Major Haemorrhage Management

Minimise bleedingConsider arterial or direct pressure

CALL FOR HELPCheck:AirwayBreathingCirculation

Give: 20 mLs/kg of warmed Saline, Hartmans or PPSContact ITU. Ask for blood warmer as an emergency – Ext 80083

Give 20 mLs/kg blood

Cap refill< 2secs

If total blood loss 40 mLs/kgGive 10 mLs/kg FFP

If platelets < 50 Give 10mLs/kg of plateletsIf Fibrinogen < 0.8g/l Give 5mLs/kg of Cryo

ReassessABC

Reassess ABC

Give 2nd bolus of clear fluid

Insert two intraosseus needles

Useful Contacts:Clinical Emergency 3333Surgical SpR page 8600Anaesthetic SpR page 8602Blood Bank Ext 80393 or via switchboardConsultant Haematologist

Take blood for: Crossmatch - pink bottleFBC - pink bottle

Phone Blood BankExt 80393 or via switchboard

>6yrs <6yrs

Consider venous cut down or intraosseus route

Insert two size appropriateLarge bore IV cannula.If unsuccessful

Following 2nd fluid bolus

Cap refill> 2secs

Following 1st fluid bolus

Major Haemorrhage Management

• Contact relevant staff – see over for details

• You must alert Blood Bank when a major haemorrhage is suspected

• Assess weight of patient

• Allocate one person to have ongoing contact with the Consultant Haematologist and Blood Bank

• Take blood for:Crossmatch, 1-5mLs EDTA bottleFBC, EDTA bottleCoag, purple topped bottleU&E’s orange topped bottle

• Blood available:O Negative2 units available in Blood Bank and Theatre.

Group SpecificAvailable 10mins after receipt of sample

Fully CrossmatchedAvailable 40mins after receipt of sample

Authors: P Bolton/E HarrisonVersion: 1.0 FinalIssue Date: March 2007