Lecture Pavenski 2021-22 - Massive Hemorrhage Protocol (MHP) Translation to the Real World

Q: What are the “Seven T’s” in the MHP framework?

They are Triggering and Treatment of Bleeding, Team (including training and communication), Tranexamic acid, Temperature, Testing, Transfusion, and Termination and Tracking Performance.

Q: What criteria support activating MHP in adult patients?

MHP is for life-threatening bleeding requiring mobilization of blood bank, lab, and clinical resources, with an anticipated need for at least 4 RBC immediately plus component therapy, and scenarios such as non-obstetrical hypotension/vasopressor need or peri-partum significant ongoing blood loss.

Q: How should bleeding be treated once MHP is activated?

Approach includes damage control resuscitation and immediate hemorrhage control, followed by restoration of blood volume and physiologic/hematologic stability using IV fluids and early transfusion, while avoiding excessive crystalloid and correcting hypothermia, acidosis, and calcium.

Oct 5, 2026

Uploaded by Mafia Boss

Lecture addresses Massive Hemorrhage Protocol (MHP) implementation in Ontario adult care, translating protocol elements into real-world management of life-threatening bleeding. Focus covers the “Seven T’s” framework—triggering, team training and communication, tranexamic acid, temperature, testing, transfusion, and termination/performance tracking—plus clear activation criteria. Interactive case prompts guide decisions on whether to activate MHP in postpartum, gastrointestinal-bleed, and traumatic gunshot scenarios. Treatment emphasizes damage control resuscitation, early transfusion, and correction of hypothermia, acidosis, and calcium.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages39

Reading Time1 h 38 min

AccessFree to download

Disclosures

Learning Objectives

MHP = The Seven T’s

Triggering and Treatment of Bleeding

Team (incl. Training and Communication)

Tranexamic acid

Temperature

Testing

Transfusion

Termination and Tracking Performance

Triggering

Triggering criteria

Case: Should MHP be activated?

Treatment of Bleeding

Transfusion Camp May 13, 2022 Massive Hemorrhage Protocol (MHP) Translation to the Real World K. Pavenski, MD FRCPC Disclosures • Advisory board participation: Pfizer • Clinical trials: Ablynx/Sanofi, Bioverativ/Sanofi, Shire/Takeda, Roche • None are relevant to the content of this talk • I will not be covering pediatric implications – refer to the ORBCON MHP Tool • [https://transfusionontario.org/wp](https://transfusionontario.org/wp) content/uploads/2021/10/MHP_Toolkit_v1_Oct2021.pdf Learning Objectives • Discuss how the different elements of MHP could be practically applied to management of bleeding adult patients Let’s review: MHP = T 7 | | The Seven T’s | | --- | --- | | | Triggering and Treatment of Bleeding | | | Team (incl. Training and Communication) | | | Tranexamic acid | | | Temperature | | | Testing | | | Transfusion | | | Termination and Tracking Performance | Triggering • MHP (Massive Hemorrhage Protocol) is a code • In Ontario hospitals, • should be announced overhead as CODE TRANSFUSION • Announcing overhead instantaneously alerts all of the relevant parties and may bring additional resources • Should be called the same – MHP – to avoid confusion • Activated by a single call to Locating/Switchboard with dissemination to all team members Triggering • Triggering criteria • May differ from hospital to hospital – KNOW YOURS • May be different for different patient populations Triggering Criteria Life-threatening bleeding requiring mobilization of blood bank, laboratory and clinical resources Anticipated need for at least 4 RBC immediately AND component therapy (platelets (PLT), plasma, and /or fibrinogen concentrate) A non-obstetrical patient with systolic BP<90 mmHg and/or requiring vasopressors A peri-partum woman with marked ongoing blood loss Should MHP be activated? • 37 year old female, 2 hours post-vaginal delivery, found by nurse on the floor. Vitals: 90/40, HR 120, oxygen saturation 97% RA, 37.0C. Patient is awake and complains of feeling dizzy. Her gown is soaked with blood. • A. Yes • B. No Should MHP be activated? • 68 year old male with known liver cirrhosis is seen in ED. He complains of vomiting blood,“about a cup or two”, about 30 minutes ago . He feels nauseated. Vitals: 157/95, HR 100, oxygen saturation 96% RA, afebrile . • A. Yes • B. No Should MHP be activated? • 19 year old male is brought to ED by ambulance . He has 2 obvious gun shot wounds to his Rt. lower chest and upper abdomen . He is actively bleeding. He is confused and combative . Vitals: 95/60, HR 130, oxygen saturation 92% RA, Temp 36C. • A. Yes • B. No Treatment of Bleeding • Damage control resuscitation • Immediate hemorrhage control • Pressure, damage control surgery, angiography, etc. • Restoration of blood volume and physiologic/hematologic stability • IV fluids • Early transfusion • Avoid too much crystalloid • Correct hypothermia • Correct acidosis • Correct calcium

FAQs

What are the “Seven T’s” in the MHP framework?

They are Triggering and Treatment of Bleeding, Team (including training and communication), Tranexamic acid, Temperature, Testing, Transfusion, and Termination and Tracking Performance.

What criteria support activating MHP in adult patients?

MHP is for life-threatening bleeding requiring mobilization of blood bank, lab, and clinical resources, with an anticipated need for at least 4 RBC immediately plus component therapy, and scenarios such as non-obstetrical hypotension/vasopressor need or peri-partum significant ongoing blood loss.

How should bleeding be treated once MHP is activated?

Approach includes damage control resuscitation and immediate hemorrhage control, followed by restoration of blood volume and physiologic/hematologic stability using IV fluids and early transfusion, while avoiding excessive crystalloid and correcting hypothermia, acidosis, and calcium.

Oct 5, 2026

Uploaded by Mafia Boss