Intraoperative Hemorrhage When There Is No Blood to Give

Ambulatory surgery centers do not stock blood, and most cannot measure a hemoglobin. So what do you do when a patient is bleeding? In this Guide Academy session, Ali Baghai, DNAP, CRNA, and Jacob Gissy, MD, walk through the physiology of hemorrhage, how to estimate blood volume and allowable loss for the patient on your table, what a liter of crystalloid actually costs, and when to make the call to transfer. The session introduces a simple communication ladder (500, 750, and 1,000 mL of measured loss), five transfer triggers that need no laboratory value, and the one bedside test that tells you fluid has stopped working. Topics covered: Oxygen delivery and the oxygen extraction ratio Estimated blood volume and maximum allowable blood loss, with worked examples Measuring blood loss without a lab Restrictive fluid resuscitation, permissive hypotension, and vasopressors Tranexamic acid: prophylaxis and rescue dosing The 500 / 750 / 1,000 mL communication ladder Five transfer triggers, and the signals that are not triggers What EMS can and cannot do for an ASC The full literature review with references is available on the Guide Anesthesia Practice Connection. Guide Academy is the clinical education series of Guide Anesthesia. This content is for educational purposes and does not replace facility policy or clinical judgment.