Editing Haemostasis (section)

== '''Stopping major bleeding''' ==

* Need a graded response. Try and think in terms of your top 3 or 4 options for this bleeding, and deploy them in turn.
* Start with the simplest

# Obtain temporary control (work your way through options until you have control)
## Compression - use finger/hand first
## Don’t panic
## Does the organ have a vascular pedicle to access?
## Elevate structure
## Compress with hand/gauze pad
## Vascular clamp such as Satinsky
## Proximal and distal control
# Don't panic
## Is this a small problem or BIG TROUBLE?
### Bleeding rate vs accessibility defines this
### Attack small problems head-on
### Deploy multi-pronged, team-based approach for BIG TROUBLE
# BIG TROUBLE
## Temporary control
## STOP
## Tell anaesthetist - they will need more blood from blood bank
## Autotransfusion device?
## Get equipment from nurses - vascular trays, thoracic trays, etc
## Figure out what equipment you will need
## Do we need more help?
## Improve exposure
## Don't fiddle with your temporary control