This document provides guidance on managing massive hemorrhage through a massive hemorrhage protocol (MHP). It outlines the steps to take when massive hemorrhage is suspected, including alerting appropriate teams, taking initial blood samples, and administering MHP 1 which includes 4 units of red blood cells, 4 units of fresh frozen plasma, and other components as needed. It describes continuing the protocol with MHP 2 if bleeding persists and adjusting component amounts based on repeat lab tests. The goal is to maintain hemoglobin, platelets, coagulation factors, calcium, temperature, and pH within target ranges to resuscitate the patient and control bleeding through various medical and surgical interventions while closely monitoring for complications and standing down the protocol once
Surgery resident postgraduate presentation on the use of blood and products presented dept of surgery, Niger Delta University Teaching Hospital, Okolobiri, Bayelsa State, Nigeria
Blood transfusion -procedure,precaution and complicationPRANATI PATRA
medical and surgical,introduction,blood and blood products,GENERAL INSTRUCTIONS FOR GIVING BLOOD TRANSFUSIONS,Nursing Implications -Before transfusion:
Check physician’s orders
Review hospital policy
Ensure informed and written consent is provided
Check laboratory values
Understand the indications and rationale
Verification procedure occurs with
two nurses
Before transfusion (con’t):
Compatibility of blood type and Rh factor
Inspect the blood product for discolouration, clots, leaking, or presence of bubbles
Check the unit number on the unit of blood and on the form
Check the expiration date and time on unit of blood
Ask client to state first and last name
Check patient’s identification number on wristband and record
Nursing Implications in a Reaction
Stop transfusion
Remove tubing that contains blood product
Infuse with 0.9% normal saline
Monitor vital signs
Notify physician
Notify blood bank and return blood component
Administer medication depending on type of reaction
Epinephrine, antihistamines, antibiotics, antipyretics, analgesics, diuretics, corticosteroids
Define blood transfusion
Enlist the purpose of blood transfusion
Brief the history of blood transfusion
Describe various component of blood
Understand types of blood transfusion
Perform the steps of the procedure
Recognize the adverse reaction of blood transfusion
Blood products Transfusion and related complications,
Types of cell salvage, blood warming and autologous blood,
With intraoperative blood lots monitoring and transfusion
Surgery resident postgraduate presentation on the use of blood and products presented dept of surgery, Niger Delta University Teaching Hospital, Okolobiri, Bayelsa State, Nigeria
Blood transfusion -procedure,precaution and complicationPRANATI PATRA
medical and surgical,introduction,blood and blood products,GENERAL INSTRUCTIONS FOR GIVING BLOOD TRANSFUSIONS,Nursing Implications -Before transfusion:
Check physician’s orders
Review hospital policy
Ensure informed and written consent is provided
Check laboratory values
Understand the indications and rationale
Verification procedure occurs with
two nurses
Before transfusion (con’t):
Compatibility of blood type and Rh factor
Inspect the blood product for discolouration, clots, leaking, or presence of bubbles
Check the unit number on the unit of blood and on the form
Check the expiration date and time on unit of blood
Ask client to state first and last name
Check patient’s identification number on wristband and record
Nursing Implications in a Reaction
Stop transfusion
Remove tubing that contains blood product
Infuse with 0.9% normal saline
Monitor vital signs
Notify physician
Notify blood bank and return blood component
Administer medication depending on type of reaction
Epinephrine, antihistamines, antibiotics, antipyretics, analgesics, diuretics, corticosteroids
Define blood transfusion
Enlist the purpose of blood transfusion
Brief the history of blood transfusion
Describe various component of blood
Understand types of blood transfusion
Perform the steps of the procedure
Recognize the adverse reaction of blood transfusion
Blood products Transfusion and related complications,
Types of cell salvage, blood warming and autologous blood,
With intraoperative blood lots monitoring and transfusion
A Strategic Approach: GenAI in EducationPeter Windle
Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
The French Revolution, which began in 1789, was a period of radical social and political upheaval in France. It marked the decline of absolute monarchies, the rise of secular and democratic republics, and the eventual rise of Napoleon Bonaparte. This revolutionary period is crucial in understanding the transition from feudalism to modernity in Europe.
For more information, visit-www.vavaclasses.com
Model Attribute Check Company Auto PropertyCeline George
In Odoo, the multi-company feature allows you to manage multiple companies within a single Odoo database instance. Each company can have its own configurations while still sharing common resources such as products, customers, and suppliers.
Welcome to TechSoup New Member Orientation and Q&A (May 2024).pdfTechSoup
In this webinar you will learn how your organization can access TechSoup's wide variety of product discount and donation programs. From hardware to software, we'll give you a tour of the tools available to help your nonprofit with productivity, collaboration, financial management, donor tracking, security, and more.
Instructions for Submissions thorugh G- Classroom.pptxJheel Barad
This presentation provides a briefing on how to upload submissions and documents in Google Classroom. It was prepared as part of an orientation for new Sainik School in-service teacher trainees. As a training officer, my goal is to ensure that you are comfortable and proficient with this essential tool for managing assignments and fostering student engagement.
Operation “Blue Star” is the only event in the history of Independent India where the state went into war with its own people. Even after about 40 years it is not clear if it was culmination of states anger over people of the region, a political game of power or start of dictatorial chapter in the democratic setup.
The people of Punjab felt alienated from main stream due to denial of their just demands during a long democratic struggle since independence. As it happen all over the word, it led to militant struggle with great loss of lives of military, police and civilian personnel. Killing of Indira Gandhi and massacre of innocent Sikhs in Delhi and other India cities was also associated with this movement.
June 3, 2024 Anti-Semitism Letter Sent to MIT President Kornbluth and MIT Cor...Levi Shapiro
Letter from the Congress of the United States regarding Anti-Semitism sent June 3rd to MIT President Sally Kornbluth, MIT Corp Chair, Mark Gorenberg
Dear Dr. Kornbluth and Mr. Gorenberg,
The US House of Representatives is deeply concerned by ongoing and pervasive acts of antisemitic
harassment and intimidation at the Massachusetts Institute of Technology (MIT). Failing to act decisively to ensure a safe learning environment for all students would be a grave dereliction of your responsibilities as President of MIT and Chair of the MIT Corporation.
This Congress will not stand idly by and allow an environment hostile to Jewish students to persist. The House believes that your institution is in violation of Title VI of the Civil Rights Act, and the inability or
unwillingness to rectify this violation through action requires accountability.
Postsecondary education is a unique opportunity for students to learn and have their ideas and beliefs challenged. However, universities receiving hundreds of millions of federal funds annually have denied
students that opportunity and have been hijacked to become venues for the promotion of terrorism, antisemitic harassment and intimidation, unlawful encampments, and in some cases, assaults and riots.
The House of Representatives will not countenance the use of federal funds to indoctrinate students into hateful, antisemitic, anti-American supporters of terrorism. Investigations into campus antisemitism by the Committee on Education and the Workforce and the Committee on Ways and Means have been expanded into a Congress-wide probe across all relevant jurisdictions to address this national crisis. The undersigned Committees will conduct oversight into the use of federal funds at MIT and its learning environment under authorities granted to each Committee.
• The Committee on Education and the Workforce has been investigating your institution since December 7, 2023. The Committee has broad jurisdiction over postsecondary education, including its compliance with Title VI of the Civil Rights Act, campus safety concerns over disruptions to the learning environment, and the awarding of federal student aid under the Higher Education Act.
• The Committee on Oversight and Accountability is investigating the sources of funding and other support flowing to groups espousing pro-Hamas propaganda and engaged in antisemitic harassment and intimidation of students. The Committee on Oversight and Accountability is the principal oversight committee of the US House of Representatives and has broad authority to investigate “any matter” at “any time” under House Rule X.
• The Committee on Ways and Means has been investigating several universities since November 15, 2023, when the Committee held a hearing entitled From Ivory Towers to Dark Corners: Investigating the Nexus Between Antisemitism, Tax-Exempt Universities, and Terror Financing. The Committee followed the hearing with letters to those institutions on January 10, 202
4. What Are The Risks Associated With Blood
Transfusion?
• Infection transmission
• Hepatitis B
• Hepatitis C
• HIV
• Syphilis
• vCJD ?
• Transfusion of the wrong blood!!!
5.
6. Transfusion Case Study
• Patient dies following transfusion
• Elderly man with chronic renal failure, anaemia and a history
• of falls attends A&E
• Symptomatically anaemic with Hb 6.8 g/dl.
• Cross matched using a blood sample taken in A&E
• On ITU after < 100 mLblood had been transfused, developed
• fever, hypotension, bronchospasmand died a few hours later
• On investigation:
• Patient blood was group O RhD negative, he received a unit of A
• RhD negative blood.
7. What went wrong?
• No checking of patient s ID at the bedside, either with the
patient or with the wristband.
• Incorrect patient had been bled in A&E resulting in a
wrong blood in a tube incident. The sample was labelled
for the intended patient.
• Why?
• Transfusion sample protocol not followed.
• What should have happened?
• All patients being sampled must be positively identified.
• Reaction? Acute Haemolytic Transfusion Reaction
8. Sampling Procedure
• Step 1: Ask the patient to
tell you their:
• Full name and date of birth
• Check this information
against the patient s ID
wristband
• Get a second independent
check when the patient is
unconscious / compromised
9. Sampling Procedure
• Step 2: Check the patient s
ID wristband against
documentation e.g. case
notes or transfusion request
form:
• First name
• Surname
• Date of birth
• Hospital number
10. Sampling Procedure
• Only bleed one patient at a time
• Do NOT use pre-labelled tubes
• Hand write the sample tube
before leaving the patients side!
• NB: Do not take samples
from a IV drip arm.
11. Blood Request Card Mandatory Fields
Please Note:
• All patients’ requiring blood products will require two group and screen samples to be taken at
separate times in order to verify the patient’s correct blood type. Unless there is an existing
historical blood group record when an in date second sample will be required.
• Certain haematology patients must be treated with Hepatitis E (HEV) negative products
Please refer to CORP/PROT/327 or contact blood bank Tel 3746/3747 for advice
12. Why do mistakes happen?
• Not following the trust policy
• Only seeing what you want to see when checking products
/ patient ID
• Relying on the other person to carryout the check
• Labelling blood tubes away from the patient
• Remotely carrying out the bedside check
13. Do you always see what your reading?
• I cdnuolt blveiee taht I cluod aulaclty
uesdnatnrd waht I was rdgnieg. The
phaonmneal pweor of the hmuan mnid
Aoccdrnig to a rscheearch at Cmabrigde
Uinervtisy, it deosn't mttaer inwaht
oredr the ltteers in a wrod are, the
olny iprmoatnt tihng is taht the frist
and lsat ltteer be in the rghit pclae.
The rset can be a taotl mses and you
can sitll raed it wouthit a porbelm.
Tihs is bcuseae the huamn mnid deos not
raed ervey lteter by istlef, but the
wrod as a wlohe. Amzanig huh? yaeh and
I awlyas thought slpeling was
ipmorantt!
16. WHAT DO YOU KNOW ABOUT BLOOD
TRANSFUSION?
WHAT IS THE AVERAGE VOLUME
OF A BAG OF PACKED RED CELLS
• 280 MLS
• 350 MLS
• 450 MLS
17. AVERAGE VOLUME IS 280Mls
Approx 450mls is collected from donors
Blood is then fractionated into plasma
For FFP/cryoprecipitate, platelets and RBCs
RBCs are re-suspended in nutrient medium
and issued
18. HOW MUCH DO YOU KNOW ABOUT
BLOOD TRANSFUSION?
A patient's platelet count is 20 x 109/l; one bag
of platelets will raise it to
A. 70
B. 100
C. 30
19. PLATELET COUNT WILL RISE TO
APPROX. 70 x109/l
One adult dose of platelets is derived from 4
pooled donations and combined in one bag
Platelet count will rise by approx 50 after
one adult dose
20. HOW MUCH DO YOU KNOW ABOUT
BLOOD TRANSFUSION?
• A patient weighs 70kg and requires FFP
the correct dose is;
A. 20-30ml/kg
B. 12-15ml/kg
C. 5-10ml/kg
21. THE CORRECT DOSE OF FFP IS
12- 15 ml/kg
• A 70kg patient would need 3/4 bags.
• No viral inactivation steps taken
• Contains all clotting factors
• Should not be used as a volume expander
22. Warfarin Reversal Before An Urgent Or
Emergency Operation
There is no role at BVH for the use of fresh frozen plasma (FFP)
in the reversal of anticoagulation.
The preferred agent is prothrombin complex concentrate (PCC).
(Octoplex)
PCC has the following advantages over FFP:
• No need for a blood group
• No need to thaw
• Small volume to give to patients (approximately 20mls
compared to about 1 litre of FFP), which will be beneficial in
elderly patients
• No risk of FFP-associated side-effects such as anaphylaxis or
transfusion-related acute lung injury (TRALI)
23. FACTS ABOUT TRANSFUION!
There are NO clotting factors in red cells
There are no active platelets in red cells
Blood transfusion must be completed within
4 hours of removal from fridge BUT
280mls can be safely transfused into most
patients over 2 to 3 hours
24. THE GREATEST RISK TO A PATIENT
HAVING A BLOOD TRANSFUION IS?
A. Getting post transfusion hepatitis
B. Getting HIV
C. You
25. Transfusion Management of Massive Haemorrhage
Patient bleeding / collapses
Ongoing severe bleeding eg:150 mls/min
Clinical shock
Call for help
‘Massive Haemorrhage, Location, Specialty’
Alert emergency response team (including blood transfusion laboratory,
portering/ transport staff)
Consultant involvement essential
Take bloods and send to lab:
XM, FBC, PT, APTT, fibrinogen, U+E, Ca2+
NPT: ABG, TEG / ROTEM if available
and
Order MHP 1
Red cells* 4 units
(*Emergency O blood, group specific blood, XM blood depending
on availability)
FFP 4 units
Reassess
Suspected continuing haemorrhage
requiring further transfusion
Take bloods and send to lab:
FBC, PT, APTT, fibrinogen, U+E, Ca2+
NPT: ABG, TEG / ROTEM if available
Give MHP 2
Insert local arrangements:
Activation Tel Number(s)
Switchboard 2222
•Emergency O red cells
-laboratory issue room
* Time to receive at this clinical area:
•Group specific red cells
•20 minutes
• XM red cells
•45 minutes
STOP THE
BLEEDING
RESUSCITATE
Airway
Breathing
Circulation
Haemorrhage Control
Direct pressure / tourniquet if appropriate
Stabilise fractures
Surgical intervention
Interventional radiology
Endoscopic techniques
Obstetric techniques
Haemostatic Drugs
Tranexamic acid 1g bolus followed by
1g over 8 hrs
Vit K and Prothrombin complex concentrate
for warfarinised patients and
Other haemostatic agents: discuss with
Consultant Haematologist
Prevent Hypothermia
Use fluid warming device
Used forced air warming blanket
Cell salvage if available and appropriate
Consider ratios of other components:
1 unit of red cells = c.250 mls salvaged blood
Consider 10 mls Calcium chloride 10% over 10 mins
2 packs cryoprecipitate if fibrinogen < 1g/l
(<2g/l in obstetric haemorrhage) or as guided
by TEG / ROTEM
Aims for therapy
Aim for:
Hb 8-10g/dl
Platelets >75 x 109/l
PT ratio < 1.5
APTT ratio <1.5
Fibrinogen >1g/l
Ca2+ >1 mmol/l
Temp > 36oC
pH > 7.35 (on ABG)
Monitor for hyperkalaemia
STAND DOWN
Inform lab
Return unused components
Complete documentation
Including audit proforma
Transfusion lab 3746 /3747
Consultant Haematologist
Via switchboard Thromboprophylaxis should be considered when patient stable
Give MHP 1
ABG – Arterial Blood Gas APTT – Activated partial thromboplastin time ATD- Adult Therapeutic Dose
FFP- Fresh Frozen plasma MHP – Massive Haemorrhage Pack NPT – Near Patient Testing
Order MHP 2
Red cells 4 units
FFP 4 units
Platelets 1 dose (ATD)
and subsequently request Cryoprecipitate 2 packs if fibrinogen <1g/l (or
< 2g/l in obstetric haemorrhage) or according to TEG / ROTEM
Once MHP 2 administered, repeat bloods:
FBC, PT, APTT, fibrinogen, U+E,
NPT: ABG, TEG / ROTEM if available
To inform further blood component requesting
Activate Massive Haemorrhage Pathway
26.
27.
28.
29. THE ONLY SAFE TRANSFUSION IS?
THE ONE YOU DON’T GET!