8-15
What To Do:
- Perform a survey of the casualty to ensure airway stabilization, adequate respirations, and hemorrhage
control.
a. Establish two large bore (18 gauge or larger) IV lines.
(1) Draw blood.
(2) Request and/or perform labs, H/H with type and crossmatch.
b. Initiate IV fluids for resuscitation. Give Ringer’s Lactate as a first choice, normal saline as a second
choice.
NOTE: The usual initial volume for resuscitation is 1-2 liters in an adult and 20ml/kg in pediatric cases.
Other diagnostic decisions are based on the observed response.
c. Establish a set of baseline vitals.
d. Perform other resuscitative procedures as required: ABCs and secondary survey. - Monitor patient and determine if patient requires blood transfusion:
a. Indications that patient does not require a blood transfusion:
(1) Stable vital signs within normal limits, Class I or Class II shock.
(2) Patients who have lost less than 20% of their blood volume and are no longer hemorrhaging
require no further fluid bolus or immediate blood administration.
(3) H/H within normal limits.
CAUTION: With rapid blood loss, H/H will lag behind actual blood volume.
b. Indications for blood transfusion:
(1) Vital signs not stable, patient in Class III shock.
(2) Patients who have lost 20% to 40% of their blood volume and are still hemorrhaging will show
marked deterioration. Continued fluid therapy and blood replacement are indicated.
(3) Patients with little or no response to the initial fluid therapy.
(4) H/H below normal.
NOTE: Isovolemic patients can have adequate O 2 carrying capacity with Hb levels as low as 7 gm/dL. - Determine the type of blood to give to the patient. (Type Specific or Universal Donor - O Negative)
NOTE: Response to blood administration should identify patients that are still bleeding and require rapid
surgical intervention.
a. Select the appropriate blood type based on the type and crossmatch and the types of blood available.
b. Ideally, the patient should receive the same type of blood that they have.
c. In urgent situations, type O RBCs (not whole blood) may be used for patients of other blood types, and
either A or B RBCs may be used for AB recipients (but not both together).
d. Rh-negative patients should always receive Rh-negative blood except in life-threatening emergencies
when Rh-negative blood may be unavailable.
e. Rh-positive patients may receive either Rh-positive or Rh-negative blood. - Select the appropriate blood component, if available:
a. Whole blood: used for rapid massive blood loss and exchange transfusions. May be necessary if a
component is unavailable. (Higher incidence of transfusion reaction due to plasma)
b. Packed RBCs: also used for rapid massive blood loss and exchange transfusions. Packed RBCs are
preferred due to the lower chance of complications.
(1) Transfused to replace Hb or O 2 carrying capacity, including blood lost at surgery or as a result of
trauma.
(2) Consider the patient’s age, cause, degree of anemia, circulatory stability and the condition of heart,
lungs, and blood vessels.
(3) When volume expansion is required, other fluids can be used concurrently or separately.
c. Fresh frozen plasma is an unconcentrated source of all clotting factors except platelets.
(1) Used to correct a bleeding tendency of unknown cause or one associated with liver failure.
(2) Can supplement RBCs when whole blood is unavailable for exchange transfusion.
(3) Except when prepared from autologous donations, not ordinarily used as a volume expander.
d. Washed RBCs (by continuous-flow washing) are free of almost all traces of plasma, most WBCs, and
platelets. Used for patients who have severe reactions to plasma (e.g., severe allergies or IgA