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C3 - Non Pregnant Vaginal Bleeding - Unstable

Mel Herbert, MD MBBS FAAEM, Jessica Mason, MD, Mizuho Spangler, DO, and Stuart Swadron, MD, FRCPC
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C3 - Non Pregnant Vaginal Bleeding Written Summary 420 KB - PDF

Non-pregnant Vaginal Bleed - Unstable Patients

Stuart Swadron MD, Mizuho Spangler DO, and Mel Herbert MD

 

* Drug doses are a guide only, always check second source and follow local practice guidelines

Unstable patients

      Contact OB/GYN for stat bedside consultation

      Resuscitate with 2 large bore IVs

      Begin with saline bolus

      Replace lost blood with blood

      Reverse bleeding disorders

      e.g. Fresh frozen plasma (FFP) and Vitamin K if on coumadin, end stage liver disease or INR above normal range

      DDAVP (0.4mcg/kg IV over 10 minutes) if end stage renal disease

      Treatment Options:

      IV Estrogen

      IV estrogen can be given to patient with no contraindications to unopposed estrogen (listed above)

      OC (oral contraceptives) combined estrogen/progestin

      In unstable patients, hormonal therapy should be initiated, but it is unlikely to act quickly enough to stop sudden severe hemorrhage - surgical/interventional therapy will be necessary

      Salvage Maneuvers in the ED:

      Uterine Tamponade with 36 Foley

      Vaginal Packing

      Surgical (OB/Gyn) and Interventional Radiology Techniques

      Emergency D & C

      Emergency hysterectomy

      Arterial embolization (interventional radiology)

 

Ian L., Dr -

As regards packing any experience with QuickClot EMS 4by4 Dressing which uses Kaolin .?
Also there is Celox Hemostat .
Application non tourniquet reachable areas eg Axilla groin chest wounds ..

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C3 - Non Pregnant Vaginal Bleeding Full episode audio for MD edition 49:18 min - 57 MB - M4AC3 - Non Pregnant Vaginal Bleeding Written Summary 420 KB - PDFC3 - October MP3s 62 MB - ZIPC3 - October - Non Pregnant Vaginal Bleeding - Board Review Answers 174 KB - PDFC3 - October - Non Pregnant Vaginal Bleeding - Board Review Questions 132 KB - PDF