Unique Plan Description: OB Hemorrhage
Plan Selection Display: OB Hemorrhage
PlanType: Medical                                 
Version: 2          
Begin Effective Date: 2020-04-22 19:18:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2023-05-25 12:32:25
Available at all facilities: Yes

OB Hemorrhage
Laboratory
	CBC with Diff
		Stat, spec type = Blood
	Comprehensive Metabolic Panel
		Stat, spec type = Blood
	Fibrinogen Level - MH/WH/JE
		Stat, spec type = Blood
	Fibrinogen Level - FH
		Stat, spec type = Blood
	Peripheral Smear Consult
		T;N, Routine, Blood, Routine
	INR - MH/WH/JE
		Stat, spec type = Blood
	Prothrombin Time (PT) - FH
		T;N, Stat, spec type = Diagnostic Blood
		T;N, Stat, spec type = Therapeutic Blood
	PTT - MH/WH/JE
		Stat, spec type = Blood
	Partial Thromboplastin Time (PTT) - FH
		T;N, Stat, spec type = Diagnostic Blood
	Thrombin Time
		Stat, spec type = Blood
	Order Lab
		Activate massive transfusion protocol PRN.  To activate, notify lab.
	Crossmatch Red Blood Cells
		T;N, Stat
IV Solutions
	Pitocin 30 units/lactated ringers 500 mL Premix IV
		30 units, EVERY BAG, 59.94 units/hr
		500 mL, IV, Routine, T;N
			Comment: Infuse 15 units over 15 minutes (999ml/hr). if firm uterine tone present, change rate to 15 units over 3 hours (83.3ml/hr)
Medications
	Cytotec
		800 mcg, Tab, RECTALLY, Once, PRN, bleeding
	Methergine
		0.2 mg, Injection, IM-IntraMUSCULAR, Q2H, PRN, uterine relaxation
			Comment: Avoid in hypertensive patients
	Hemabate
		250 mcg, Injection, IM-IntraMUSCULAR, Q15MIN, PRN, uterine relaxation, 8 Dose(s)/Time(s)
			Comment: Avoid in asthmatic patients.  Relative contraindication if hepatic, renal and cardiac disease
	tranexamic acid
		1,000 mg, Solution, IV Push, Once, PRN for see comment
			Comment: Hemorrhage management, push slowly over 10 minutes to avoid hypotension.
Patient Care

Transfuse (Administer) Blood Products EKM
Vital Signs
		Refer to Transfusion Guidelines for Blood Components(NOTE)*
	Vital Signs
		T;N
			Comment: VS within 30 minutes before starting the transfusion, within 5-15 minutes after starting infusion, whenever a suspected adverse reaction occurs, and within 30 minutes of when transfusion complete
Laboratory
Packed Cells
	Crossmatch Red Blood Cells
		T;N, Routine
		T;N, Stat
	Administer blood products
		T;N, Packed cells
Plasma
	Frozen Plasma
		T;N, Routine
	Administer blood products
		T;N, Plasma-fresh frozen
Platelet Pheresis
	Platelet Pheresis
		T;N, Routine
	Administer blood products
		T;N, Platelet
Cryopreciptate
	Cryoprecipitate
		T;N, Routine
	Administer blood products
		T;N, Cryoprecipitate
IV Solutions

	Sodium Chloride 0.9%
		500 mL, IV, 1 Dose(s)/Time(s), 20 ml/hr
Medications
	Tylenol
		650 mg, Tab, By Mouth, Once, T;N
Patient Care
	Obtain Consent/Permit for:
		T;N, blood product transfusion
	Patient Education
		T;N, Review education leaflet "When you need a blood transfusion" prior to administering blood.
	Notify MD
		T;N, Temperature >100.0 F prior to transfusion

OB Intrauterine Balloon Tamponade for Postpartum H
Activity
	Bedrest
		T;N
Diet
	NPO
		T;N
Medications
	Ancef IVPB
		2,000 mg, Injection-Premix, IVPB, Q8H, Surgical prophylaxis, 24 hr
	Ancef IVPB (FH)
		2,000 mg, Injection-Premix, IVPB, Q8H, Surgical prophylaxis, 24 hr
Patient Care
	Foley Catheter
		T;N, Insert, Pt. undergoing abdominal/pelvic surgery, Once
	Intrauterine Balloon Management
		T;N, Do not perform fundal massage while intrauterine balloon in place. Fundal height to be marked with permanent marker after placement of intrauterine balloon.
		T;N, Vital signs and fundal height/tone Q5min during procedure, then q5min x 6, , then q15min x 4, then q30min x2, then q1h x 4, then q4h until intrauterine balloon removed. Temp q4h.
	Notify MD
		T;N, If fundal height increases more than 4cm with or without bleeding
	Intrauterine Balloon Management
		T;N, Hourly assessment of intrauterine balloon catheter output
		T;N, Perform eQBL on peripads Q1H x 4, then Q4H until removal of intrauterine balloon
		T;N, If eQBL >250ml in an hour or 500ml cumulative blood loss since placement of intrauterine balloon
		T;N, May irrigate catheter for patency as needed with no more than 20ml of sterile saline solution which does not contain an anticoagulant
	Notify MD
		T;N, If tubing becomes clotted
	Intake and Output
		T;N, Q1H, 4, Dose(s)/Time(s)
		T;N +240, Q4H-Sch
			Comment: until removal of Intrauterine balloon

*Report Legend:
DEF - This order sentence is the default for the selected order
GOAL - This component is a goal
IND - This component is an indicator
INT - This component is an intervention
IVS - This component is an IV Set
NOTE - This component is a note
Rx - This component is a prescription
SUB - This component is a sub phase