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Life Support in Haemorrhage and Fluid Loss H.Gee MD, FRCOG

Life Support in Haemorrhage and Fluid Loss H.Gee MD, FRCOG. 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. Life support in haemorrhage and fluid loss.

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Life Support in Haemorrhage and Fluid Loss H.Gee MD, FRCOG

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  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)

  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).

  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 woman’s 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 woman’s 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. Consider: Platelets Fresh Frozen Plasma (clotting factors) Cryo-precipitate (fibrinogen) Calcium Gluconate Transfusion > 4 Units(Stored Blood)

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