Page 21 - JSOM Winter 2021

APPENDIX C
Clinical Indications of Hemorrhagic Shock
Clinical Evidence Hemorrhagic Shock Is Present
H Hypotension Systolic blood pressure <100mmHg
T Tachycardia >100 BPM; Unresponsive to a 250–5000cc fluid bolus (NS/LR)
R Respirations Rapid/shallow
P Pulse (poor character) Weak and thread (ineffective)
M Mental status Decreased (excluding head injury)
S Skin color Pale/cyanotic
C Continued bleeding From non-compressible wound

APPENDIX D
Transfusion Procedures

TRANSFUSION PROCEDURES 9. Non-Medical person can assist with documentation on the
SF 518 for Pre and Post transfusion in formation
Maintain Universal Precautions (Gloves & Eye Protection)
STEP 1: ESSENTIAL BLOOD ADMINISTRATION ITEMS STEP 3: TRANSFUSION TASK
1. “Y” Type Filtered Blood Administration Set (UNDER NO 1. OPEN main line clamp for blood product to begin infusion.
circumstances should non-filtered tubing be used) a. ENSURE CLAMP to NS REMAINS CLOSED.
2. Blood Product to Transfuse (Universal Donor is approved b. UNDER NO CIRCUMSTANCES will other medications
for Prehospital) or IV fluid (including 3%NS) be introduced through
3. 0.9% NS (Dedicated Line Only for Blood Products) transfusion line. This will cause hemolysis/clotting of
4. Blood Pressure Cuff/Monitor blood products.
5. Blood Warmer Device 2. Blood products must be transfused within 4 hours of re-
6. Pressure bag (if available) moval from a storage container – if not, the product(s) will
be returned to issuing facility or delivered with patient to
STEP 2: PRE-TRANSFUSION TASK MTF to be discarded.
Two Person Verification Process 3. If using pressure infuser set pressure to 300mmHg.
4. Monitor vitals IAW TCCC Guidelines.
Verify Blood Label. Complete SF 518 for 5 items below or 5. When blood product has been infused, CLAMP blood
transcribe items from Blood Label onto blank SF 518:
product line and OPEN NS line to deliver residual blood
(1) Unit#; (2) Type of Product; (3) Donor ABO/Rh (Must be product.
O for RBCs; and A or AB for Plasma); (4) Expiration Date; 6. If 2nd Unit required – CLOSE NS clamp.
and (5) Temperature Indicator (RED = NOT ACCEPTABLE) 7. Spike 2nd Unit – OPEN blood product and main line
clamps to begin 2nd infusion.
1. CLOSE all 3 clamps on Y tubing 8. Monitor closely and continue VS assessment.
2. NOTE: When using blood/fluid warming device, attach 9. VS goal: SBP >l00mmHg; and/or Pulse <100; MAP 70–
line to fluid warmer cartridge and fluid warmer extension 80mmHg.
line.
a. Ensure warming device is functioning IAW manufactur-
ers guidelines STEP 4: DOCUMENTATION TASK
3. Insert is 1 spike into NS bag and hang; OPEN clamp and 1. Pre-transfusion Data
prime only the “Y” section; CLOSE clamp a. Unit Number
4. Insert 2nd spike into blood product and hang; OPEN clamp b. Type of Blood Product (RBC/Plasma)
and run the length of the tubing c. Donor ABO/Rh
5. Attach line to IV or 10 site **Ensure good flow through d. Expiration Date
IV/ 1O before initiating transfusion** e. Vital Signs (HR and B/P)
6. Ensure all clamps are CLOSED 2. Post Transfusion Data
7. NOTE: Document pre-transfusion vitals – at a minimum a. Vital Signs
BP and HR b. Date/Time started/completed
8. Medical person will visually inspect blood product if pos- c. Note if interrupted and reason for interruption
sible for gas, discoloration, clots, foreign objects, or, sedi- d. Patient Identification (as much as possible)
ment, and ensure no cracking of the plastic bag that has led
to leaking.
a. Visually inspect the Temperature Indicator (RED = NOT
ACCEPTABLE)

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