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 #BloodLoss #Hemorrhage #Anesthesiology #Anesthesia #Intraoperative #Checklist #Diagnosis #Management #Workup
