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A guide to major haemorrhage management in paediatrics

Don't Forget the Bubbles

Major haemorrhage protocols typically include a mixture of packed red blood cells (pRBCs), platelets, and fresh frozen plasma (FFP). Platelets and FFP replace lost platelets and coagulation factors, which help with clotting and also provide some volume expansion. Rhaenyra continues to receive blood products in a 1:1:1 ratio.

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ED care of refugee populations from sub-Saharan Africa

EMDocs

Severe malaria management. 84 Adapted from: World Health Organization (WHO). WHO Guidelines for Malaria.; Accessed June 11, 2023.

ED 74
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ToxCard: Iron

EMDocs

Coagulopathy: Parenteral vitamin K and/or fresh frozen plasma (FFP) as clinically indicated. Can titrate up to maximum of 40 mg/kg/hr, although hypotension may limit dose of deferoxamine. 10 Maximum daily dose of 6-8g total of defuroxamine. Blood transfusion for clinically significant blood loss.

E-9-1-1 96
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EM@3AM: Systematic Approach to Massive Hemorrhage and Nuances in Special Patient Populations

EMDocs

9 Current best practice suggests a 1:1:1 administration of PRBC, Platelets, and FFP. Balanced transfusion of packed red blood cells (PRBCs), platelets and fresh frozen plasma (FFP) in a 1:1:1 ratio is the current best practice to avoid inducing coagulopathy by large volume blood product administration.

E-9-1-1 105
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emDOCs Podcast – Episode 116: Massive Hemoptysis

EMDocs

Warfarin: vitamin K 10 mg IV and PCC or FFP. Fibrinogen level < 150 mg/dL: cryoprecipitate or fibrinogen concentrate (not FFP). Key: morbidity and mortality are due to asphyxiation, not blood loss primarily. Blood products are recommended in those with hypovolemia, cardiovascular compromise, coagulopathy. microg/kg IV.

E-9-1-1 71
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Severe Malaria: ED Presentation, Evaluation, and Management

EMDocs

11 Transfuse patients who are anemic or coagulopathic, ideally with fresh whole blood; if this is not available, use packed red blood cells (PRBCs) for anemia, and replete coagulopathy with platelets, fresh frozen plasma (FFP), or cryoprecipitate as indicated.

ED 83
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Podcast 185.0: Anticoagulation Reversal

Core EM

Comparison between Prothrombin Complex Concentrate (PCC) and Fresh Frozen Plasma (FFP) for the Urgent Reversal of Warfarin in Patients with Mechanical Heart Valves in a Tertiary Care Cardiac Center. Iran J Pharm Res. 2015;14(3):877-885. Fariborz Farsad B, Golpira R, Najafi H, et al.