red cells.

Question 3

What is the 2 main principles for the general management of massive haemorrhage ?

Answer 3

1. Definitive tx = stop the bleeding
2. Supportive tx = blood component support

Question 4

What is the purpose of the massive harmorrhage protocol?

Answer 4

It allows a standardised approach to the initial management of massive haemorrhage

Question 5

When the massive harmorrhage protocol is initiated what is initially done ?

Answer 5

• Send urgent blood samples - FBC, coag screen, fibrinogen, crossmatch, Us&Es, calcium
• ABCDE approach
• Large bore IV acess + IV fluids
• Call for senior help!
• Transfuse red cells, FFP & platelets

Question 6

What is done if a patient with massive haemorrhage persists with ongoing bleeding after initial mx/transfusion ?

Answer 6

• Repeat blood samples
• Transfuse further RBC & FFP at a ratio of 2:1 (1:1 in trauma)
• Also give cryopreciptate if fibrinogen <1g/L (or <2g/L in obstetrics)
• Consider further platelets

Question 7

When blood results are available from a patient with massive haemorrhage what are the levels which are important to maintain above?

Answer 7

• Hb > 80
• APTT & PT < 1.5
• Platelets > 50x10⁹
• Fibrinogen > 1.5 (>2 in obstetrics)
• Use blood warmer & consider cell salvage where available

Question 8

In trauma patients with massive haemorrhage what should be given within the first 3hrs ?

Answer 8

Tranexamic acid

Question 9

For specific haemorrhage mx refer to appropriate block e.g. AAA, varices, PPH & trauma