Emergency Medicine Cases Ep 206 Massive Hemorrhage Protocols 2.0 – Update on the 7 Ts
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Aug 4, 2025 Dr. Jeannie Callum, a transfusion hematologist, and Dr. Andrew Petrosoniak, a specialist in high-performance resuscitation teams, discuss cutting-edge strategies for managing massive hemorrhage. They delve into alternatives to fresh frozen plasma when it’s unavailable and the significance of fibrinogen testing. The pair also emphasize the importance of tailored approaches for different patient scenarios, including trauma and obstetrical cases, while highlighting the critical role of teamwork in effective hemorrhage management.
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Trauma MHP Activation Strategy
- Start with two to three units of red blood cells before activating MHP in trauma patients.
- Activate MHP if more than three units are needed, coagulopathy is suspected, or urgent surgical control is required.
Low Threshold for Obstetric MHP
- MHP activation threshold should be low for obstetrical hemorrhage due to rapid blood loss potential.
- Obstetric hemorrhage needs faster aggressive resuscitation compared to trauma or GI bleed.
MHP Caution in GI Bleeds
- For GI bleeds, avoid full MHP activation unless plasma or multiple components are clearly needed.
- Prefer transfusing uncrossmatched red cells and expedited source control over plasma or TXA.