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

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