Massive haemorrhage - AMx





Goals

Need to optimise:

  • Oxygenation
  • Tissue perfusion
  • Cardiac output
  • Metabolic state
    • pH
    • Temp

AMx

See Blood conservation strategies

Initial stabilisation (ABC)

May be required in unexpected / sudden massive haemorrhages

➤ Airway

  • Maintain patent airway
  • Intubate if necessary

➤ Breathing

  • 100% oxygen
  • Apply pulse oximetry

➤ Circulation

  • Positioning
  • Large bore IV cannulae x 2
  • Fluid resuscitation
  • Send blood sample off for:
    • FBC
    • Crossmatch
    • Coagulation profile
    • Electrolytes (esp Ca2+)
  • Notify haematology re activation of ... massive transfusion protocol (MTP)

⦿ Positioning:

  • Head down
  • Legs up
  • Left lateral tilt (if pregnant)

⦿ Fluid resuscitation:

Give

  • Crystalloid (initially)
  • Colloids
  • Consider bloods
    • Crossmatched blood, otherwise O-negative bloods
    • FFP, cryoprecipitate, platelets

Use

  • Pressure bags
  • Fluid warmers

Other considerations

  • Restrictive transfusion strategy
    • i.e. tolerating lower Hb before RBC transfusion
  • Permission hypotension
  • Avoid hypothermia
  • Early use of TXA
  • Direct compression / tourniquet