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Massive Blood Loss Protocol for Bleeding Trauma Patients Massive Blood Loss Emergency Numbers: Blood Bank Ext: 50041 Place Addressograph Here Dispatch Ext: 32777 Massive Blood Loss Protocol for Bleeding Trauma Patients Activation The Trauma Team Leader is responsible for activating the MBLP considerin▯g the following criteria: a. Haemorrhagic shock b. Impending haemorrhagic shock due to major haemorrhage c. Blood loss more than 150 mL/min d. SBP <90 mmHg with suspected haemorrhage Baseline Investigation Baseline bloods must be taken prior to transfusion including: a. Full blood count b. Group and cross match c.Coagulation screen including fibrinogd. Biochemistry Near patient testing - Arterial or venous blood gas Targeting Coagulopathy Tranexamic Acid - This should be administered within 3 hours of injury Dose: 1g intravenous bolus followed by infusion of 1g over 8 hours Correct acidosis and hypothermia Immediate Blood Transfusion 4 units of ORhD negative and 2 units of trauma plasma* are available in the ED resuscitation fridge for immediate transfusion Trauma Pack 1 On activation of the protocol the blood bank will start Trauma Pack 1 for dispatch Trauma Pack 1 contains: Platelets 1 bag (transfuse first) + FFP 4 units + PRBCs 4 units** Consider 1 gram of calcium chloride***, if clinical or biochemical evidence of hypocalcaemia/TEG as a guide if available Is the patient still bleeding? Inform the blood bank regarding the location of the trauma patient Trauma Pack 2 If bleeding continues a nominated person must request blood banTrauma Pack 2 Trauma Pack 2 contains: FFP 4 units + PRBCs 4 units** + Cryoprecipitate 2 pools + Platelets 1 bag Continue requesting Trauma Pack 2 until bleeding is stopped Is the patient still bleeding? Inform the blood bank regarding the location of the trauma patient Stand Down Once bleeding is controlled, inform the blood bank and dispatch / Return unused components / Complete documentation Repeat bloods including full blood count and clotting screen Use ROTEM/TEG as a guide if available Continued Resuscitation Administer further products if: 9 a.Platelets <50x10 /L - 1 dose of platelet b.Fibrinogen <1.5g/L - 2 pools cryoprecipitate c.PT and/or APTT >1.5 x normal - FFP 15-20ml/kg If bleeding persists contact the on-call haematologist for advice Major Trauma Blood Administration Procedure Activation and Preparation c Massive blood loss protocol for trauma patient has been activated c Has the Blood Bank been contacted: 50041 c Has the Dispatch been contacted: 32777 c Has the patient got an Armband Administer Products from Resus Fridge 1. 1st O negative Red Cells Time: c Component given 2. 2nd O negative Red Cells Time: c Component given 3. 1st unit of Trauma Plasma Time: c Component given 4. 2nd unit of Trauma Plasma Time: c Component given 5. c Component given 3rd O negative Red Cells Time: 6. 4th O negative Red Cells Time: c Component given Total Red Cells Total Trauma Plasma On arrival of Trauma Pack1, administer components in the following order: Trauma Pack 1 1. 1 bag of Platelets Time: c Component given 2. 1st unit Fresh Frozen Plasma Time: c Component given 3. 2nd unit Fresh Frozen Plasma Time: c Component given c Component given 4. 5th O negative Red Cells Time: 5. 6th O negative Red Cells Time: c Component given 6. 3rd unit Fresh Frozen Plasma Time: c Component given 7. 4th unit Fresh Frozen Plasma Time: c Component given 8. 7th O negative Red Cells Time: c Component given 9. 8th O negative Red Cells Time: c Component given Total Platelets Total FFP Total Red Cells On arrival of Trauma Pack 2, administer components in the following order: Trauma Pack 2 1. Transfuse 2 pools of CryoprecipitaTime: c Component given 2. 5th unit Fresh Frozen Plasma Time: c Component given 3. 2nd unit Fresh Frozen Plasma Time: c Component given 4. c Component given 9th O negative Red Cells Time: 5. 10th O negative Red Cells Time: c Component given 6. 7th unit Fresh Frozen Plasma Time: c Component given 7. 8th unit Fresh Frozen Plasma Time: c Component given 8. 11th O negative Red Cells Time: c Component given 9. 12th O negative Red Cells Time: c Component given 10. 1 bag of Platelets Time: c Component given Total Platelets Total FFP Total Red Cells