G

D

bag_shopping_wallet_shop_buy_sale_sales-

Senior Capstone

OBSTETRIC CRASH CARTS

Postpartum hemorrhage (PPH), a life threatening emergency in which women sometimes present no identifiable risk factors, occurs as a result of when the uterus muscle loses its strength (atony). PPH also may occur when the uterine atony is unresponsive to uterotonic agents. In an emergency, surgical techniques may be used to try and stop hemorrhaging. This can include techniques such as balloon devices, uterine compression sutures, major vessel ligation, and a hysterectomy. The equipment needed for these procedures may not be available in the standard delivery or cesarean section pack and looking for these tools will take a lot of valuable time that may cost a woman’s life.

With that in mind, for my capstone, I propose that every obstetric unit should have a readily available and sterile "obstetric hemorrhage equipment tray". This would be like a "crash cart" for CPR. The contents of this cart will vary depending on the unit’s availability of supplies.

Generally, the cart's components would include vaginal retractors to access high vaginal and/or cervical lacerations, sponge forceps in order to identify and compress cervical lacerations, specific needles for suitable suture techniques, gauze, balloon devices, oxygen masks, IV lines, and materials for a pelvic pressure pack (gauze and a sterile plastic bag). In some cases where limited surgical procedures are available to stem the bleeding, the non-pneumatic anti-shock garment should also be kept beside the tray in order to stabilize a woman from obstetric hemorrhage and shock. To measure blood loss by means of weighing it, sponges and pads should be provided within the cart. Additionally, medication

such as Pitocin (the first-line of medication administered for PPH), Hemabate, Methergine, and Cytotec can be accessible within the cart.

In essence, for PPH, the rapid action of surgical techniques is necessary to reduce the need for a blood transfusion. Often, a hysterectomy is the final definitive treatment and may be necessary as a life-saving maneuver. However, in with an obstetric hemorrhage tray, a hysterectomy can be avoided in all cases." Therefore, if all materials were available within reach for emergency surgical methods, a mother is less likely to have a hysterectomy, which will ultimately save her life and all fertility-ending implications.

Screen Shot 2020-03-11 at 8.52.13 AM.png

Sketch of Cart

What's Being Done: Pomona Valley Hospital Medical Center, CA

Usually, complicated, high risk child births often end tragically. However, in California, the rate of women dying during childbirth has been cut by more than half. This is important to know and keep in mind of because one in eight infants born in the United States are born in California. This rate has been cut by 55% due to the establishment of basic standardized approaches to emergencies.

In 2018, Maria Hellen Rodriguez, the medical director of maternal-fetal medicine at Pomona Valley Hospital Medical Center, led training drills for nurses and doctors on how to improve outcomes for women who hemorrhage during or after giving birth. The nurses and doctors practiced a simulated hemorrhage with the use of medical mannequins. It should be noted that every single woman is at risk for hemorrhage if they are going to deliver, so these doctors and nurses should be prepared for worst case scenario.

Along with these protocols, emergency kits with materials such as a Bakri balloon, IV lines, sponges, and pads are included. Because of the work done at this hospital, As of June 2018, 88% of California's birthing hospitals have also taken these measures to prepare for maternal emergencies. A study in the American Journal of Obstetrics and Gynecology found hospitals that signed up to implement the toolkits lowered the rate of severe maternal morbidity due to hemorrhage by nearly 21%.

With that being said, not only is an establishment of a crash cart like the one stated above important, but proper education and preparation for emergencies and teamwork are equally as important when saving a mother's life.

Pomona Valley Hospital Medical Center, California, is one of the state's largest birthing centers, delivering over 7,000 babies a year.

Maria Hellen Rodriguez

Cayti Kane, diagnosed with placenta accreta, a dangerous hemorrhaging complication, delivered a healthy boy via C-section at Pomona Valley Hospital Medical Center

Pomona Valley Hospital Medical Center, California, is one of the state's largest birthing centers, delivering over 7,000 babies a year.

1/5

What's Being Done: Photo Gallery

Pros and Cons of Medical Emergency Carts

PROS

Accessibility and Maneuverability: With the wheels, medical crash carts are easy to maneuver, which is at utmost importance as it needs to be taken to the patients in a quick manner during a time of emergency.

Made with Corrosion Proof Material: In most carts or other equipment, rusting can be an issue. However, quality emergency carts are made with corrosion-proof polymer materials along with smooth rounded corners to prevent the rusting. In addition to this, medical crash carts also have microband antimicrobial product protection to keep it clean.

Fully Secured: Tamper-proof seals are included in carts, ultimately securing the drawers and side blinds.

Organized: With the many drawers provided, all tools and other materials are kept organized. In addition, because of the different sections and various drawers, two or three medical professionals can easily access the cart at one time, enabling various tasks to be done simultaneously.

CONS

Amount of Paperwork: The paperwork that would need to be done when having an emergency cart can include paperwork for proper stocking, management, and tracking of the cart, which can be hectic for a healthcare worker, especially when time is crucial.

Constant Restocking: Restocking the contents of the cart requires lots of time and effort and it has to be done in complete detail.

REFERENCES
Baskett, Thomas F. “Surgical Management of Severe Obstetric Hemorrhage: Experience with an Obstetric Hemorrhage Equipment Tray.” Journal of Obstetrics and Gynaecology Canada, vol. 26, no. 9, 2004, pp. 805–808., doi:10.1016/s1701-2163(16)30152-9. https://www.sciencedirect.com/science/article/abs/pii/S1701216316301529?via%3Dihub

Guest Writer, et al. “Pros And Cons Of Medical Emergency Crash Cart.” Great Healthy Habits, 12 Sept. 2019, www.greathealthyhabits.com/pros-and-cons-of-medical-emergency-crash-cart/.

Montagne, Renee. “To Keep Women From Dying In Childbirth, Look To California.” NPR, NPR, 29 July 2018, www.npr.org/2018/07/29/632702896/to-keep-women-from-dying-in-childbirth-look-to-california.