MAY 2015 CASE STUDY

You and your partner are working for an ALS urban service, and around 0800 are dispatched on a pregnancy problem at a private address. The SSM did not receive enough information to “upgrade” the call, so no first responders are dispatched. As you role up to the scene, it is a middle class neighborhood that seems well kept with no obvious threats to safety noted. You walk into the house and right in the middle of the living room floor is a woman, in her mid-to-late 30s. The patient’s pants are around her ankles and you notice dried blood to her inner thighs, as well as minor active bleeding from the pelvic region. The patient is a GCS of 15, but lethargic; her skin is gray, cool, and moist. The patient states that two days ago, she had a spontaneous abortion, and did no ED/OB follow up. This morning around 0300, she awoke lying in puddle of blood; since then she states that she has passed approx. 3-5 “plum” to “baseball” sized clots, and has soaked at least 4-5 pads. Patient has a BP of 60/30, HR of 48, SpO2 of 96%, and RR of 28/unlabored. Your nearest hospital is 8-10 mins away, but your nearest OB center is 20 mins away. She has NO peripheral access (ACs/EJs/Pedal veins). What do you do?

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