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Life Support in Haemorrhage

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Life Support in Haemorrhage and Fluid Loss H.Gee MD, FRCOG TRIAGE Priority 1 Requires emergency treatment and resuscitation soon or she will die. – PowerPoint PPT presentation

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Title: Life Support in Haemorrhage


1
Life Support in Haemorrhage and Fluid Loss H.Gee
MD, FRCOG
2
TRIAGE
  • Priority 1
  • Requires emergency treatment and resuscitation
    soon or she will die.
  • Priority 2
  • Care may be delayed a few hours.
  • Priority 3
  • Condition permits significant delay.

3
Life support in haemorrhage and fluid loss
  • Recognise circulatory collapse (SHOCK) and treat
  • ABC
  • Call for help.
  • CAUSES
  • Haemorrhage
  • Sepsis.
  • Life-threatening needs immediate and intensive
    treatment - PRIORITY 1
  • Inadequate perfusion of organs and cells with
    oxygenated blood.

4
Recognising circulatory collapse (SHOCK)
Main signs and symptoms Other signs and symptoms
Pulse weak and fast (gt110 beats/minute) Pallor
BP low (systolic lt90 mmHg) (late sign) Sweatiness or cold and clammy skin
Rapid breathing
Anxious, confused
Unconscious
Fetal distress
5
Classification of circulatory volume loss
NB A pregnant woman has a circulation volume of
about 100 ml/kg (for a woman of 60kg this is 6
litres).
Class Circulating volume lost Signs
1 15 or less (not much more than 700ml) You may notice only a mild rise in pulse rate If the woman is otherwise healthy and if not anaemic she will not require a blood transfusion
2 15-30 (over 1.5L) Symptoms will include rising pulse rate and rising breathing frequency Use crystalloids to replace fluid loss
3 30-40 (over 2L) It is only at this stage that the blood pressure falls Remember a drop in BP is a later sign of hypovolaemia Patient will need a blood transfusion in addition to crystalloids
4 gt40 This is immediately life threatening Blood transfusion is required immediately
6
Action
  • Call for help
  • Position woman on her left side with legs higher
    than her chest
  • Remember in the pregnant woman any shock is
    made worse by aorta-caval compression
  • Insert at least one IV line give fluids at
    rapid rate
  • Cover patient to keep warm
  • Assess condition of mother and child
  • If at Health Centre, once initial treatment
    commenced, refer to hospital
  • Management of haemorrhage or sepsis.

7
Fluid Management
  • Insert IV line and give fluids
  • Clean womans skin with spirit at site for IV
    line
  • Insert an IV line using 16-18 gauge needle
  • Infuse Ringer lactate or normal saline.
  • Give fluids at rapid rate if systolic blood
    pressure (BP) less than 90 mmHg, pulse faster
    than 110 beats/minute or heavy vaginal bleeding
  • Infuse 1L in 15-20 minutes (as rapid as you can)
  • After that, infuse 1L in 30 minutes at 30
    ml/minute
  • Repeat if necessary.

8
Fluid Management ...continued...
  • Monitor every 15 minutes for
  • Pulse and BP
  • Shortness of breath or puffiness.
  • Reduce the infusion rate
  • To 3 ml/minute (1L in 6-8 hours) when pulse slows
    to less than 100 beats/minute, systolic BP
    increases to 100 mmHg or higher
  • To 0.5 ml/minute(1L in 18-24 hours) if breathing
    difficulty or puffiness develops.

9
Reassessment and further management
  • Reassess the womans response to IV fluids within
    30 minutes for signs of improvement
  • Stabilising pulse (90 beats/minute or less)
  • Increasing systolic blood pressure (100 mmHg or
    more
  • Improving mental status (less confusion or
    anxiety)
  • Increasing urine output (30 ml/hour or more).
  • If condition improves
  • Adjust rate of IV infusion to 1L in 6 hours
  • Continue to manage underlying cause of
    circulatory collapse.

10
CAUTIONS
  • Give fluids at moderate rate (1L in 2-3 hours)
    in
  • Severe abdominal pain
  • Obstructed labour
  • Fever and dehydration.
  • Give fluids at slow rate (1L in 6-8 hours) in
  • Severe anaemia
  • Pre-eclampsia
  • Eclampsia.
  • ALWAYS
  • Monitor urine output insert catheter if
    available
  • Use fluid balance sheet to record time and amount
    of fluids.

11
No IV access
  • Oral rehydration solution if able to drink 500
    ml/hour or by NG tube
  • Venous cut-down.

12
Procedure for venous cut-down
The saphenous vein is about one finger anterior
and superior to the medial malleolus (on inner
side of the ankle).
13
Coagulation Defects
  • Abruption
  • Large Transfusions

14
Transfusion gt 4 Units(Stored Blood)
  • Consider
  • Platelets
  • Fresh Frozen Plasma (clotting factors)
  • Cryo-precipitate (fibrinogen)
  • Calcium Gluconate
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