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Table 4 Treatment pathway checklist

From: The European guideline on management of major bleeding and coagulopathy following trauma: fourth edition

Treatment phase Yes No N/A Reason for variance
Initial assessment and management     
  Extent of traumatic haemorrhage assessed  
  Patient in shock with identified source of bleeding treated immediately  
  Patient in shock with unidentified source of bleeding sent for further investigation  
  Coagulation, haematocrit, serum lactate, base deficit assessed  
  Antifibrinolytic therapy initiated  
  Patient history of anticoagulant therapy assessed (vitamin K antagonists, antiplatelet agents, oral anticoagulants)  
Resuscitation     
  Systolic blood pressure of 80–90 mmHg achieved in absence of traumatic brain injury  
  Measures to achieve normothermia implemented  
  Target haemoglobin level 7–9 g/dl achieved  
Surgical intervention     
  Abdominal bleeding control achieved  
  Pelvic ring closed and stabilised  
  Peritoneal packing, angiographic embolisation or surgical bleeding control completed in haemodynamically unstable patient  
  Damage control surgery performed in haemodynamically unstable patient  
  Local haemostatic measures applied  
  Thromboprophylactic therapy recommended  
Coagulation management     
  Coagulation, haematocrit, serum lactate, base deficit, calcium reassessed  
  Target fibrinogen level 1.5–2 g/l achieved  
  Target platelet level achieved  
  Prothrombin complex concentrate administered if indicated due to vitamin K antagonist, oral anticoagulant or evidence from viscoelastic monitoring