Major haemorrhage in the resuscitation area - overview
Major haemorrhage is life‑threatening bleeding likely to require massive transfusion and urgent specialist haemorrhage control. Common causes seen in the resuscitation room include major trauma, ruptured abdominal aortic aneurysm, large gastrointestinal bleeds, obstetric haemorrhage and post‑operative or interventional bleeding.
Rapid recognition, immediate mechanical haemorrhage control, early haemostatic transfusion and escalation to surgery or interventional radiology are the priorities; delays increase the risk of the “lethal triad” (hypothermia, acidosis, coagulopathy) and mortality (NICE NG24; NG39).
Recognition and triage triggers Use pragmatic quantitative and clinical triggers to identify major haemorrhage (NICE NG24):
- Loss of greater than 1 blood volume in 24 hours (~70 mL/kg; ≈5 L for a 70 kg adult).
- Loss of 50% of blood volume within 3 hours (~2.5 L in a 70 kg adult).
- Ongoing bleeding at greater than 150 mL/min.
- Clinical markers: systolic blood pressure <90 mmHg or heart rate >110 bpm suggest major blood loss; hypotension is often a late sign.
- Be aware that profound shock may produce bradycardia in some elderly or trauma patients.
- Lactate is a useful perfusion marker; lactate >4 mmol/L correlates with worse outcome and should prompt escalation (RCEM).
Immediate resuscitation priorities (resus‑room actions)
Primary goal: stop catastrophic bleeding, restore perfusion without worsening bleeding, and activate the Major Haemorrhage Protocol (MHP).
Do these immediately, in...