Adult Medical Emergency Handbook - Scottish Intensive Care Society

Table 2 continued
IMMEDIATE REACTION
CATEGORY 3: LIFE-THREATENING
1. Maintain airway and give high concentration (60-100%) oxygen
by mask.
2. Stop the transfusion. Replace the giving set and keep the IV line
open with 0.9% saline.
3. Manage as anaphylaxis protocol and ensure help is coming:
stridor, wheeze and hypotension require treatment with oxygen
and im adrenaline. Critical care admission will be necessary.
4. Notify the Consultant Haematologist and the Hospital
Transfusion Laboratory immediately.
5. Send the blood unit with the giving set, freshly collected
blood samples with appropriate request form to the Hospital
Transfusion Laboratory for investigations.
6. Check a fresh urine sample visually for signs of haemoglobinuria.
7. Commence a 24 hour urine collection and fluid balance chart
and record all intake and output. Maintain fluid balance.
8. Assess for bleeding from puncture sites or wounds, if DIC
suspected seek expert advice.
9. Reassess:
• Treat bronchospasm and shock as per protocol.
• Acute renal failure or hyperkalaemia may require urgent renal
replacement therapy.
10. If bacteraemia is suspected (rigors, fever, collapse, no evidence
of a haemolytic reaction), take blood cultures and give broad
spectrum antibiotics with Pseudomonas cover: Piperacillintazobactam
4.5G tds IV plus gentamicin 7mg/kg od IV (ideal
bodyweight). Discuss with haematologist on call.
adult medical emergencies handbook | NHS LOTHIAN: UNIVERSITY HOSPITALS DIVISION | 2009/11
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