Post on 28-Aug-2019
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