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A TEXTBOOK OF POSTPARTUM HEMORRHAGE - PART 5

Đầu phẫu thuật hoặc can thiệp sản khoa Thượng G / I đường thủ tục can thiệp X quang thích hợp phẫu thuật đội thuế ngân hàng gây mê máu Chèn rộng ống ngắn ngoại vi mang tặng khối lượng đầy đủ của tinh thể / Mục tiêu máu để duy trì huyết áp bình thường và lượng nước tiểu 30 ml / h ở người lớn | Resuscitation Table 2 Acute massive blood loss a template guideline Immediate actions Key points Other considerations Arrest bleeding Early surgical or obstetric intervention Upper G I tract procedures Interventional radiology Contact key personnel Most appropriate surgical team Duty anesthetist Blood bank Restore circulating volume Insert wide-bore peripheral cannulae Blood loss is often N.B. In patients with major Give adequate volumes of underestimated vessel or cardiac injury crystalloid blood Refer to local guidelines for the it may be appropriate to Aim to maintain normal blood resuscitation of trauma patients restrict volume replacement pressure and urine output 30 ml h and for red cell transfusion after discussion with surgical in adults or 0.5 ml kg h Monitor CVP if team hemodynamically unstable Request laboratory FBC PT APTT fibrinogen blood Take samples at earliest investigations bank sample biochemical profile opportunity as results may be blood gases affected by colloid infusion Repeat FBC PT APTT fibrinogen Misidentification is most every 4 h or after one-third blood common transfusion risk volume replacement or after infusion May need to give FFP of FFP platelets before the FBC and coagulation results available Request suitable red cells Blood needed immediately - use Contact blood transfusion N.B. All red cells are now Emergency stock group O Rh laboratory or oncall BMS and leukocyte-depleted. The D -negative provide relevant details volume is provided on each Blood needed in 5-10 min - type-specific Collect sample for group and pack and is in the range of will be made available to maintain cross-match before using 190-360 ml O Rh D -negative stocks emergency stock Blood needed in 30 min or longer - fully Blood warmer indicated if large cross-matched blood will be provided volumes are transfused rapidly Consider the use of Anticipate platelet count 50 X 109 l Target platelet count - platelets after 2 liters blood loss with continued 100 X 109 l for