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 #Hemorrhagic #Shock #Management #Summary #CriticalCare #MassiveTransfusion
