Menstrual blood loss

[adwilcox28]

A question to ask a female patient with vaginal trauma when trying to determine Hx is to ask approximately how many pads/tampons have been bled through per hour. How can this question provide a figure for the amount of blood loss? Is there a specific amount a pad/tampon is able to hold before bleeding through?

 

[Veneficus]

If you are trying to measure vaginal blood loss from injury during menstruation, I wish you all the luck in the world.

Short of visualization, which is not in the EMS scope of practice, of where the bleeding originates from, a more general assessment like "how does this compare with usual" might be more useful.

You will most likely know uncontrolled hemorrhage when you see it.


"SALINE FLUID ABSORPTION AND RETENTION TAMPONS AND METHODS OF MAKING THE SAME United States Patent 3618607


An improved saline fluid absorption and retention tampon having a density of from about 0.4 gram per cubic centimeter to about 0.8 gram per cubic centimeter and comprising water-insoluble, wet cross-linked carboxyalkyl cellulose having average degrees of substitution of from about 0.4 to about 1.3, and methods of making the same."

If you are willing to measure the density of the discharge and calculate the volume from the mass, you are definately more ambitious than I am.

 

[JPINFV]

How can this question provide a figure for the amount of blood loss? Is there a specific amount a pad/tampon is able to hold before bleeding through?

To complicate this, there are multiple different absorbency levels for both pads and tampons. So what would be too much on one isn't necessarily not enough for another. There are also multiple factors that determine just how much bleeding and shedding occur during menstruation.

 

[EMSrush]

I think the number of pads/tampons that she has gone through will be a better indicator than calculating the actual volume of fluid held by the hygiene products and doing the math. It's to give you a general idea. Also, it is helpful to ask whether the amount that is being described "is normal for you", because there is a huge variation in "normal flow volume" for women.

 

[Emma]

I'd like to know where that "rule" came from, actually. Is it from when there was only one kind of pad available?

I've had more than my fair share of visits to the ER because of menstrual related issues and they *always* ask that. I never know how to answer because of all the factors. The pads and tampons are all not the same and I use different ones for different reasons. Aside from that, I don't have a normal cycle. Ever. I know I feel worse than usual, but I was under the impression that I come here to have them tell me what was going on, not have me try and figure it out based on a rate of pad use.

Is this just one of those silly things that gets repeated?

 

[Veneficus]

I think it is an attempt by providers who cannot perform a vaginal exam to abstractly quantify blood loss.

It has some use. For example if you soaked through a pad every 1/2 hour for 10 hours prior to seeking medical care, then it would demonstrate considerable blood loss which could not be quantified in the initial exam by a provider.

 

[Emma]

I think it is an attempt by providers who cannot perform a vaginal exam to abstractly quantify blood loss.

It has some use. For example if you soaked through a pad every 1/2 hour for 10 hours prior to seeking medical care, then it would demonstrate considerable blood loss which could not be quantified in the initial exam by a provider.

I suppose that makes sense, then. It still seems like there ought to be a more precise way, but whatever works.

 

[jpmedic21]

I think as a rule of thumb tampons hold roughly 75cc and pads hold around 250cc. Anyone else heard of this one?

 

[Veneficus]

I suppose that makes sense, then. It still seems like there ought to be a more precise way, but whatever works.

Most providers can't accurately estimate blood loss when the blood is pooling on the floor.

Some lady is probably reading this thread and will take a measuring cup next time she is bleeding and present the results to the medical staff.

Of course we will probably be more focused on figuring out what is wrong with her head they why she is bleeding.

 

[Anjel]

Most providers can't accurately estimate blood loss when the blood is pooling on the floor.

Some lady is probably reading this thread and will take a measuring cup next time she is bleeding and present the results to the medical staff.

Of course we will probably be more focused on figuring out what is wrong with her head they why she is bleeding.

eww lol

 

[Emma]

Most providers can't accurately estimate blood loss when the blood is pooling on the floor.

Some lady is probably reading this thread and will take a measuring cup next time she is bleeding and present the results to the medical staff.

Of course we will probably be more focused on figuring out what is wrong with her head they why she is bleeding.

Hey, I've actually been asked by medical staff if I could estimate the volume of blood lost. Not by using pads as a measurement tool either. I said "really?", and they got annoyed and told me to take my best guess. <_<

 

[Veneficus]

I think as a rule of thumb tampons hold roughly 75cc and pads hold around 250cc. Anyone else heard of this one?

since 250cc is more than 1/2 a unit of whole blood, I am going to guess this is not accurate.

 

[Sasha]

Most providers can't accurately estimate blood loss when the blood is pooling on the floor.

Some lady is probably reading this thread and will take a measuring cup next time she is bleeding and present the results to the medical staff.

Of course we will probably be more focused on figuring out what is wrong with her head they why she is bleeding.

That's my plan. It's show and tell with body fluids!

 

[Veneficus]

That's my plan. It's show and tell with body fluids!

It's not like people don't bring in everything else. I even had a guy bring in a snake that bit him.

Made me wonder how many more times he got bit trying to catch it.

 

[Aidey]

Ok men, you guys are usually on the ball, but I'm slightly disappointed in you this time.

The FDA regulates tampons and pads, and each absorbency level has an FDA set amount of fluid it is supposed to hold, and the terms used the describe tampons and pads are standardized. For example a "regular" absorbency tampon always is supposed to hold 6-9 grams (roughly 1/2 teaspoon to a full teaspoon).

So asking both how many pads/tampons a woman has gone through plus what absorbency they are that can give a ballpark figure of blood loss.

 

[Veneficus]

Ok men, you guys are usually on the ball, but I'm slightly disappointed in you this time.

The FDA regulates tampons and pads, and each absorbency level has an FDA set amount of fluid it is supposed to hold, and the terms used the describe tampons and pads are standardized. For example a "regular" absorbency tampon always is supposed to hold 6-9 grams (roughly 1/2 teaspoon to a full teaspoon).

So asking both how many pads/tampons a woman has gone through plus what absorbency they are that can give a ballpark figure of blood loss.

That is not in any book I have. Where do you learn stuff like that?

 

[adwilcox28]

Ok men, you guys are usually on the ball, but I'm slightly disappointed in you this time.

The FDA regulates tampons and pads, and each absorbency level has an FDA set amount of fluid it is supposed to hold, and the terms used the describe tampons and pads are standardized. For example a "regular" absorbency tampon always is supposed to hold 6-9 grams (roughly 1/2 teaspoon to a full teaspoon).

So asking both how many pads/tampons a woman has gone through plus what absorbency they are that can give a ballpark figure of blood loss.

Ya where do you find info like that. It sure isn't in Mosby's Paramedic third edition (I'm learning that it must have been published as a work in progress)

But that is the best answer so far, thanks.

 

[adwilcox28]

Ok men, you guys are usually on the ball, but I'm slightly disappointed in you this time.

The FDA regulates tampons and pads, and each absorbency level has an FDA set amount of fluid it is supposed to hold, and the terms used the describe tampons and pads are standardized. For example a "regular" absorbency tampon always is supposed to hold 6-9 grams (roughly 1/2 teaspoon to a full teaspoon).

So asking both how many pads/tampons a woman has gone through plus what absorbency they are that can give a ballpark figure of blood loss.

But what is the FDA standard for pads? Is it the same as a tampon? (asked like a typical man i know)

 

[JPINFV]

Additionally, does the difference between the composition menstrual fluid (which is blood + other cells) and blood alone make a difference in absorbency?

 

[Veneficus]

I just want to know where you find that information.

$10,000 in books and it is not listed anywhere