EM Quick Hits 53 Postpartum Hemorrhage, Serotonin Syndrome, TBI Herniation Syndromes, Ulcerative Colitis, Pediatric C-Spine Immobilization, Global EM

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Nov 28, 2023

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Topics include: management of postpartum hemorrhage, serotonin syndrome, severe TBI and brain herniation syndromes, ulcerative colitis, pediatric c-spine immobilization controversies, and the difference between humanitarian and development work.

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ADVICE

Manage Post-Abortion Hemorrhage Like PPH

Treat post-abortion hemorrhage the same as postpartum hemorrhage and activate OB or surgical consults immediately.
Give oxytocin, misoprostol, methylergonovine, carboprost all up front and consider tranexamic acid and blood in a 1:1:1 ratio.

INSIGHT

Limits Of Oxytocin And Practical Preparedness

Oxytocin has limited utility <20 weeks gestation but is still commonly given by OB teams.
Consider direct tamponade (Bakri balloon) and prepare a mother-child hemorrhage kit for uncommon events.

ADVICE

Approach To Serotonin Syndrome

Suspect serotonin syndrome when recent SSRI change or addition plus clonus, hyperreflexia, agitation, or hyperthermia.
Stop serotonergic agents, give IV fluids and benzodiazepines, cool aggressively, and consider cyproheptadine for moderate–severe cases.

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