Major Obstetric Haemorrhage Flashcards
1
Q
- What is the first thing you should do when you notice a haemorrhage?
A
Call for help and pull the emergency buzzer
2
Q
- Which people should attend?
A
Senior midwife Experienced obstetrician Experienced anaesthetist Experienced neonatologist Additional support staff
3
Q
- Who should be on standby?
A
Haematologist
Blood bank technician
Theatre staff
Porter
4
Q
- Which position should you place the woman in?
A
Left lateral
5
Q
- What is the next thing you should do?
A
Give high-flow oxygen with a non-rebreath mask
6
Q
- What observations should be taken?
A
Pulse Blood pressure Capillary refill Respiratory rate Oxygen saturation
7
Q
- How often should observations be taken?
A
Every 5 minutes
8
Q
- What size cannulae should be sited?
A
x2 grey 16 gauge large bore cannulae
9
Q
- What urgent bloods should be taken?
A
FBC Clotting screen (including fibrinogen) Kleihauer group and save cross-match 4 units
10
Q
- How much IV fluid for fluid resuscitation be given?
A
2 litres warmed crystalloid like Hartmanns or 0.9% saline
11
Q
- How should you assess where the blood loss is coming from?
A
Use the 4 Ts Tone (uterine atony) Tissue (retained products) Trauma Thrombin (coagulopathy)
12
Q
STOP THE BLEEDING
What drugs should you administer?
A
Syntocinon 10 units or
Ergometrine 500 mcg
IM or slow IV injection
(ergometrine contraindicated if raised BP)
13
Q
Next drug?
A
Syntocinon infusion
40 units syntocinon IV infusion via pump over 4 HOURS
14
Q
Drugs for bleeding
A
Tranexamic acid 1 g (100mg/mL) given as slow intravenous injection (at rate of 1mL/minute) Repeat after 30 minutes if PPH continues
15
Q
Urine output?
A
Site urinary catheter with urometer
Empty bladder and monitor urine output hourly
