Approach to Hemorrhagic Shock

PLAN FOR CONTROLLING HEMORRHAGE & ACTIVATE MASSIVE TRANSFUSION PROTOCOL

 • Activate massive transfusion protocol

 • Determine how hemorrhage can be controlled (surgical, IR, or GI intervention) and call for help from the appropriate team(s)

USE THE RIGHT LINES AND EQUIPMENT

 • Don't wait for central access to begin resuscitation; often PIVs are superior for resuscitation anyway

 • Use a pressure infuser/heater to give product faster

USE BLOOD PRODUCTS IN A BALANCED RATIO

 • Initially, perform hemostatic resuscitation with blood products in a fixed ratio, e.g. 1 RBC/1 FFP/1 platelet

 • Goal is to provide an overall balanced resuscitation (but don't wait for a particular product to resuscitate)

 • Use hemodynamic stability (not hematocrit) as the resuscitation endpoint.

 • Can use CBC, coags, or TEG/ROTEM to guide additional resuscitation (see OnePager on TEG)



Nick Mark MD @nickmmark



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