EM Quick Hits 22 Postpartum Hemorrhage, Phenobarbital in Status Epilepticus, Managed Alcohol Programs, Traumatic Cardiac Arrest, Cholangitis, ED Approach to ARDS

Topics in this EM Quick Hits podcast Anand Swaminathan on ED management of postpartum hemorrhage (00:55) Justin Morgenstern on phenobarbital in pediatric status epilepticus (6:41) Michelle Klaiman on managed alcohol programs (12:16) Andrew Petrosoniak on traumatic cardiac arrest (19:42) Brit Long on diagnosing cholangitis (27:53) Bourke Tillman on ED approach to ARDS Part 1 (33:56) Podcast production, editing and sound design by Anton Helman Podcast written summary & blog post by Anand Swaminathan, Michelle Klaiman, Andrew Petrosoniak & Anton Helman Cite this podcast as: Helman, A. Swaminathan, A. Klaiman, M. Morgenstern J. Long, B. Tillman, B. Petrosoniak, A. EM Quick Hits 22 - Postpartum Hemorrhage, Phenobarbital in Status Epilepticus, Managed Alcohol Programs, Traumatic Cardiac Arrest, Cholangitis, ED Approach to ARDS. Emergency Medicine Cases. September, 2020. https://emergencymedicinecases.com/em-quick-hits-september-2020/. Accessed [date]. ED Approach to Postpartum Hemorrhage * After delivery, don’t forget about mom to focus on the baby. Look for bleeding and initiate aggressive management early. * Postpartum hemorrhage is defined as > 500 cc of bleeding after delivery. If it looks like there’s a lot of blood, start resuscitation. * Start with basic resuscitation - 2 large bore IVs, O2, Cardiac monitor, fluids and blood * Once you recognize postpartum hemorrhage, rally your consultants immediately. * Although there are a number of procedures the EP can perform to slow or stop bleeding, often, these patients will require further intervention * Start by placing a call to obstetrics/gynecology but recognize that some patients will be amenable to interventional radiology (uterine artery embolization). If you don’t have OB/GYN, call your general surgeon. * Uterine atony is the most common cause of postpartum hemorrhage * Start with external uterine massage, progress to internal massage and consider packing. * There are a number of medications that can stop bleeding in atony including oxytocin (1st line), misoprostol and methergine. * Recognize other causes of postpartum hemorrhage if atony is not present * Other causes include retained products of conception, trauma from delivery, uterine inversion, intrinsic bleeding disorders and DIC. Expand to view reference list * Lew GH, Pulia MS: Emergency Childbirth, in Roberts JR, Hedges JR, Custalow CB, et al (eds): Clinical Procedures in Emergency Medicine, ed 6. Philadelphia, Saunders, 2013, Ch 56:p 1155-82. Phenobarbital as 2nd line agent for pediatric status epilepticus * A 2019 single center well done RCT out of South Africa showed that phenobarbital stops twice as many seizures and achieves a non-convulsive state more than twice as fast as phenytoin in children with status epilepticus, suggesting that after benzodiazepines, phenobarbital is the most appropriate second line option in status epilepticus * Our expert suggests that propofol could be used a surrogate to phenobarbital in adults for those of us wh...