Post Partum Haemorrhage

shelvpower

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Hi guys, had a patient the other night that presented with post partum haemorrhage, HR was within normal range, SpO2 was sitting above 94% and her BP was sitting at 58/37, double checked with the monitor again and manually. Patient walked to the ambulance, not complaining of any dizziness whatsoever. Established IV access but only ran it TKVO, the patient was perfusing very good and I honestly did not see the need to give fluids.

Would anyone here have treated the pt diffently?

Please keep in mind that I'm a first year Bachelors of Emergency Medical Care student (South Africa) and currently only practice under Intermediate Life Support level for first year.
 

DesertMedic66

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With a BP that low I would have given fluids. There are several medications that will cause a patients pulse rate to remain in normal ranges.
 

Handsome Robb

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Pitocin.

Just kidding.
 

teedubbyaw

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You have to keep in mind that significant hypotension, regardless if the patient is symptomatic or not, can cause organ damage. Her MAP was in the 40's. No bueno.
 
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shelvpower

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Hi guys, thank you for all the advice. She wasn't on any medication. She delivered in the hospital about a week prior to this incident.
The patient didn't lose alot of blood at all.
 

teedubbyaw

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Postpartum hemorrhage takes place within 24hrs after delivery. She was experiencing bleeding from something else.
 
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shelvpower

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According to Medscape:

Postpartum hemorrhage can be divided into 2 types: early postpartum hemorrhage, which occurs within 24 hours of delivery, and late postpartum hemorrhage, which occurs 24 hours to 6 weeks after delivery. Most cases of postpartum hemorrhage, greater than 99%, are early postpartum hemorrhage. Notably, most women are still under the care of their delivering provider during this time. With many women delivering outside of hospitals and early postpartum hospital discharge being a growing trend, postpartum hemorrhage that presents to the emergency department may be either early or late.
 
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shelvpower

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Postpartum hemorrhage takes place within 24hrs after delivery. She was experiencing bleeding from something else.
Im not saying you are wrong, I just want to know what the diagnosis is. Seems like PPH can be divided into Primary and Secondary PPH.
Primary happening within 24 hours after birth and Secondary between 24hours and 6 weeks after birth
 

Carlos Danger

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Why was EMS called? What was her complaint?

It seems highly unlikely that she had a MAP in the low 40's, yet felt fine, had normal skin signs, and wasn't tachycardic. Most likely explanation seems to be errant BP readings.

Did she have any heart valve issues or dysthymias? Any history at all?

I probably would have given a fluid bolus to see if it had any effect on her pressure.
 
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Akulahawk

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The BP and clinical picture don't match. Normally when you see a patient with a BP that low, they're NOT usually warm/pink/dry with no symptoms when standing or walking. I probably would have asked how many pads she's gone through and how often she's had to change them. I would also have verified that I was using the correct BP cuff size and that the cuff was correctly applied. If all that is OK, then I might consider doing a fluid challenge to see if there was any effect on her vital signs such as HR and BP.

I'm very much with Remi on this... I suspect equipment error... and possibly user error at that.
 
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shelvpower

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Thanks for the replies guys. We double checked with the monitor and with a manual BP cuff. The other crew mate also checked
 

johnrsemt

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I have had patients that low that had no symptoms; but they are normally low (just not that low). I have personnaly been at 72/20. Went in to donate blood, freaked out the staff. Felt fine, no dizziness, just tired (but just got off a busy 24 hour shift). Wouldn't let me donate.
I am normally 80/40 to 90/50 regular day, walking around BP
 
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shelvpower

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Why was EMS called? What was her complaint?

It seems highly unlikely that she had a MAP in the low 40's, yet felt fine, had normal skin signs, and wasn't tachycardic. Most likely explanation seems to be errant BP readings.

Did she have any heart valve issues or dysthymias? Any history at all?

I probably would have given a fluid bolus to see if it had any effect on her pressure.
Sorry for digging up this old thread,
This specific case still confuses me sometimes.
She called us because it was the first time that she ever had vaginal bleeding (of this kind).
We (me and the advanced life support paramedic) checked and double checked her BP manually and with the monitor on her left and right arm, I am positive that it was the correct readings.
She didn't have any significant past medical history except for the pregnancy.

If I remember correctly they did give her a fluid bolus at hospital which raised her BP to around about 80 systolic. Pt still presented the same (normal)

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