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Haemostatic Drugs Discuss with Consultant Haematologist Vit K and Prothrombin Complex Concentrate for warfarinised patients Other haemostatic agents and reversal of new anticoagulants: Order MHP 2 & Give Red cells 4 units FFP 4 units Platelets 1 dose (ATD) request Cryoprecipitate 2 packs if fibrinogen <2g/l or if indicated by TEG RPH Management of Massive Obstetric Haemorrhage Call for help ( 2222 State - ‘Massive Obstetric Haemorrhage, location, extension number’ wait by phone Laboratory will contact extension number on alert and ask for details from nominated ‘co- ordinator’ Order MHP 1 & Give Red cells* 4 units FFP 4 units Platelets 1 dose (ATD) (*Emergency O blood, group specific blood, XM blood depending on availability) Reassess Suspected continuing haemorrhage requiring further transfusion Take bloods and send to lab: FBC, PT, APTT, fibrinogen, U+E, Ca 2+ NPT: ABG, TEG if available Emergency O –ve red cells available at: •SGU Delivery Suite •RPH General Theatre Fridge Blood available from sample receipt •Group specific red cells – 20 mins • XM red cells - 45 mins •FFP – 30 mins •Platelets – 1 hour NB: Blood can be removed immediately from Hemonine fridge on delivery suite when a second G&S sample has been tested and patient has no irregular antibodies – check on Blood Manager STOP THE BLEEDING RESUSCITATE Airway Breathing Circulation Antepartum Haemorrhage refer to Antepartum Haemorrhage Postpartum Haemorrhage refer to Postpartum Haemorrhage Prevent Hypothermia Use fluid warming device Used forced air warming blanket Cell salvage - if available and appropriate Consider ratios of other components: 1 unit of red cells = c.250 mls salvaged blood Consider 10 mls Calcium chloride 10% over 10 mins 2 packs cryoprecipitate if fibrinogen < 2g/l or as indicated by TEG Aims for therapy Aim for: Hb 80-100g/l Platelets >75 x 10 9 /l PT ratio < 1.5 APTT ratio <1.5 Fibrinogen >2 g/l Ca 2+ >1 mmol/l Temp > 36 o C pH > 7.35 (on ABG) Monitor for hyperkalaemia STAND DOWN Inform lab Return unused components Complete documentation Including traceability Transfusion lab ( 2605 or Bleep 2703 (5pm-8am + weekends/BH) Consultant Haematologist if required ( via switchboard Thromboprophylaxis should be considered when patient stable ABG - Arterial Blood Gas APTT - Activated partial thromboplastin time ATD - Adult Therapeutic Dose FFP - Fresh Frozen plasma MHP - Massive Haemorrhage Pack NPT - Near Patient Testing PT - Prothrombin Time TEG - Thromboelastograph XM - Crossmatch Once MHP 2 administered, repeat bloods: FBC, PT, APTT, fibrinogen, U+E, NPT: ABG, TEG if available to guide further blood component requesting Activate Massive Haemorrhage Pathway Continuous cardiac monitoring REF TR 37: Review March 17 If blood loss ≥ 2000ml and on-going Administer Tranexamic Acid – esp. in trauma and ideally within 1 hour (1g bolus followed by 1g infusion over 8 hours) Take bloods and send to lab: XM, FBC, PT, APTT, fibrinogen, U+E, Ca2+ NPT: ABG, TEG if available

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Page 1: Activate Massive Haemorrhage Pathway · Antepartum Haemorrhage refer to Antepartum Haemorrhage Postpartum Haemorrhage refer to Postpartum Haemorrhage Prevent Hypothermia Use fluid

HaemostaticDrugsDiscusswithConsultant

Haematologist

VitKandProthrombinComplexConcentrate forwarfarinised

patientsOtherhaemostaticagentsandreversalofnewanticoagulants:

OrderMHP2&GiveRedcells 4unitsFFP 4unitsPlatelets1dose(ATD)

requestCryoprecipitate2packsiffibrinogen<2g/lorifindicatedbyTEG

RPHManagementofMassiveObstetricHaemorrhage

Callforhelp( 2222State- ‘MassiveObstetric

Haemorrhage,location,extensionnumber’

waitbyphoneLaboratorywillcontactextensionnumberonalertandaskfordetailsfromnominated‘co-

ordinator’

OrderMHP1&GiveRedcells* 4unitsFFP 4unitsPlatelets1dose(ATD)

(*EmergencyOblood,groupspecificblood,XMblooddependingon

availability)

ReassessSuspectedcontinuinghaemorrhage

requiringfurthertransfusionTakebloodsandsendtolab:

FBC,PT,APTT,fibrinogen,U+E,Ca2+NPT:ABG,TEGifavailable

EmergencyO–veredcellsavailableat:

•SGUDeliverySuite•RPHGeneralTheatreFridge

Bloodavailablefromsamplereceipt•Groupspecificredcells– 20mins• XMredcells- 45mins•FFP– 30mins•Platelets– 1hour

NB:BloodcanberemovedimmediatelyfromHemoninefridgeondeliverysuitewhenasecondG&Ssamplehasbeentestedandpatienthasnoirregularantibodies– checkonBloodManager

STOPTHEBLEEDING

RESUSCITATEAirway

BreathingCirculation

AntepartumHaemorrhagereferto

AntepartumHaemorrhage

PostpartumHaemorrhagereferto

PostpartumHaemorrhage

PreventHypothermiaUsefluidwarmingdevice

Usedforcedairwarmingblanket

Cellsalvage- ifavailableandappropriate

Considerratiosofothercomponents:

1unitofredcells=c.250mlssalvagedblood

Consider10mlsCalciumchloride10%over10mins

2packscryoprecipitateiffibrinogen<2g/lorasindicatedby

TEG

AimsfortherapyAim for:Hb 80-100g/lPlatelets >75x109/lPTratio <1.5APTTratio <1.5Fibrinogen >2g/lCa2+ >1mmol/lTemp >36oCpH>7.35(onABG)Monitorforhyperkalaemia

STANDDOWNInformlab

Returnunusedcomponents

CompletedocumentationIncludingtraceability

Transfusionlab ( 2605orBleep2703(5pm-8am+

weekends/BH)

ConsultantHaematologistifrequired

( viaswitchboard

ThromboprophylaxisshouldbeconsideredwhenpatientstableABG- ArterialBloodGasAPTT- Activatedpartialthromboplastintime ATD- AdultTherapeuticDoseFFP- FreshFrozenplasma MHP- MassiveHaemorrhagePack NPT- NearPatientTestingPT- ProthrombinTime TEG- Thromboelastograph XM- Crossmatch

OnceMHP2administered,repeatbloods:

FBC,PT,APTT,fibrinogen,U+E,NPT:ABG,TEGifavailable

toguidefurtherbloodcomponentrequesting

ActivateMassiveHaemorrhagePathway

Continuouscardiacmonitoring

REF TR 37: Review March 17

Ifbloodloss≥2000mlandon-goingAdministerTranexamicAcid– esp.intraumaandideallywithin1

hour(1gbolusfollowedby1ginfusionover8hours)

Takebloodsandsendtolab:XM,FBC,PT,APTT,fibrinogen,U+E,Ca2+NPT:ABG,TEGifavailable

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