Massive haemorrhage
EoE major haemrrhage protocol?
recognition
- Blood is everywhere or clear history of trauma = no prizes for you
- More easily missed when due to ruptured aortic aneurysm, massive Upper GI bleed, Postpartum haemorrhage, recent surgery...
definition
Not that you'll be referring to this when blood is all over.
- Loss of >1 blood volume in 24h
- 50% blood volume lost in <3h
- Bleeding > 150ml/min
Normal blood volume conventionally calculated as 70ml/kg in an adult = >5L in a 70kg adult
physiology
- A/B:
- C: hypotension is a late sign - pts may also be bradycardic
resuscitation
- ratio of blood products
- 1 FFP to every 6 RBCs
- risks of massive transfusion: hyperkalaemia, Hypocalcaemia, TRALI
- other drugs:
- TXA
- other considerations
- TEG?
- replace Ca
- temperature
- consider Anticoagulant reversal
control source
- Good trauma assessment including log roll!
- IR, theatre, etc.
interventional radiology
Indications:
- Uncontrolled bleeding of arteries that are inaccessible to tourniquet eg profunda femoris artery
- Splenic injury with active bleeding, false aneurysm formation or splenic artery injury
- Renal injury with active bleeding, arterio-venous fistula, false aneurysm or haematuria
- Hepatic injury with focal active arterial bleeding, or continued bleeding after damage control surgery
- Pelvic arterial bleeding on CT or patients who are haemodynamically unstable despite a pelvic binder.