Pre-hospital bundle | Intra-hospital bundle | Coagulation bundle |
---|---|---|
• Pre-hospital time minimised • Tourniquet employed in case of life-threatening bleeding from extremities • Damage control resuscitation concept applied • Trauma patient transferred directly to an adequate trauma specialty centre | • Full blood count, prothrombin time, fibrinogen, calcium, viscoelastic testing, lactate, BE and pH assessed within the first 15 min • Immediate intervention applied in patients with haemorrhagic shock and an identified source of bleeding unless initial resuscitation measures are successful • Immediate further investigation undertaken using focused assessment with sonography for trauma (FAST), computed tomography (CT) or immediate surgery if massive intra-abdominal bleeding is present in patients presenting with haemorrhagic shock and an unidentified source of bleeding • Damage control surgery concept applied if shock or coagulopathy are present • Damage control resuscitation concept continued until the bleeding source is identified and controlled • Restrictive erythrocyte transfusion strategy (haemoglobin 7–9 g/dl) applied | • Tranexamic acid administered as early as possible • Acidosis, hypothermia and hypocalcaemia treated • Fibrinogen maintained at 1.5–2 g/l • Platelets maintained at >100 × 109/l • Prothrombin complex concentrate administered in patients pre-treated with warfarin or direct-acting oral coagulants (until antidotes are available) |