Management of Hemorrhage

Immediate Actions

The American Society of Anesthesiologists recommends applying direct pressure, tourniquets, or haemostatic dressings to obvious bleeding points, and establishing large-bore IV access or considering intra-osseous access if peripheral access fails, in patients with hemorrhage 1, 2, 3, 4
The American College of Surgeons suggests administering high-flow oxygen to patients with hemorrhage 1, 2, 3

The American Association of Blood Banks recommends resuscitating patients with hemorrhage using warmed blood and blood components, not crystalloids alone, and maintaining a 1:1 ratio with red blood cells until coagulation results are available 1, 2, 3
The American College of Obstetricians and Gynecologists advises keeping platelet count >75 × 10⁹/L in patients with hemorrhage, as levels <50 × 10⁹/L are strongly associated with microvascular bleeding 5

The American College of Surgeons recommends administering 1 g IV over 10 minutes, followed by 1 g over 8 hours, to patients with hemorrhage, and notes that it must be given within 3 hours of bleeding onset for maximum mortality benefit 6

The Society of Critical Care Medicine suggests considering surgery early, and using radiologically-guided arterial embolization, which is highly effective and may eliminate the need for surgery, particularly in obstetric hemorrhage 1, 2, 3, 6

The American Thoracic Society recommends aggressively normalizing blood pressure, acid-base status, and temperature once bleeding is controlled, but avoiding vasopressors during active bleeding 1, 2, 3
The Society of Critical Care Medicine advises admitting patients to critical care for monitoring of coagulation, hemoglobin, blood gases, and wound drains, and starting venous thromboprophylaxis as soon as bleeding is controlled 1, 2, 3, 5