Massive haemorrhage scenario
scenarios
- trauma context
- 78yo 3 days post op hemicolectomy with worsening abdo pain, was discharged originally on enhanced recovery pathway. The nurse in ambulance handover has put in a pink cannula, taken bloods and a VBG, and escalated due to a lactate of 7.
- Massive PR bleed
script
- Recognise massive haemorrhage
- Activate massive haemorrhage protocol
- Allocates roles
- e.g. drugs, checking blood products
- 2x Wide bore cannulae, asks for group+save and crossmatch e.g. 4 units
- TXA (if appropriate)
- Transfuses blood when available → 'flying squad'/emergency O negative blood
- Transfuses in 1:1:1 ratio Red cells/FFP/platelets
- Considers reversing any anticoagulation
- Permissive hypotension
- Considers FAST scan in trauma context
- Considers correcting calcium and potassium e.g. on repeat VBGs
- Arranges appropriate investigations e.g. CT angio to identify bleeding point
- Hands over to specialty (critical care, surgery...)
- Leads team well
- Global mark from examiner