Acute Haemorrhage

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ACUTE HAEMORRHAGE 

  • In massive hemorrhage i.e., from trauma it is difficult to estimate how much blood a patient has lost. However, a good estimate can be made by calculating the patient's normal circulating volume versus vital signs and other organ function tests. See Table below.
  • Restoration of blood volume with suitable replacement fluids is more important than red cell replacement in the management of previously healthy patients who have lost under 30% of their blood volume
  • The need for blood transfusion must be determined by:
    • The amount and speed of blood loss
    • The patient’s vital signs

Assessment of Blood Loss (For a 70Kg Adult)

 

Stage 1

Stage 2

Stage 3

Stage 4

Blood loss (litres)

<0.75

0.75-1.5

1.5-2

>2

Pulse rate

<100

>100

>120

>140

BP

Normal

Normal

90/60

<70

Respiratory Rate

<20

>20

>30

>40

Capillary Refill

<3 seconds

<3 seconds

>3 seconds

>3 seconds

Mental State

Normal

Anxious

Confused

lethargic

Urine output/ Hour

>30 mls

20-30 mls

<20 mls

<10 mls

Replacement fluid vol

(L)

2l

2-4.5l

>5l plus 2 units blood

>6l plus 3 units Blood

 

  • Replacement fluids which may be used are:
    • Haemacel: Replace every 1 ml of blood lost with 1 ml of fluid
    • Sodium lactate compound (Ringer’s lactate) IV infusion or Normal saline IV infusion Replace 1 ml of blood lost with 3 mls of fluid.

Do not use dextrose 5% or Darrow's ½ strength in dextrose 5% as replacement fluids

  • Maintain the airway and give oxygen by face mask first, especially for patients in stage 3 and 4. Make sure they are breathing adequately.
  • Insert 2 large bore cannula (gauge 14 or 16) and collect blood samples for full blood count {FBC}, grouping and cross- matching.
  • Give half of the calculated dose of replacement fluid in the first hour and give the other half over 3 hours.
  • Always assess the effects of fluid therapy. Remember to give warm fluids and cover patients to avoid hypothermia.
  • Aim at improving oxygen carrying capacity first before correcting anaemia. Remember to add maintenance fluids to the replacement fluid plus any on-going losses.

Maintenance fluids can be calculated as follows:

 Adults

Body weight x 1.5mls

Children

May use the rule of 4.2.1 for children or refer to section on diarrhoea.

  • Remember: deficit + maintenance + on- going loss