Synopsis
Recognise major traumatic bleeding before profound hypotension, control accessible sources, activate coordinated blood-component support, and move rapidly to definitive operative or radiological haemostasis.
- Control visible catastrophic bleeding first with firm direct pressure, wound packing or an approved tourniquet; record tourniquet placement and application time clearly.
- Search the chest, abdomen, pelvis, retroperitoneum and long bones for concealed loss; a small external wound does not explain away abnormal physiology.
- Activate the major-haemorrhage protocol from clinical suspicion and response, not after laboratory confirmation, and state the delivery location and responsible clinician.
Key red flags
Uncontrolled external bleeding, expanding swelling, traumatic amputation, suspected pelvic disruption or blood loss into chest or abdomen requires immediate haemorrhage-control action.
Investigation priorities
Quantify perfusion and rapidly identify calcium, potassium and acid-base danger.
Guide targeted haemostatic replacement during active major bleeding.
Management branches
Life-threatening bleeding is seen or strongly suspected from mechanism and physiology.
- Apply direct pressure, haemostatic packing or a tourniquet as anatomically appropriate, splint long-bone injury and position a pelvic binder over the greater trochanters when indicated.
- Call the major-haemorrhage protocol with patient identifiers and location, obtain large-bore intravenous or intraosseous access and send urgent blood samples without delaying transfusion.
Key medicines
Tranexamic acidAdminister 1 g intravenously over 10 minutes, followed immediately by 1 g by intravenous infusion over 8 hours; start treatment as early as possible and no later than 3 hours after traumatic injury.