{"id":396,"date":"2010-11-01T00:00:01","date_gmt":"2010-11-01T00:00:01","guid":{"rendered":"https:\/\/awge.doctime.es\/?p=396"},"modified":"2010-11-01T00:00:01","modified_gmt":"2010-11-01T00:00:01","slug":"awge","status":"publish","type":"post","link":"https:\/\/awge.doctime.es\/index.php\/2010\/11\/01\/awge\/","title":{"rendered":"Guidelines. Blood transfusion and the anaesthetist: management of massive haemorrhage."},"content":{"rendered":"<p>Anaesthesia<br \/>\nThomas D, Wee M, Clyburn P, Walker I, Brohi K, Collins P, Doughty H, Isaac J, Mahoney PM, Shewry L.<\/p>\n<p><a href='' target='_blank'>Acceso al enlace publicador<\/a><\/p>\n<p>Summary<br \/>\n1. Hospitals must have a major haemorrhage protocol in<br \/>\nplace and this should include clinical, laboratory and<br \/>\nlogistic responses.<br \/>\n2. Immediate control of obvious bleeding is of paramount<br \/>\nimportance (pressure, tourniquet, haemostatic<br \/>\ndressings).<br \/>\n3. The major haemorrhage protocol must be mobilised<br \/>\nimmediately when a massive haemorrhage situation is<br \/>\ndeclared.<br \/>\n4. A fibrinogen < 1 g.l)1 or a prothrombin time (PT)\nand activated partial thromboplastin time (aPTT) of\n> 1.5 times normal represents established haemostatic<br \/>\nfailure and is predictive of microvascular bleeding.<br \/>\nEarly infusion of fresh frozen plasma (FFP;<br \/>\n15 ml.kg)1) should be used to prevent this occurring<br \/>\nif a senior clinician anticipates a massive haemorrhage.<br \/>\n5. Established coagulopathy will require more than<br \/>\n15 ml.kg)1 of FFP to correct. The most effective way<br \/>\nto achieve fibrinogen replacement rapidly is by giving<br \/>\nfibrinogen concentrate or cryoprecipitate if fibrinogen<br \/>\nis unavailable.<br \/>\n6. 1:1:1 red cell:FFP:platelet regimens, as used by the<br \/>\nmilitary, are reserved for the most severely traumatised<br \/>\npatients.<br \/>\n7. A minimum target platelet count of 75 \u00b7 109.l)1 is<br \/>\nappropriate in this clinical situation.<br \/>\n8. Group-specific blood can be issued without performing<br \/>\nan antibody screen because patients will have<br \/>\nminimal circulating antibodies. O negative blood<br \/>\nshould only be used if blood is needed immediately.<br \/>\n9. In hospitals where the need to treat massive<br \/>\nhaemorrhage is frequent, the use of locally developed<br \/>\nshock packs may be helpful.<br \/>\n10. Standard venous thromboprophylaxis should be<br \/>\ncommenced as soon as possible after haemostasis has<br \/>\nbeen secured as patients develop a prothrombotic<br \/>\nstate following massive haemorrhage.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Anaesthesia Thomas D, Wee M, Clyburn P, Walker I, Brohi K, Collins P, Doughty H, Isaac J, Mahoney PM, Shewry<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[3],"tags":[],"_links":{"self":[{"href":"https:\/\/awge.doctime.es\/index.php\/wp-json\/wp\/v2\/posts\/396"}],"collection":[{"href":"https:\/\/awge.doctime.es\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/awge.doctime.es\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/awge.doctime.es\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/awge.doctime.es\/index.php\/wp-json\/wp\/v2\/comments?post=396"}],"version-history":[{"count":0,"href":"https:\/\/awge.doctime.es\/index.php\/wp-json\/wp\/v2\/posts\/396\/revisions"}],"wp:attachment":[{"href":"https:\/\/awge.doctime.es\/index.php\/wp-json\/wp\/v2\/media?parent=396"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/awge.doctime.es\/index.php\/wp-json\/wp\/v2\/categories?post=396"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/awge.doctime.es\/index.php\/wp-json\/wp\/v2\/tags?post=396"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}