Dale Renno
Journal of Paramedic Practice, Vol. 10, Iss. 3, 02 Mar 2018, pp 118 - 125

Major haemorrhage remains the highest preventable cause of death
following trauma, accounting for 30-40% of trauma mortality (Kauvar et
al, 2006). Therefore, pre-hospital intervention is a key aspect of paramedic
practice. Paramedics are often first on the scene and have a range of local
and systemic treatment options. Pre-hospital medical advances, such as
the introduction of tranexamic acid, allow paramedics to deliver a higher
standard of care. In addition, the number of patients on anticoagulants and
antiplatelet drugs is increasing; therefore, knowledge of how these drugs
interact with the haemostatic response would be beneficial. It is important
that paramedics fully understand the mechanisms of drugs interacting with the
haemostatic response, and the theory underpinning the management of major
haemorrhage (Kreuziger et al, 2012). This enables paramedics to understand
why they are administering the care they are providing. This article gives a
detailed overview of two physiological responses to major haemorrhage:
haemostasis and blood pressure. This is followed by an explanation of how
these systems are deranged and altered by major haemorrhage through
pathophysiological consequences. Finally, recent research covering advances in
the understanding of how deranged coagulation occurs is also discussed.

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