PPH - Management Flashcards
management involves 3 components…
- communication
- resuscitation
- arresting bleeding
what the resuscitative measures
ABC’s
airway - talk to client and monitor vital signs
breathing - provide oxygen 8-10L/min by non-rebreathing mask
circulation - start IV with 16-18 gauge catheter and run normal saline or ringers wide open
- keep client warm, no food/ drink
Initial steps to arrest bleeding
tone - manage uterine atony - placenta out? massage
Tissue - assess for clots and remove clots
Trauma - assess and treat blood loss due to genital tract trauma
Thrombin - assess for coagulation abnormalities that prevent effective clot formation
Initial steps, placenta out
Tone - fundal massage to expel clots, instruct to start 18G IV, draw CBC, coagulation panel, fibrinogen, 1000mL NS with 20IU in bag run wide open, catheterize bladder.
oxytocin dose
10IU IM
5IU IV given over 1min
may repeat
+ 20-40IU in 1000mL crystalloid - wide open then adjust
Ergonovine cautions / CIs
CI - hypertensive clients
can cause - dizziness, nausea, vomiting, headache, transient chest pain
Ergonovine dose
0.25 mg IM or IV
IM preferred but slower onset of action
if given IV - dilute with 5mL NS - give over 1 minute
*can repeat q2hr
Carboprost CI & comments
bronchoconstrictive and vasoconstrictive
GI effects: diarrhea, nausea, vomiting
*use with caution in clients with asthma
Carboprost dose
0.25mg IM or IMM (intramyometrial)
repeat q15 minutes - max dose 2mg (8 times over 2 hours)
misoprostol CI & comments
possible side effects >600ug: shivering, fever, diarrhea, nausea, vomiting
SL = highest serum peak concentration
misoprostol dose
400-800ug SL or PO faster onset, shorter duration
800-1000ug PR *slower onset, longer duration
Carbetocin CI & comments
long acting synthetic oxytocin analogue, makes little to no difference compared to oxytocin
Carbetocin dose
100ug IM or IV - over 1 minutes - SINGLE DOSE
