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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.",{"@graph":14,"@context":73},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/document/","Document",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/document/healthcare/","Healthcare",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/document/lecture-pavenski-2021-22-massive-hemorrhage-protocol-mhp-translation-to-the-real-world/506470/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/lecture-pavenski-2021-22-massive-hemorrhage-protocol-mhp-translation-to-the-real-world/506470.png","ImageObject",300,407,{"name":42,"@type":43},"Mafia 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significant ongoing blood loss.",{"name":70,"@type":61,"acceptedAnswer":71},"How should bleeding be treated once MHP is activated?",{"text":72,"@type":64},"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.","https://schema.org",{"og:url":32,"og:type":75,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":77,"canonical":32},"index,follow",{"doc_id":79,"site_id":7},506470,1791546214,{"code":4,"msg":82,"data":83},"success",[84,88,92,96,101,105,109,114,119,122,126],{"id":22,"doc_module":4,"doc_module_name":25,"category_name":85,"show_sort_weight":86,"slug":87},"Story & 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\nK. Pavenski, MD FRCPC  \nDisclosures  \n• Advisory board participation: Pfizer  \n• Clinical trials: Ablynx/Sanofi, Bioverativ/Sanofi, Shire/Takeda, Roche  \n• None are relevant to the content of this talk  \n• I will not be covering pediatric implications – refer to the ORBCON MHP Tool  \n• [https://transfusionontario.org/wp](https://transfusionontario.org/wp)  \ncontent/uploads/2021/10/MHP_Toolkit_v1_Oct2021.pdf  \nLearning Objectives  \n• Discuss how the different elements of MHP could be practically applied to management of bleeding adult patients  \nLet’s review:  \nMHP = T 7  \n\n|  | The Seven T’s |\n| --- | --- |\n|  | Triggering and Treatment of Bleeding |\n|  | Team (incl. Training and Communication) |\n|  | Tranexamic acid |\n|  | Temperature |\n|  | Testing |\n|  | Transfusion |\n|  | Termination and Tracking Performance |\n\nTriggering  \n• MHP (Massive Hemorrhage Protocol) is a code  \n• In Ontario hospitals,  \n• should be announced overhead as CODE TRANSFUSION  \n• Announcing overhead instantaneously alerts all of the relevant parties and may bring additional resources  \n• Should be called the same – MHP – to avoid confusion  \n• Activated by a single call to Locating/Switchboard with dissemination to all team members  \nTriggering  \n• Triggering criteria  \n• May differ from hospital to hospital – KNOW YOURS  \n• May be different for different patient populations  \nTriggering Criteria  \nLife-threatening bleeding requiring mobilization of blood bank, laboratory and clinical resources  \nAnticipated need for at least 4 RBC immediately AND component therapy (platelets (PLT), plasma, and /or fibrinogen concentrate)  \nA non-obstetrical patient with systolic BP\u003C90 mmHg and/or requiring vasopressors  \nA peri-partum woman with marked ongoing blood loss  \nShould MHP be activated?  \n• 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.  \n• A. Yes  \n• B. No  \nShould MHP be activated?  \n• 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 .  \n• A. Yes  \n• B. No  \nShould MHP be activated?  \n• 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.  \n• A. Yes  \n• B. No  \nTreatment of Bleeding  \n• Damage control resuscitation  \n• Immediate hemorrhage control  \n• Pressure, damage control surgery, angiography, etc.  \n• Restoration of blood volume and physiologic/hematologic stability  \n• IV fluids  \n• Early transfusion  \n• Avoid too much crystalloid  \n• Correct hypothermia  \n• Correct acidosis  \n• Correct calcium","cbCaipk7zvKVVNXA","https://ap.wps.com/l/cbCaipk7zvKVVNXA","pdf",2324239,39,"English","# Disclosures\n# Learning Objectives\n# MHP = The Seven T’s\n## Triggering and Treatment of Bleeding\n## Team (incl. Training and Communication)\n## Tranexamic acid\n## Temperature\n## Testing\n## Transfusion\n## Termination and Tracking Performance\n# Triggering\n## Triggering criteria\n## Case: Should MHP be activated?\n## Case: Should MHP be activated?\n## Case: Should MHP be activated?\n# Treatment of Bleeding","[{\"question\":\"What are the “Seven T’s” in the MHP framework?\",\"answer\":\"They are Triggering and Treatment of Bleeding, Team (including training and communication), Tranexamic acid, Temperature, Testing, Transfusion, and Termination and Tracking Performance.\"},{\"question\":\"What criteria support activating MHP in adult patients?\",\"answer\":\"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.\"},{\"question\":\"How should bleeding be treated once MHP is activated?\",\"answer\":\"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.\"}]","Lecture Pavenski 2021-22 - Massive Hemorrhage Protocol (MHP) Translation to the Real World | PDF",1791165543,98]