Major Haemorrhage MCQs

A decrease in the red blood cell component (hematocrit) to 25% can lead to reduced oxygen delivery to the brain, resulting in lightheadedness.

Major hemorrhage is a serious condition characterized by a rapid loss of a significant portion of blood volume within a short period, typically more than 50% of blood volume within 2 hours.

Clinical signs of major hemorrhage include a significantly elevated heart rate (above 110 bpm) and a low systolic blood pressure (below 90 mmHg).

The body counteracts blood volume loss by activating the sympathetic nervous system. This leads to increased heart rate and contractility, as well as vasoconstriction, aiming to elevate blood pressure and maintain blood flow.

Baroreceptors, located in the aortic arch and carotid arteries, sense changes in blood pressure and volume. They send signals to the brain to trigger appropriate compensatory mechanisms.

The intrinsic pathway of blood clotting is activated when there is direct damage to blood vessels. This triggers a cascade of events that ultimately leads to the formation of a stable fibrin clot.

The extrinsic pathway of blood clotting is activated by tissue damage outside the blood vessels. This pathway involves the release of tissue factor (TF), which interacts with clotting factors to initiate the clotting process.

Thrombin, a key enzyme in the coagulation cascade, is responsible for converting fibrinogen into fibrin. Without thrombin, this conversion cannot occur, halting clot formation.

A blood pressure reading below 90 mmHg systolic is a clinical indication of significant blood loss. This occurs when the body cannot compensate for lost blood volume through increased heart rate and vasoconstriction.

A capillary refill time (CRT) exceeding 2 seconds indicates poor blood flow in the periphery. This is a sign of reduced tissue perfusion.

An elevated heart rate (HR) above 120 BPM is a homeostatic response to low stroke volume in order to maintain cardiac output. This is triggered by baroreceptors and the sympathetic nervous system.

Pale and cool extremities are a sign of peripheral vasoconstriction. This occurs as the body attempts to maintain central blood flow and pressure by diverting blood away from the extremities.

Hypoglycemia (low blood sugar) may be a consequence of starvation or trauma. This can further complicate the patient's condition.

The amount of blood lost per minute in a major haemorrhage.

A state of low blood pressure, usually defined as a systolic blood pressure below 100 mmHg.

A rapid infusion of fluids to increase blood volume and improve circulation.

A surgical procedure performed to stabilize a patient with uncontrolled bleeding, aiming to control the bleeding and prevent further complications.

A condition characterized by a combination of hypothermia, coagulopathy, and acidosis, often seen in patients with major trauma and haemorrhage.

A medical procedure that involves inserting a tube into the trachea to help a patient breathe.

A surgical procedure to expose the femoral bone, usually performed to control severe bleeding in the femoral region.

A type of dressing used to apply pressure to an open wound in order to control bleeding.

Calcium and Fibrinogen are essential components in the clotting cascade. Calcium acts as a cofactor, facilitating enzyme activity, while Fibrinogen is a precursor to fibrin, the protein that forms the meshwork of a blood clot.

Citrate, a common anticoagulant, binds to calcium, preventing it from participating in the clotting cascade. This ultimately disrupts the entire clotting process.

The lethal triad in major haemorrhage is a dangerous combination of coagulopathy, metabolic acidosis, and hypothermia. These factors synergistically worsen the bleeding and increase the risk of death.

During major haemorrhage, the body rapidly consumes enzymes that stimulate clot formation to compensate for ongoing blood loss.

Tranexamic acid is a medication given within the first 3 hours of a major bleed to inhibit the breakdown of blood clots. It helps stabilize the clotting process and reduce bleeding.

A major haemorrhage leads to a loss of oxygen, forcing cells to rely on anaerobic respiration, which produces lactic acid, causing metabolic acidosis.

During major haemorrhage, the goal of fluid replacement is to maintain adequate blood pressure and tissue perfusion. This is achieved through restricted crystalloid fluid replacement targeting a lower, but safe, blood pressure.

The aim of treatment for major haemorrhage is to address the lethal triad. This involves reversing coagulopathy, correcting metabolic acidosis, and maintaining normothermia. These measures help stabilize the patient and reduce the risk of death.

Cryoprecipitate is a concentrated form of plasma proteins, primarily containing fibrinogen, Factor VIII, and von Willebrand factor. It's used in major haemorrhage to enhance clotting and replace these vital clotting factors.

Calcium is crucial for blood clotting. During massive transfusion, fluid replacement can dilute calcium levels, leading to clotting dysfunction. Administering calcium helps restore normal clotting function.

The ODP (Operating Department Practitioner) plays a vital role in major haemorrhage management. Their responsibilities include procuring and managing blood products and medications, actively warming the patient to prevent hypothermia, and assisting with regular arterial blood gas analysis to monitor blood oxygenation and acidity.

Hypocalcaemia (low calcium levels) in a major haemorrhage can disrupt cardiac function. Decreased calcium can lead to a weakened heart, affecting its ability to pump effectively.

Rapid sequence induction and intubation (RSI) is a crucial step in major haemorrhage management. During severe bleeding, the body's oxygen levels rapidly decline, and the patient may lose respiratory function. RSI allows for immediate airway protection and mechanical ventilation to ensure oxygen delivery.

Hartmann's Solution or 0.9% Sodium Chloride (NaCl) are common IV fluids used for fluid volume replacement. However, excessive fluid replacement can dilute clotting factors, potentially worsening bleeding. Therefore, fluid replacement should be carefully managed in uncontrolled haemorrhage.

Tranexamic Acid is a medication that helps stabilize clots. While it may be helpful in certain situations, it is not used to prevent clotting. Instead, its purpose is to promote clot formation and reduce bleeding.