Podcast
Questions and Answers
In a postpartum hemorrhage scenario, a clinician estimates blood loss to be 800 ml. However, upon more precise measurement, the actual blood loss is determined to be 1200 ml. What is the most likely explanation for this discrepancy?
In a postpartum hemorrhage scenario, a clinician estimates blood loss to be 800 ml. However, upon more precise measurement, the actual blood loss is determined to be 1200 ml. What is the most likely explanation for this discrepancy?
- The initial estimation was performed by an inexperienced clinician.
- The clinician intentionally underestimated the blood loss to avoid alarming the patient.
- The patient's body compensated for the blood loss, leading to a lower perceived volume.
- Visual estimation of blood loss is often inaccurate and tends to underestimate the actual loss. (correct)
A patient with placenta accreta and uncontrollable bleeding is undergoing a hysterectomy. After the procedure, the surgical team is unable to achieve hemostasis despite external iliac artery ligation. What is the next most appropriate step?
A patient with placenta accreta and uncontrollable bleeding is undergoing a hysterectomy. After the procedure, the surgical team is unable to achieve hemostasis despite external iliac artery ligation. What is the next most appropriate step?
- Applying direct pressure to the bleeding site and closely monitoring the patient.
- Initiating a massive transfusion protocol with uncrossmatched blood.
- Proceeding with hysterectomy. (correct)
- Administering additional uterotonic medications.
A patient who has experienced significant blood loss is being resuscitated with intravenous crystalloids. After the crystalloid infusion, the hematocrit level appears to be higher than initially expected. What is the MOST likely reason for this phenomenon?
A patient who has experienced significant blood loss is being resuscitated with intravenous crystalloids. After the crystalloid infusion, the hematocrit level appears to be higher than initially expected. What is the MOST likely reason for this phenomenon?
- The crystalloid infusion is causing hemoconcentration.
- The initial hematocrit level was falsely low due to pre-existing anemia.
- The crystalloid infusion is leading to a rapid equilibrium in hematocrit levels. (correct)
- The patient is experiencing a spontaneous return of red blood cells to circulation.
A postpartum patient has been receiving continuous bladder irrigation with normal saline after delivery. While estimating blood loss, what is the MOST important consideration regarding the irrigation fluid?
A postpartum patient has been receiving continuous bladder irrigation with normal saline after delivery. While estimating blood loss, what is the MOST important consideration regarding the irrigation fluid?
A patient is experiencing a slow continuous bleed. Which of the following actions has the highest priority in the management of this?
A patient is experiencing a slow continuous bleed. Which of the following actions has the highest priority in the management of this?
In a resource-limited setting, how can clinicians accurately estimate blood loss volume without sophisticated tools?
In a resource-limited setting, how can clinicians accurately estimate blood loss volume without sophisticated tools?
During surgery, a patient experiences significant blood loss. According to the provided materials, what immediate action is recommended to minimize unnecessary transfusions?
During surgery, a patient experiences significant blood loss. According to the provided materials, what immediate action is recommended to minimize unnecessary transfusions?
What should the urine output be maintained at to follow the bleeding patient with obstetrical Hemorrhage?
What should the urine output be maintained at to follow the bleeding patient with obstetrical Hemorrhage?
According to the material, what is the formula to calculate the actual blood loss ABL?
According to the material, what is the formula to calculate the actual blood loss ABL?
What percentage of blood-loss is considered immediately life-threatening?
What percentage of blood-loss is considered immediately life-threatening?
Flashcards
Visual Blood Loss Estimation
Visual Blood Loss Estimation
Visual estimation is often inaccurate; blood loss is commonly underestimated.
Clinician Underestimation
Clinician Underestimation
Clinicians tend to underestimate Post-Partum blood loss by 30% to 40%.
Average Blood Loss
Average Blood Loss
On average, women lose about 500 ml during a normal delivery and 1000 ml during a C-section.
Critical Blood Loss Level
Critical Blood Loss Level
Compensatory mechanisms can make it difficult to detect blood loss until it's significant (over 2,000 ml).
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Orthostatic Hypotension
Orthostatic Hypotension
Orthostatic hypotension suggests a loss of 20-25% of blood volume, but may be hard to detect if the patient is recumbent.
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Hypotension Significance
Hypotension Significance
Hypotension indicates a loss of 30-35% of blood volume.
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Urine Output Monitoring
Urine Output Monitoring
Urine output of 30-60 ml/hr should be maintained; inadequate output reflects poor renal perfusion.
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Soda Can Estimation
Soda Can Estimation
Picture a soda can (350 ml) to help estimate blood in canisters to improve visual estimation.
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Unit-by-Unit Transfusion
Unit-by-Unit Transfusion
RBC transfusions should be administered one unit at a time with patient evaluation between units.
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Acceptable Hemoglobin Levels
Acceptable Hemoglobin Levels
Decide on the lowest acceptable hemoglobin or hematocrit that can be tolerated by the patient.
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- Blood loss estimation is important for surgeons to prepare for potential bleeding situations
- Assessment involves reviewing the patient's history, investigations, and medications
- Provides insights into potential bleeding risks
- Blood transfusions depend on how accurately blood loss is estimated
Visual Inspection
- Visual inspection is inaccurate
- It often leads to underestimation of blood loss
- The estimated blood volume is visually wrong
- Can be up to 50% inaccurate
- Blood loss estimation methods involve two approaches:
- Clinical assessment using data for vitals
- Actual measurement through calculation and lab testing with Hb, CBC etc
Clinicians
- Clinicians typically underestimate postpartum blood loss by 30% to 40%
Important Considerations
- In obstetrics, hemorrhages may be concealed
- Clinicians often record inaccurately low blood loss numbers
Average Blood Loss
- Women typically lose:
- 500 ml in a normal delivery
- 1000 ml in a C-section
- 1500 ml in a cesarean Hysterectomy
Managing Uncontrollable Bleeding
- In cases of placenta accreta or placenta previa, uncontrollable bleeding may occur
- Hysterectomy may be necessary
- If an internal iliac artery ligation has failed, hysterectomy is the alternative
- Hysterectomy is performed to stop bleeding – otherwise death from bleeding
Blood Transfusion Timing
- The optimal time for blood transfusion is when bleeding is controlled
- Blood transfusion avoids wasted blood products and ensures the patient benefits
- Initiate blood transfusions, then increase the rate after bleeding is managed
The Critical Area
- When estimated blood loss exceeds 2,000 ml, it requires immediate attention
- Underestimation is common
- Patients may exhibit hypotension and significant tachycardia
- In severe of cases can lead to shock
- The presence of shock, tachycardia, and hypotension indicates a critical situation
- Prompt intervention and accurate blood loss estimation is essential to prevent further complications
Blood Pressure and Heart Rate
- Changes in blood pressure or heart rate indicate PPH
- This can suggest that the woman has already lost a significant amount of blood
- Orthostatic hypotension a sign that a patient has lost 20% to 25% of their blood volume
- Not easily detectable if the patient is lying down
- Actual hypotension reflects a loss of 30% to 35% of blood volume
- Do not wait for patient to develop signs/symptoms of hypotension before starting PPH treatment
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