Synopsis
Activate coordinated haemorrhage control early, deliver safe empirical component support, prevent lethal physiological deterioration and transition rapidly to targeted haemostasis.
- First-line management is immediate major-haemorrhage activation plus anatomical bleeding control; transfusion is support, not source control.
- Activate on physiology, bleeding rate, mechanism and poor response rather than waiting for an arbitrary unit count or one risk score.
- Obtain correctly labelled pretransfusion samples before blood if this does not delay resuscitation and tell the laboratory about pregnancy potential, antibodies and special requirements.
Key red flags
Persistent hypotension, tachycardia, altered consciousness, mottling, rising lactate or ongoing visible bleeding despite initial resuscitation indicates uncontrolled haemorrhagic shock.
Investigation priorities
Enable rapid transition from emergency group O to group-specific and antigen-appropriate blood.
Track anaemia, platelet loss, factor deficiency and fibrinogen depletion.
Management branches
Bleeding and physiology suggest life-threatening or rapidly escalating blood loss.
- Call the major-haemorrhage number and summon the appropriate procedural, anaesthetic, critical-care and transfusion teams.
- State identifiers, location, cause, pregnancy potential, antibodies and urgency; assign a component coordinator and recorder.
Key medicines
Tranexamic acid in major traumaGive 1 g intravenously over 10 minutes as soon as possible after injury, followed by 1 g intravenously over 8 hours; start within 3 hours of injury and do not use later unless laboratory evidence of hyperfibrinolysis supports it.
Calcium chloride during major transfusionWhen ionised hypocalcaemia develops during rapid major transfusion, give 10 mL of 10% calcium chloride intravenously, providing about 6.8 mmol calcium, through secure central or large-bore access under the local protocol and repeat according to ionised calcium and ECG response.