What initial assessments should I perform in a patient presenting with signs of major haemorrhage?

Initial assessments for a patient presenting with signs of major haemorrhage include:

• Clinical assessment of haemodynamic status: Measure systolic blood pressure and heart rate to identify hypotension (systolic BP <90 mmHg) or tachycardia (heart rate >110 bpm), which are indicators of major haemorrhage NICE NG24.
• Rapid identification of bleeding source: Perform focused clinical examination and use targeted imaging such as chest X-ray, pelvic X-ray, or focused assessment with sonography for trauma (FAST) to detect internal bleeding, especially in trauma patients NICE NG39.
• Urgent imaging interpretation: Images should be interpreted immediately by trained healthcare professionals to guide urgent intervention NICE NG39.
• Assessment of bleeding severity: Use clinical criteria including the volume and rate of blood loss, and signs of haemodynamic instability to classify bleeding severity and activate major haemorrhage protocols NICE NG24,NICE NG39.
• Establish vascular access: Secure peripheral intravenous access promptly, or intraosseous access if peripheral access is difficult, to enable fluid and blood product administration NICE NG39.
• Consider anticoagulant status: Identify if the patient is on anticoagulants and plan for rapid reversal if active bleeding is present NICE NG39.

Summary: Initial assessment focuses on rapid clinical evaluation of vital signs, identification of bleeding source through examination and imaging, immediate interpretation of findings, securing vascular access, and consideration of anticoagulation status to guide urgent management NICE NG24,NICE NG39.