Acute major blood loss is a surgical / anaesthetic emergency.
A loss of up to 25% blood volume will produce a characterisitic clinical picture of tachycardia and reducing capillary refill with peripheral vasoconstriction, oliguria. Blood pressure may be maintained.
A loss of 25-40% blood volume will produce hypotension and increasing tachycardia. Intense peripheral vasoconstriction and falling urinary output.
A loss of greater than 40% blood volume will result in severe hypovolaemic shock: hypotension, tachycardia, anuria and confusion / coma.
1) Inform the surgeon (if he is unaware of the extent of blood loss), get senior anaesthetic help.
2) Confirm large bore venous access (at least 2) and secure the airway.
3) Urgent cross-match / use of O-ve blood.
4) High-flow fluid warmer, colloid.
5) Monitor clotting status and manage in consultation with haematology:
6) FFP to maintain PT/APTT below 1.5 x control, cryo if fibrinogen low, platelets as advised.
7) Place a urinary catheter. Arterial montoring when technically possible, central venous monitoring: IJV or femoral v as clotting permits.
