Massive Intraoperative Haemorrhage

🔑 Key Priorities

• Restore circulating volume

• Maintain perfusion and haemostasis

---

🧠 Team Actions

Role	Task
Team Leader	Coordinate MTP and surgical discussion
Circulation	Insert large-bore access, manage rapid infuser
Runner	Liaise with blood bank and collect products

---

🧭 Management Algorithm

1. Call for help and declare major haemorrhage

2. Initiate warming measures (patient, fluids, theatre)

3. Insert 2x 14–16G cannulas ± central line

4. Activate Massive Transfusion Protocol (MTP)

5. Administer blood products in 1:1:1 or 2:1:1 ratio

6. Use tranexamic acid early (1g IV over 10 mins)

7. Monitor for coagulopathy (labs ± ROTEM)

8. Target parameters:

   • Temp > 35°C, pH > 7.2

   • Plt > 75, Fibrinogen > 1.5, Ca²⁺ > 1.1

---

🔄 Ideal Crisis Flow

  Severe Intraoperative Haemorrhage
                ↓
         Call Help + Activate MTP
                ↓
    Warm Patient + Insert Large Bore IVs
                ↓
     Balanced Transfusion + Monitor Labs
                ↓
         Achieve Haemostasis + ICU Plan