Intraoperative Massive Blood Loss - Guidelines for Crises in Anaesthesia
Expected or unexpected major haemorrhage
❶ Call for help, inform theatre team of problem and note the time.
❷ Increase FiO2 and consider cautiously reducing inhalational/intravenous anaesthetics.
❸ Check and expose intravenous access.
❹ Control any obvious bleeding (pressure, uterotonics, tourniquet, haemostatic dressings).
❺ Call blood bank (and assign one person in theatre to liase with them):
• Activate major haemorrhage protocol.
• Communicate how quickly blood is required.
• Communicate how much blood and blood product is required.
❻ Begin active patient warming.
❼ Use rapid infusion and fluid warming equipment.
❽ Discuss management plan between surgical, anaesthetic and nursing teams:
• Liaise with haematologist if necessary (Box A).
• Consider interventional radiology.
• Consider use of cell salvage equipment.
❾ Monitor progress:
• Use point of care testing: Hb, lactate, coagulation, etc.
• Use lab testing: including calcium and fibrinogen.
❿ Replace calcium and consider giving tranexamic acid (Box C).
⓫ If bleeding continues consider giving recombinant factor VIIa: liase with haematologist.
⓬ Plan ongoing care in an appropriate clinical area.
By Association of Anaesthetists @ https://twitter.com/AAGBI
Quick Reference Handbook - Guidelines for crises in anaesthesia
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