Operating Department Skills
  • Calculate
  • Emergency
  • Monitoring
  • Science
  • Surgery
  • Anaesthetics
    • Code Red (3640)
    Description:
    A protocol for managing massive haemorrhage.
    Initiation:

    The Blood Bank (ext 3640) must be immediately informed of a Code Red situation, and full patient details should be made available to them.
    Baseline Samples:
    Send samples to Lab immediately.
    Pack request:
    Ask Blood Bank (ext 3640) for one Code Red Pack 'A', and send a Porter/Nurse to collect.

    Pack A contains:

    Continued bleeding:
    Request 1 Code Red Pack 'B'.

    Continue to request Pack 'B' until bleeding stops.

    Pack B contains:

    (Anticipate coagulopathy.)

    If bleeding persists, call Haematology SPR on bleep 6311 (or switch board, out of hours).
    Cessation of bleeding:
    When bleeding is under control, repeat Full Blood Count and clotting. Screen/administer further products if:
    Emergency Group O stocks:
    Satellite fridges in St James' and Lanesborough Theatres (1st floor) each contain 2 units of Group O negative - for extreme emergencies only.
    If used, notify Blood Bank (ext 3640) immediately, so that the stocks may be replenished.
    Laboratory timings:

    Blood Grouping and Cross Matching
    With a correctly labelled sample, a blood group can be identified within 10 minutes, so that group specific blood may be issued. An antibody screen takes approximately 40 minutes.

    Fresh Frozen Plasma
    FFP has to be defrosted before issue, and takes approximately 30 minutes.
    Each dose of FFP contains 15 ml/kg. The average adult requires 4 units.

    Cryoprecipitate
    Cryoprecipitate takes approximately 30 minutes to defrost. For the average adult, a dose should contain 2 pools.

    Platelets
    Platelets are not stocked in the Blood Bank (ext 3640), and must be obtained from the National Blood Service (hospital bank). Issuance takes 30-40 minutes.

    Note:
    1. There should be no delay in administering Platelets.
    2. Platelets should NEVER be refrigerated.

    Useful numbers:
    CentreNumber
    Blood BankExtension 3640
    Haematology SPRBleep 6311
    Definitions

    Full Blood Count:
    The Full Blood (or Complete) Count, using a sample or peripheral blood, provides information about the type, number and appearance of red blood cells, white blood cells, and platelets. The test can indicate anaemia, infection, and blood disorders.

    Group & save:
    1. To determine the ABO and Rhesus type.
    2. To detect red cell antibodies, plus anti A or anti B which could haemolyse transfused red cells.
    3. Save the serum for 7 days, for further type testing, if blood is needed later.
    Group and Save does not allow blood to be immediately available, and is used when a need to transfuse is possible, but not expected. The Group and Save test is easy and quick to perform, and does not remove blood from the common pool.

    Cross matching:
    1. Determines the patient's ABO and Rhesus D type
    2. Detects red cell antibodies which could haemolyse transfused red cells
    3. Confirms compatibility with each of the units of red cells to be transfused
    Cross match means to fully type a sample and a unit of donated blood (from a common pool), to look for cross reaction. It takes up to an hour to perform, but makes blood available for immediate use.

    Clotting Screen:
    A clotting Screen provides a baseline assay of the blood's coagulation ability. The test comprises:
    Fibrinogen (Factor I):
    Fibrinogen is a soluble plasma glycoprotein, synthesised by the liver, which is converted by thrombin into fibrin during blood coagulation. Fibrin is cross linked, by factor XIII, to form a clot.