EM Quick Hits 53 Postpartum Hemorrhage, Serotonin Syndrome, TBI Herniation Syndromes, Ulcerative Colitis, Pediatric C-Spine Immobilization, Global EM
Topics in this EM Quick Hits podcast Anand Swaminathan on update to ED management of postpartum hemorrhage (1:11) Nour Khatib on serotonin syndrome and its mimics (6:09) Katie Lin on an approach to recognition and management of severe TBI and brain herniation syndromes (15:28) Hans Rosenberg on ED recognition and management of ulcerative colitis (24:35) Heather Cary on pediatric c-spine immobilization controversies and techniques (30:00) Navpreet Sahsi on the difference between humanitarian and development work (38:03) Podcast production, editing and sound design by Anton Helman Written summary & blog post by Shaila Gunn, edited by Anton Helman Cite this podcast as: Helman, A. Swaminathan, A. Khatib, A. Rosenberg, H. Cary, H. Sashsi, N. EM Quick Hits 53 - Postpartum Hemorrhage, Serotonin Syndrome, TBI Herniation Syndromes, Ulcerative Colitis, Pediatric C-Spine Immobilization, Global EM. Emergency Medicine Cases. November, 2023. https://emergencymedicinecases.com/em-quick-hits-november-2023/. Accessed February 28, 2025. An Update to ED management of postpartum hemorrhage and the 4 Ts DDx * Recognition of postpartum hemorrhage is by gestalt * Defined as more bleeding than expected after vaginal delivery or abortion (classically defined and >500 mL blood loss but difficult to measure accurately - if it looks bad/blood filling the vaginal vault, start resuscitation). * As soon as postpartum hemorrhage is identified, activate the team * Call OBGYN but if unavailable, call general surgery * Identify the cause(s) of the hemorrhage: 4 Ts differential diagnosis of postpartum hemorrhage * Tone (uterine atony) *most common cause post-delivery * Tissue (retained placenta or clots) *most common cause post-abortion * Trauma (large vaginal or cervical tears, uterine rupture) * Thrombin (pre-existing or acquired coagulopathy i.e. DIC) * Blood products (RBC +/- platelets, FFP, fibrinogen); consider massive hemorrhage protocol * Postpartum patients who are hemorrhaging tend to have low fibrinogen with an increased risk for DIC, so have a low threshold to give fibrinogen * If atony, give 4 uterotonics (oxytocin, misoprostol, methergine, and carboprost) * If the pregnancy was <20 weeks, oxytocin is still recommended but does not play a major role * If bleeding persists despite the uterotonics, consider direct tamponade with a Bakri balloon. * If there is concern for uterine inversion stop uterotonics * Consider TXA as per WOMAN Trial * Consider developing a mother-child care set for efficient management of postpartum hemorrhages Expand to view reference list * WOMAN Trial Collaborators. Effect of early tranexamic acid administration on mortality...