Haemorrhagic Hypovolemia

Haemorrhagic Hypovolemia (CPG A0801)

Care Objectives

Identify and control major haemorrhage.
Ensure vital organ perfusion while minimising the development of coagulopathy, acidosis and
hypothermia.
Rapid transport to a facility capable of definitive haemorrhage control.

General Notes

Minimising the volume of fluid administered may require accepting tachycardia and a degree of
hypotension prior to definitive control of the haemorrhage.
A BP can be difficult to ascertain accurately in critically ill patients. Patients with a BP < 70 mmHg
will often present with absent radial pulses and decreased alertness. It may be appropriate to
combine these assessments with the use of BP, especially where BP is thought to be inaccurate or
cannot be taken.
Where the patient is not alert but has a BP ≥ 70 mmHg / radial pulse present, consider other causes
of altered conscious state (e.g. TBI, ETOH, OD, hypoglycaemia, dementia).
If an adequate BP cannot be achieved or there are other signs of unacceptably poor perfusion or
deterioration, consult for further management. Options include further fluid, the use of pressors
and/or the delivery of blood products

General Care

Blood products are the preferred resuscitation fluid and, where possible, should be considered in
preference to normal saline (e.g. blood products delivered to the scene, interfacility transfer, HEMS).
Always consider tension pneumothorax, particularly in the patient with chest injury with IPPV or
persistent hypotension despite fluid therapy.
Where the patient condition and presentation allow, expedite transport with concurrent management
of pain (e.g. penetrating trauma, amputation). Where possible, DO NOT delay transport for IV therapy
in haemorrhagic hypovolaemia, especially penetrating trauma.
This guideline applies to patients with suspected ruptured AAA, massive GIT haemorrhage, and
pregnant trauma patients.
This guideline DOES NOT apply to patients with TBI, isolated SCI or PPH. Manage as per the
relevant CPG.

Blood Administration

Advanced Paramedics credentialed in blood product administration may administer Packed Red Blood
Cells (PRBC), if available, when HEMS is significantly delayed or unavailable.
Advanced Paramedics not credentialled may still administer PRBC under consultation with the receiving
hospital or sending hospital in IHT.
Consult with Watch Officer to assist in getting PRBC to scene. The initial attending MICA unit should
not delay arrival at the scene to access PRBC.
Scene time should not be prolonged waiting for PRBC.
Watch Officer should be notified of any patient requiring PRBC that is not transported to a Major Trauma
Centre. This facilitates early support of Regional Trauma Centers and arrangement of secondary
transfer where appropriate.
The use of blood products is audited via the Limited Occurrence Screening system.
PRBC must not be administered to a patient who identifies as Jehovah’s Witness and refuses
consent to a ‘blood transfusion’.
iCa should be measured in patients with haemorrhagic hypovolaemia where possible (e.g. Inter
Hospital Transfer). Calcium Gluconate 10% may be administered empirically following 4 units of
PRBC or where hypocalcaemia is identified (regardless of the number of units of PRBC
administered). If hypocalcaemia is present following the initial dose for either indication, a repeat
dose may be administered.

Flow Chart