Major Haemorrhage Management Useful Contacts: Clinical Emergency 3333 Surgical SpR page 8600 Anaesthetic SpR page 8602 Blood Bank Ext 80393 or via switchboard Consultant Haematologist CALL FOR HELP Check: Airway Breathing Circulation Minimise bleeding Consider arterial or direct pressure Insert two size appropriate Large bore IV cannula.If unsuccessful >6yrs <6yrs Consider venous cut down or intraosseus route Insert two intraosseus needles Take blood for: Crossmatch - pink bottle FBC - pink bottle Phone Blood Bank Ext 80393 or via switchboard Give: 20 mLs/kg of warmed Saline, Hartmans or PPS Contact ITU. Ask for blood warmer as an emergency – Ext 80083 Cap refill > 2secs Cap refill < 2secs Reassess ABC Following 1st fluid bolus Following 2nd fluid bolus Reassess ABC Give 2nd bolus of clear fluid Give 20 mLs/kg blood If total blood loss 40 mLs/kg Give 10 mLs/kg FFP If platelets < 50 Give 10mLs/kg of platelets If Fibrinogen < 0.8g/l Give 5mLs/kg of Cryo

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 bottle FBC, EDTA bottle Coag, purple topped bottle U&E’s orange topped bottle Blood available: O Negative 2 units available in Blood Bank and Theatre. Group Specific Available 10mins after receipt of sample Fully Crossmatched Available 40mins after receipt of sample Authors: P Bolton/E Harrison Version: 1.0 Final Issue Date: March 2007