Theatre Checklists
Theatre Checklists
Theatre Checklists
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Control Bleeding<br />
Minimise time to Surgery<br />
Use tourniquets to control peripheral<br />
Tamponade bleeding eg: pelvic binder, direct pressure, sutures<br />
Uterine massage, oxytocin, misoprostol, haemabate<br />
Consider Massive Transfusion Protocol (MTP)<br />
ABC Score<br />
Anticipate needs, if > 4 units/2hrs<br />
Mobilise Resources<br />
Lab staff, Porters, Nursing, <strong>Theatre</strong> Staff<br />
Retrieval Service & Blood Bank<br />
Empirical Treatment<br />
Transfuse at a 1:1 ratio of PRCs : FFP<br />
Permissive hypotension MAP 65-70 mmHg<br />
(unless TBI/spinal injury/exsanguination)<br />
Send FBE, X-Match, Venous Gas, Calcium, Coags<br />
Arterial line, consider Calcium (citrate toxicity)<br />
WARM FLUIDS/WARM THEATRE<br />
MASSIVE BLOOD LOSS<br />
ABC SCORE<br />
penetrating injury<br />
positive FAST exam<br />
HR > 120/min<br />
systolic BP < 90mmHg<br />
[no lab results - purely clinical]<br />
0/4 = 1% risk of MTP<br />
1/4 = 10% risk of MTP<br />
2/4 = 41% risk of MTP<br />
3/4 = 48% risk of MTP<br />
4/4 = 100% risk of MTP<br />
[Activate MTP if 3 + criteria met]<br />
IV ACCESS - LARGE BORE IV x 2 (14G)<br />
CONSIDER USE OF RAPID INFUSER KIT (7Fr)<br />
CONSIDER USE OF INTEROSSEOUS DEVICE<br />
CONSIDER VENOUS CUTDOWN<br />
TRANEXAMIC ACID - give 1g stat in first 3 hrs for TRAUMA<br />
WARM FLUIDS - level I infuser/water bath<br />
CRYSTALLOID - 250ml boluses titrate to MAP/radial pulse<br />
AIM FOR<br />
t > 35, pH > 7.2, Lactate < 4, BE < -6<br />
Ca > 1.1, Plt > 50, INR < 1.5 Fibrinogen > 1
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