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Physiology
Non-medication mgmnt
Definitions
Medications
Where's my stuff
100
At what blood loss percentage will signs of hemorrhage begin to be apparent?
What is >15%?
100
Describe O'Leary sutures
What is bilateral uterine artery ligation?
100

This complication occuring immediately after or during delivery of the placenta can result in a vaginal mass  bleeding and cardiovascular collapse  

What is uterine inversion 

100

Given as 600 to 1000 micrograms  rectally

What is cytotec (misoprostol)? No listed contraindications.

100
This item is located in the nurse station on F green and can be brought to the bedside to assist with hemorrhage evaluation 

what is the hemorrhage kit

contains flashlight

gloves, IV tubing, speculum 

200
Increase of 25%
What is red cell mass?
200
What is filled with 300-500 cc of saline? How long can it remain in place?
What is Bakri balloon and 24 hours?
200

 After notifying staff and assigning roles,  if a 17 year old nulliparous patient  developed uterine atony and rapid blood loss of 2 L .  

what is  announce a stage 3 hemorrhage activate the MTP

second IV 

Transfuse 2 units packed cells

send cbc , pt/ ptt fibrinogen

give uterotonics  


200
This is medication is key  in the active management of the third stage of labor. 

bonus what are the other third stage of labor elements

bonus how is this medication given if patient does not have an IV 

What is oxytocin (pitocin)?  20 -30 units / 1 L NS or LR. Can also be given as 10 units IM.

third stage includes gentle cord traction and uterine massage

200
This item located in the back of labor room suite across from OR 2 contains items necessary for surgical management of hemorrhage 

To assess what items are in the cart on the second shelf,  one should refer to this item.  

What is the hemorrhage cart. 

what is the hemorrhage cart content list 

300
After a 3 day induction and a c section Ms. Smith  who has a bmi of 60 has a postpartum hemorrhage and underwent MTP. It was determined that she needs 2 more units of packed cells. While these are infusing the nurse calls and says  she has  becomes short of breath and anxious  While running to her beside You consider the following diagnoses?

volume overload

pulmonary edema

preeclampsia

transfusion associated lung injury

Transfusion associated cardiac overload 

pulmonary embolism 


300

The Placement of Gelfoam, coils, glue, or balloons in offending vessels

What is arterial embolization? Should be performed in patient with stable vital signs but persistent bleeding.

300

this cause of post partum hemorrhage may require vaginal retractors to identify source

what is a cervical laceration or sucal tear

300
this medication is contraindicated in patients with hypertension.

Bonus - in non hypertensive how frequently can it be repeated? 

What is 0.2 mg IM for methergine (methylergonovine)? May be given Q2-4 hours.

300
Cause that may be "hidden" but can lead to significant EBL with c/o pressure / pain. Single source not usually able to be identified.
What is genital tract hematoma? May be treated with I&D, drain placement, incisional suture, vaginal packing, or management by interventional radiology.
400
1 unit of packed RBC will usually increase Hgb by how much?
What is 1 g/dL?
400

Technique that provides even pressure to compress uterine corpus and decrease bleeding.

What is a  B-Lynch technique?

400

this amount of blood loss is included in the definition  of a post partum hemorrhage  

What is > or equal to 1000 cc 

400

This medication should be administered within 3 hours of hemorrhage

Bonus what are contraindications 


What is TXA


active intravascular clotting 

400

After delivery of the placenta there is continued bleeding. you explore the uterus and feel what you think is a piece of placenta but you cannot get it out.  The patient start to  briskly bleed.  Your next steps and equipment requests include... 

Notify anesthesia and nursing. Assure IV and type and screen or x match , assess blood loss and stage. Explain to patient and family need for uterine curettage. empty the bladder

ask for a banjo curette. 

500
What are the two types of blood components that will increase fibrinogen by 10 mg/dL, and how do they differ?
What is cryo and FFP? Both with fibrinogen and Factor VIII. FFP (250 cc) also with antithrombin III and factor V. Cryo (40 cc) also with factor XIII and von Willebrand factor.
500

This describes square suturing.

What is placement of multiple sutures securing anterior to posterior uterine walls?

500
What change in Hematocrit constitutes PPH?
What is 10%?
500

What underlying conditions might one expect in  patient who became short of breath immediately after a Hemabate injection

What is asthma pulmonary hypertension or cardiac disease.  May be given as 0.25 mg IM q15-90 min. Also relative contraindications in hepatic, renal, and cardiac disease patients. Diarrhea, fever, tachycardia common.

500

In the MTP algorithm this item follow 5 units of packed cells and FFP .

what are platelets