activate massive haemorrhage pathway · antepartum haemorrhage refer to antepartum haemorrhage...

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