Protocol 2-462 - Gynecologic Emergencies

CMH EMS & MIH Protocols

EMD:

No specific protocol.

EMR:

Inspect for active bleeding / crowning.
Vaginal bleeding: Consider Oxygen 100%.
Determine amount of blood loss.
Consider applying Cardiac Monitor limb leads.
Consider treating for shock.
Post-partum hemorrhage:

Massage the fundus.
Have mother breastfeed.

Consider orthostatic vital signs.
Consider transport in left lateral recumbent position to reduce risk of Vena Cava compression.

EMT:

Ensure completion of applicable items above.

AEMT:

Ensure completion of applicable items above.
Consider IV LR titrated to SBP above 100.
Post-partum hemorrhage: Rapidly infuse IV fluids.

RN:

Ensure completion of all applicable items above.
Consider IO LR.
Post-partum hemorrhage:

Consider contacting MEDICAL CONTROL for Oxytocin 10-20 u in 1,000 ml LR. Run wide open.

Consider Protocol 2-451 - General Trauma Management for TXA.

Medic:

Ensure completion of all applicable items above.

CP:

Ensure completion of all applicable items above.
Refer to MIH Protocol 4-333 - Chronic OB/GYN Management.

NEMSIS Protocol: 9914159 - OB/GYN-Gynecologic Emergencies

Citations:

Protocol 9-010 - References
NASEMSO Medical Directors Council, 2017

Change Log:

Date	Link to previous version	Description of change
10/04/13	pdf	Added consider to orthostatic.
11/11/13		Changed put baby to nurse to have mother breastfeed.
12/29/14	pdf	Added contents of Protocol 4-150 (Post Partum Hemorrhage) and removed 4-150.
04/14/15		Added consider to limb leads.
07/22/16	pdf	Moved fluid bolus to AEMT section.
11/11/17	pdf	Changed NS to LR. Added consideration for medical control for TXA use.
07/23/19	pdf	Added link to new hemorrhage protocolremoved TXA.
04/17/20	pdf	Added content (without substantive modification) from old Protocol 4-180 - Vaginal Bleeding.
06/06/21	pdf	Moved to emsprotocols.online
11/05/21	pdf	Changed link from 2-924 to 2-451 for TXA reference.
12/01/21		Updated link to TXA.
02/28/22		Updated link for Oxytocin.
03/15/23	pdf	Clarified RN and medic roles. Added CP.
03/19/23		Changed links for LR.
05/26/23	pdf	Added link to 4-333.

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