Adults

Hemorrhage

Diagnosis

Acute massive bleeding

Diagnosis

Acute massive bleeding

  1. Call for help

    • Ask: "Who will be the crisis manager?"
    • Crisis manager designates checklist reader

  2. Crystalloid bolus until blood products available

  3. Obtain large bore IV access, rapid infuser

    • Obtain arterial access

  4. Turn FiO2 to 100% and reduce volatile anesthetics

  5. Call blood bank

    • Activate massive transfusion protocol
      • Consider whole blood
      • Consider uncrossmatched Type O RBC and Type AB plasma
      • Consider autologous blood salvage
    • Assign 1 person as primary contact for blood bank

  6. Begin transfusion in 1 PRBC : 1 FFP : 1 Platelet

    • Calcium repletion for massive transfusion
    • Fibrinogen replacement as indicated

  7. Consider TXA administration

  8. Warm patient and fluids

  9. Discuss management plan with surgical, anesthesiology, and nursing teams

    • Call for additional surgery consultation as indicated
    • Consider damage control surgery (pack, close, resuscitate)
    • Consider resuscitative endovascular balloon occlusion of the aorta (REBOA) for hemorrhage below the diaphragm
    • Consider ECMO or cardiac bypass to facilitate surgical repair

  10. Send labs

    • CBC, PT / PTT / INR, fibrinogen, lactate, arterial blood gas, potassium, and ionized calcium
    • Viscoelastography

  11. Consider re-dosing antibiotics if EBL > 1500 mL

Patient weight

Between 30 kg and 250 kg

Reset the checklist?

Checked steps, the timer and this crisis log are cleared. The patient’s weight is kept.

Finish the crisis?

The timer pauses, and you can review the case and the event log.