Major haemorrhage

Question 1

How do you recognise a life-threatening haemorrhage?

Answer 1

Patient bleeding/collapses
Ongoing bleeding 150 ml/min (difficult to assess as blood loss may be hidden)
Clinical shock
Low BP
Tachycardia
There’s a risk of over activation of the management pathway as people may not recognise the signs of life-threatening haemorrhage.

Question 2

Which clinical scenarios are most associated with major haemorrhage?

Answer 2

Obstetric (1st) 
Vascular (2nd) 
Upper GI (3rd) 
Lower GI (4th)
Trauma and cardiac are least likely

Question 3

Transfusion management of major haemorrhage

Answer 3

Recognise blood loss
Resuscitate (ABCDE)
Call for help
Stop the bleeding (TXA, PCC-prothrombin complex concentrate)
Blood samples (FBC, U&Es, LFTs, PT, APTT, fibrinogen, crossmatch)
Team approach
Communicate with lab early and clearly (request red cells, FFP and platelets)
Know where the emergency O negative blood is
Massive haemorrhage packs 1 and 2 (detailed recording for traceability)
Monitor coagulation tests and move to goal-directed therapy
Let the lab know when the patient is stable

Question 4

Which healthcare professionals activate the major pathway for haemorrhages?

Answer 4

Registrars and consultants- should be a consultant

Question 5

What does pack 1 include?

Answer 5

4 units of red cells, 4 units of FFP (doesn’t provide coagulation factors or platelets)
Major haemorrhage is associated with coagulopathy

Question 6

What does pack 2 include?

Answer 6

4 units of red cells, 4 units FFP, 1 dose of platelets, 2 packs of cryoprecipitate.
Pack 2 is only required if haemorrhage continues.

Question 7

Complications of major haemorrhage

Answer 7

Thrombus so the patient will require thrombosis and thromboprophylaxis

Question 8

When is self-salvage useful?

Answer 8

AAA

Post-partum haemorrhage