A fictional patient becomes tachycardic and hypotensive after abdominal surgery, with rapidly increasing fresh blood in a surgical drain.
Frame the danger first.
- Active bleeding with physiological deterioration is major haemorrhage until proved otherwise.
- Haemoglobin may not reflect early blood loss; use physiology, bleeding rate and serial assessment.
- Hypothermia, acidosis and coagulopathy can accelerate deterioration.
Act, escalate, reassess.
- Activate the local Major Haemorrhage Protocol and call senior surgical, anaesthetic and transfusion support immediately.
- Use ABCDE with simultaneous haemorrhage control, warming and monitored resuscitation.
- Send appropriate blood samples and repeat point-of-care or laboratory assessment according to the local protocol.
- Plan definitive source control early; do not let transfusion replace surgical or interventional action.
Red flags that change pace.
- Hypotension, altered consciousness, escalating oxygen requirement or rapidly rising lactate
- Visible rapid blood loss, high drain output or suspected concealed bleeding
- Persistent bleeding despite first resuscitation measures
What makes care less safe.
- Waiting for a haemoglobin result before escalating
- Large-volume unmonitored crystalloid resuscitation
- Failing to identify who owns source control and the next reassessment time
Say the concern plainly.
Major haemorrhage: suspected source [location], bleeding [rate/estimate], physiology [trend], MHP [activated/time], products/interventions [given] and source-control plan [team/time].