Catastrophic bleeding must be managed as a priority. Assess for blood loss in five places:
Consider hypovolaemic shock, early signs include:
Cool peripheries / > 2 seconds CRT
Anxiety, abnormal behaviour, decreased mental status
Increased respiratory rate
Catastrophic haemorrhage can be defined as extreme bleeding likely to cause death in minutes.
Decompensating patients might present with Bradycardia.
Adult permissive hypotension is a systolic blood pressure of 70mmHg.
In the TBI, adult patient attempts should be made to maintain systolic blood pressure at 90mmHg.
In general, hypotension in adults can be defined as a systolic blood pressure of less than 90mmHg or greater than 30% decrease from that person’s baseline and in children less than: (70 mmHg + [2 x age]) from 1 – 10yo.
Adult patients with penetrating trauma, ectopic pregnancy or aortic aneurysm with hypotension and signs of impaired organ perfusion may benefit from permissive hypotension (systolic blood pressure of 70mmHg)
If major veins of the neck are severed, do not sit the patient up as air may be sucked in and develop into a venous air embolism. If air embolism occurs (sudden deterioration, collapse, neurological changes), lie the patient
down and administer high concentration oxygen. Apply local pressure with broad pad and hand.