Podcast
Questions and Answers
In the Extrinsic pathway of the clotting cascade, what directly triggers the clotting process?
In the Extrinsic pathway of the clotting cascade, what directly triggers the clotting process?
If thrombin is depleted, which substance will NOT be activated during the clotting process?
If thrombin is depleted, which substance will NOT be activated during the clotting process?
Why can massive red blood cell transfusions impair clotting?
Why can massive red blood cell transfusions impair clotting?
A patient with 25% red blood cells is most likely to present with which of the following?
A patient with 25% red blood cells is most likely to present with which of the following?
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During a major haemorrhage, which condition is least likely to occur?
During a major haemorrhage, which condition is least likely to occur?
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During a major haemorrhage, which of the following is rapidly consumed?
During a major haemorrhage, which of the following is rapidly consumed?
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Following a stabbing, which of the following indicates a major haemorrhage?
Following a stabbing, which of the following indicates a major haemorrhage?
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Which of the options below are clinical indications of a major haemorrhage?
Which of the options below are clinical indications of a major haemorrhage?
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Within what timeframe should Tranexamic Acid be administered to have the most effect?
Within what timeframe should Tranexamic Acid be administered to have the most effect?
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During major haemorrhage, what results from oxygen loss?
During major haemorrhage, what results from oxygen loss?
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During a major haemorrhage, how does the body attempt to maintain homeostasis?
During a major haemorrhage, how does the body attempt to maintain homeostasis?
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What physiological responses occur as a result of blood volume loss?
What physiological responses occur as a result of blood volume loss?
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How might an altered pH during major haemorrhage affect the body?
How might an altered pH during major haemorrhage affect the body?
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Where are baroreceptors mainly located?
Where are baroreceptors mainly located?
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Which of the following describes the intrinsic pathway of the clotting cascade?
Which of the following describes the intrinsic pathway of the clotting cascade?
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What is the main function of the baroreceptor reflex?
What is the main function of the baroreceptor reflex?
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Why is rapid sequence induction and intubation indicated early in a major haemorrhage?
Why is rapid sequence induction and intubation indicated early in a major haemorrhage?
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Which intravenous fluid is most appropriate for initial fluid replacement in active bleeding?
Which intravenous fluid is most appropriate for initial fluid replacement in active bleeding?
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What is the primary goal of early intervention in the 'Lethal Triad'?
What is the primary goal of early intervention in the 'Lethal Triad'?
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During a blood transfusion, which blood product contains the most fibrinogen per unit?
During a blood transfusion, which blood product contains the most fibrinogen per unit?
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What is a key criterion for declaring a major haemorrhage?
What is a key criterion for declaring a major haemorrhage?
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What does Tranexamic Acid (TxA) do?
What does Tranexamic Acid (TxA) do?
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If group-specific blood is unavailable, which type of packed red blood cells should be used in an emergency?
If group-specific blood is unavailable, which type of packed red blood cells should be used in an emergency?
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Which statement best describes the goal of transfusion during major haemorrhage?
Which statement best describes the goal of transfusion during major haemorrhage?
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Which physiological change impairs normothermia during major haemorrhage?
Which physiological change impairs normothermia during major haemorrhage?
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During the initial fluid resuscitation for major haemorrhage, what is the recommended approach while awaiting blood products?
During the initial fluid resuscitation for major haemorrhage, what is the recommended approach while awaiting blood products?
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What does the 'lethal triad' of major haemorrhage aim to eliminate?
What does the 'lethal triad' of major haemorrhage aim to eliminate?
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Why is cryoprecipitate administered during major haemorrhage?
Why is cryoprecipitate administered during major haemorrhage?
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During massive transfusion, which of the following is NOT routinely administered?
During massive transfusion, which of the following is NOT routinely administered?
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What is the role of the ODP during a major haemorrhage?
What is the role of the ODP during a major haemorrhage?
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Hypocalcaemia during major haemorrhage can cause which of the following?
Hypocalcaemia during major haemorrhage can cause which of the following?
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In an uncontrolled haemorrhage, what is the preferred initial fluid administration?
In an uncontrolled haemorrhage, what is the preferred initial fluid administration?
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What is the primary role of fibrinogen during major haemorrhage?
What is the primary role of fibrinogen during major haemorrhage?
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What surgical approach might be employed to stabilise a patient with an uncontrolled haemorrhage?
What surgical approach might be employed to stabilise a patient with an uncontrolled haemorrhage?
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Which medication would promote clotting in a patient experiencing a haemorrhage?
Which medication would promote clotting in a patient experiencing a haemorrhage?
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What is the target for systolic blood pressure in a patient experiencing an uncontrolled haemorrhage?
What is the target for systolic blood pressure in a patient experiencing an uncontrolled haemorrhage?
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In the provided case study, what is the initial action for controlling the patient’s catastrophic bleed?
In the provided case study, what is the initial action for controlling the patient’s catastrophic bleed?
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The patient's respiratory rate (RR) of 28 in the case study is primarily linked to what pathological process?
The patient's respiratory rate (RR) of 28 in the case study is primarily linked to what pathological process?
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What physiological mechanism causes the patient’s heart rate (HR) of 120 in the case study?
What physiological mechanism causes the patient’s heart rate (HR) of 120 in the case study?
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What is the priority for the patient's breathing (B) in the initial assessment, according to the information?
What is the priority for the patient's breathing (B) in the initial assessment, according to the information?
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Study Notes
Major Haemorrhage MCQs
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Patient presentation with 25% red blood cells: Likely to present with lightheadedness (low O2 to brain), breathing issues (low plasma), or clotting issues (low platelets).
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Indication of major haemorrhage (stabbing): Loss of 50% blood volume within 2 hours, or blood loss exceeding 100 ml/minute.
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Clinical indication of major haemorrhage: Heart rate above 110 bpm and systolic blood pressure below 90 mmHg.
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Body's compensatory mechanisms during major haemorrhage: Baroreceptors communicate volume loss to the brain, and sympathetic responses (increased heart rate and vasoconstriction) occur.
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Baroreceptor location: Aortic arch, pharyngeal walls, and blood vessels.
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Clotting cascade (intrinsic pathway): Triggered by indirect damage to blood vessels, internal damage causes fluid loss, and collagen triggers temporary clot formation.
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Clotting cascade (extrinsic pathway): Triggered by direct damage to blood vessels, collagen activates platelets, and potassium plays a role in the process.
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Thrombin depletion: Prothrombin and calcium activation will not occur.
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Massive blood transfusion and clotting: Citrate binding to calcium impairs the clotting cascade.
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Major haemorrhage risk factors: Coagulopathy (coagulation disorder), metabolic acidosis, hypothermia.
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Rapidly depleted substances in major haemorrhage: Clotting enzymes.
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Tranexamic Acid administration timing: Within the first 3-6 hours for optimal clot formation.
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Major haemorrhage treatment goal: Eliminate the lethal triad of coagulopathy, metabolic acidosis, and hypothermia.
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Cryoprecipitate use: To replenish fibrinogen.
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Massive transfusion administration: Calcium to activate clotting.
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Oxygen loss implications: Reduced oxygen leads to anaerobic respiration, and altered pH.
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Normothermia impairment in major haemorrhage: Peripheral vasoconstriction prevents 02-rich blood from reaching body extremities.
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Fluid replacement strategy in major haemorrhage: Replace fluid aiming for a target (lower) baseline blood pressure.
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Post-hemorrhage management: Eliminate coagulopathy, metabolic acidosis, and hypothermia
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Patient presentation details Important patient information, e.g., Respiratory rate(RR), heart rate(HR), systolic blood pressure, capillary refill time(CRT), SpO2(blood oxygen saturation).
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Damage control surgery: May be used to manage patients in uncontrolled haemorrhage.
Other important points
- Note the difference between intrinsic and extrinsic pathways of the coagulation cascade.
- Understand the importance of tranexamic acid in major haemorrhage.
- Be familiar with the clinical implications of the lethal triad.
- Know the role and administration of blood products.
- Remember the vital signs and patient assessments for major haemorrhage cases.
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Description
Test your knowledge on major haemorrhage with this quiz that covers patient presentations, indications, compensatory mechanisms, and the clotting cascades involved. Perfect for medical students and healthcare professionals looking to reinforce their understanding of emergency response to critical blood loss.
