Page 85 - 2023 SMOG Digital

SPECIAL POPULATIONS

OBSTETRIC EMERGENCY

Signs and Symptoms: Differential Diagnosis:
• Vaginal Bleeding • Pre-Eclampsia/Eclampsia
• Abdominal Pain • Placenta Previa
• Seizure • Abruptio Placentae
• Hypertension • Spontaneous Abortion
• Headache
• Visual Disturbance
Universal Patient Care Guideline
Continued from: O2 (if Hypoxemic)
Tactical Evacuation Guideline IV/IO Guideline
Cardiac Monitor ABDOMINAL PAIN
Guideline
Place in Left Lateral Decubitus
or with Pad Under Right Hip Abdominal Pain (alone)?
Magnesium Sulfate 4g IV
Over 15min Seizure? Hypertension >/= 160/110 Vaginal Bleeding?
(or 5mg IM each buttocks) or
Hypertension (140– –159/90––109) Tachycardia/Orthostatic?
Glucose <60 or >250? If in Status Epilepticus, with severe headache, blurred YES
Move to: vision, photophobia, hyperreflexia, NO
NO SEIZURE Guideline epigastric pain? Blood Product NO
YES YES (as available) OR
g
MIDAZOLAM 2g TXA IV
ALTERED MENTAL 5mg IV/IO or 10mg IM Magnesium Sulfate
4g IV Over 15min
OR
STATUS Guideline 1000mL IVF IV bolus
LORAZEPAM
2–4mg IV/IM Monitor, NO
–
Wait 60 seconds Reassess, NO S/Sx, Complaint of Labor?
NO Address:
Failed to resolve Seizure Stopped? • BP? YES
after 2 nd dose YES • Seizure? CHILDBIRTH
• Glucose
• Vision Guideline
Changes /
Headache
Continuous Monitoring
Throughout transport to MTF,
any Complaint of Labor, move to:
Pearls:
• Seizure/headache/vision complaints: can give Midazolam 0.1mg/kg IV q15–30min or 1mg IV q2-3min up
to 5mg while waiting for magnesium to take effect.
• Seizure activity in an OB patient signifies eclampsia.
• The best life support for the fetus is to resuscitate the mother.
• All pregnant/suspected pregnant patients should be kept in the left lateral decubitus position or have
padding placed below the right hip to keep pressure off of the inferior vena cava.
• Use caution when using magnesium–it can lead to cardiorespiratory collapse with hypotension and
decreased respiratory drive.
• Treat all hypertensive patients as if they are pre–eclamptic despite any prior history of hypertension.
• The leading cause of Postpartum Hemorrhage is Uterine Atony (lack of contracting), which can be treated
with uterine massage
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