Optimizing nonsurgical management of major hemorrhage

Major hemorrhage is life-threatening and can occur in a variety of clinical settings. A review paper in CMAJ, entitled "Nonsurgical management of major hemorrhage," advocates for the implementation of massive hemorrhage protocols across all types of hospitals to optimize patient care.

Dr. Jeannie Callum, the article's lead author and the Director of Transfusion Medicine at Kingston's Health Sciences Centre speaks with Drs. Blair Bigham and Mojola Omole about her work standardizing massive hemorrhage protocols throughout Ontario. Dr. Callum shares the transformative moment that inspired her to develop a province-wide protocol, starting from the point of roadside patient care.

She then details the critical need for precision in managing major hemorrhage, emphasizing a rapid response within the "golden hour." Dr. Callum outlines key components of care such as swift administration of tranexamic acid and the detection of coagulopathy. She then simplifies the main elements of a massive hemorrhage protocol into what she calls "the seven 'T’s."

In rural settings, Dr. Callum identifies the need for a simplified protocol due to constraints like smaller medical teams and a lack of comprehensive laboratory tests. Despite these challenges, she recommends innovative solutions like the immediate administration of tranexamic acid and encourages physicians to educate themselves about novel point-of-care testing technologies such as viscoelastic testing.

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