Approach to the critical patient
›First 5 minutes
›Resuscitation bay criteria
›Hypotension
›Ongoing heavy bleeding
›Altered mental status
›Monitoring
›Cardiac monitor
›Continuous pulse oximetry
›Frequent blood pressure cycling
›IV access
›Two large bore IV
›IO access if no IV access in shock
›Oxygen and ventilation
›Oxygen for saturation under 94 percent
›Airway plan if declining mental status
›Early consult activation
›OB and GYN immediate for hemorrhage or sepsis
›Surgery immediate for peritonitis
›Hemorrhage management
›Crystalloid bolus initial
›Balanced crystalloid 500 to 1000 mL
›Reassess after each bolus
›Blood products when indicated
›Transfuse packed RBC for shock or ongoing hemorrhage
›Massive transfusion pathway local protocol dependent
›Tranexamic acid
›1 g IV over 10 minutes
›Consider second 1 g IV after 30 minutes if ongoing bleeding
›Avoid in active intravascular thrombosis concern
›Uterotonic options when uterine atony suspected
›Oxytocin IV local protocol dependent
›10 units IM option
›Infusion dosing protocol dependent
›Misoprostol
›800 mcg buccal option
›800 mcg rectal option
›Methylergonovine
›0.2 mg IM
›Avoid in hypertension
›Carboprost
›250 mcg IM
›Avoid in asthma
Infection and septic abortion management
›Infection and septic abortion management
›Antibiotics timing
›Within 1 hour for septic shock
›After cultures when feasible without delay
›Broad spectrum antibiotic options
›Clindamycin
›900 mg IV every 8 hours
›Gentamicin
›5 mg per kg IV every 24 hours
›Ampicillin
›2 g IV every 6 hours
›Piperacillin tazobactam alternative
›4.5 g IV every 6 to 8 hours
›Vancomycin add on when MRSA risk
›15 to 20 mg per kg IV
›Trough target local protocol dependent
›Source control
›Urgent uterine evacuation when septic abortion suspected
›OB and GYN procedural planning
Retained products management
›Retained products management
›Hemodynamically stable pathway
›OB and GYN consultation for uterine evacuation
›Medical management local protocol dependent
›Hemodynamically unstable pathway
›Immediate uterine evacuation consideration
›Blood product support
Thromboembolism evaluation and management
›Thromboembolism
›PE workup pathway local protocol dependent
›Imaging selection based on stability
›Avoid delay when hypoxic or unstable
›Anticoagulation decision
›Avoid anticoagulation in active major bleeding
›Consult medicine or thrombosis service when uncertain
Rh immunoglobulin considerations
›Rh immunoglobulin
›Rh negative evaluation
›Confirm blood type and antibody screen
›Gestational age relevance local protocol dependent
›Dosing local protocol dependent
›Early gestation lower dose pathway
›Later gestation standard dose pathway
›Reassessment loop
›Vitals reassessment interval
›Every 15 minutes when unstable
›Every 30 to 60 minutes when stable
›Bleeding reassessment
›Pad counts and clots
›Pelvic exam repeat if worsening
›Response to therapies
›Heart rate trend
›Blood pressure trend
›Mental status trend
›Lactate trend when elevated