RED CODE

Postpartum hemorrhage: it is defined as blood loss in the first 24 hours.

Loss of more than 500ml of blood after a vaginal delivery
Loss of more than 1000ml of blood after a cesarean delivery.
Symptoms and signs suggestive of hemodynamic instability: (Alteration of the state of
Awareness. Chest pain, dyspnea. Hypotension.
They have a high maternal mortality rate worldwide: both FIGO and WHO in the
attempt to reduce maternal mortality have created schemes, guidelines and one of them is
the red code
Red code is a scheme that allows for coordinated and orderly work.
avoiding the omission and duplication of actions, rain dance syndrome (all
they run without knowing their functions
In postpartum hemorrhage, time is gold; every passing minute increases the risk of.
maternal mortality.
What makes a woman survive or die?
Causes of maternal morbidity and mortality in postpartum hemorrhage, all related to the
time
Delay in fluid administration
2. Delay in blood administration
3. Delay in transportation
TIME PLAYS A VERY IMPORTANT ROLE FOR THAT A TEAM IS NEEDED
ASSISTANCE
1. Coordinator: Location on the right side of the patient or in front of the perineal region,
taken on by the responsible physician of the emergency, their role is to diagnose and treat
the patient, define whether to refer or not quickly
2. Assistant #1: location at the patient's head, can be assigned to another doctor or
to the nursing staff, responsibilities include checking the airway, administering oxygen, monitoring the
state of consciousness, will shelter the patient to avoid hypothermia and take signs
vital
3. Assistant #2: is located on the left side of the patient, assigned to the person who has
greater capacity to channel veins, responsible for ensuring two good accesses
caliber, take laboratory samples and administer liquids and
medications
4. Circulating: notes specific location or function, responsible for facilitating or assisting the
functioning of the most members of the care team.
APPROACH
PHASE OF ASKING FOR HELP
Activate the red code: criteria is evidenced in the physical exam: signs and symptoms of
hypovolemic shock or an estimated blood loss calculation greater than
1000ml
Who activates the red code: any member of the care team who enters.
on first contact with the patient and notify the on-duty doctor.
Act to reserve the units of red blood cells at the laboratory park.
packaged group or RH negative in case there is a need for transfusion, reserve
the medications and liquids will notify the operating room or, if not possible, the unit of
intensive care.
2. RESUSCITATION AND STABILIZATION PHASE
A: Maintain permeable air route
B: Ventilation in case the patient is unblocked can be administered
oxygen by cannula or venturi
C: Circulation raise the patient's upper limbs or position of
put on the non-pneumatic shock suit indicated for patients
with postpartum hemorrhage or signs of hemodynamic instability
It is necessary to secure two good caliber venous accesses with catheter #14 or 16 for
administer intravenous fluids and medications and in case of shock
hypovolemic is severe, as an immediate indication transfuse with two
units of packed red blood cells group O RH NEGATIVE if not available O
Positvo
Continuous monitoring in these patients, extract laboratory samples
(complete blood count, coagulation times, hemoclasification, creatinine, electrolytes and
fibrinogen depending on the level of complexity of the situation
MANAGEMENT OF LIQUIDS AND BLOOD DERIVATIVES IN POSTPARTUM BLEEDING
Management of intravenous crystalloids: first line Ringer's lactate,
Second line normal saline solution is made in boluses of 300 to 500cc.
evaluating hemodynamic response and clinical parameters of shock.
Administer excessive amounts of 2000 cc bolus of lactate
ring or replenish a 3 to 1 ratio can increase hemorrhage and the
mortality due to thrombus delusional leg
The administration of blood derivatives: in case the shock is classified
as severe, administer two units of packed red blood cells
GROUP O NEGATIVE RH IF NOT PUT OR POSITIVE
EXAMPLE FEMALE PATIENT G1 25 YEARS OLD VAGINAL DELIVERY AND STARTS TO BLEED
 1. evaluate whether the patient has clinical manifestations of shock or make a calculation
estimated blood loss more than 1000ml
What are the suggestive signs of shock? If the systolic pressure is less than 90
mmHg, pulse greater than 90 bpm, THE RED CODE IS ACTIVATED IMMEDIATELY.

2. Alert the entire healthcare team and laboratory this at a first level if it is being
at a higher level of complexity, surgery is notified, gynecology specialty,
uci
3. Resuscitation and stabilization phase
You secure the airway, check how the patient is doing; if they are unblocked, you should...
Administer oxygen with a cannula or Venturi if saturation is good; just monitor.
Circulation to have two peripheral venous access with 14 or 16 catheter.
Administer intravenous fluids, Ringer's lactate, 300 to 500 cc.
Evaluate the hemodynamic response and clinical signs of shock, add it.
Mind extracting a sample for study with the aim of finding the cause.
bleeding
4. CLASSIFY THE SEVERITY OF HYPOVOLEMIC SHOCK
SHOCK INDEX: classification of hypovolemic shock
Heart rate divided by systolic pressure
Normal: 0.7-0.9
Mild shock: 1-1.2
Moderate Shock: 1.3 - 1.5
Severe shock: greater than 1.5: 2 units of blood must be transfused.
packaged
5. IDENTIFY THE CAUSE OF THE BLEEDING
Tone: uterine atony 70%
Trauma: injury Birth canal, tear 20%
Tissue: remaining placental tissue, membranes retained clots 10%
coagulopathies 1%

TREATMENT OF UTERINE ATONY

How do I suspect it from a clinical point of view? Abdominal examination palpation at the bottom.
of the uterus, if we see that there is no uterus or it is soft or hypotonic, it suggests atony.
uterine
Uterine massage
Administer uterotonics:
 First line: oxytocin: administer a slow intravenous bolus of 5 units or international units.
while I prepare a mixture of 30 units, that is, three ampoules of 10 units each in
500cc of crystalloids and I administered it over 4 hours
In case of not responding to oxytocin or if methergine is not available
0.2 milligram ampoules, apply one ampoule intramuscularly, it can be repeated.
dose at 20 minutes, then every 4 to 6 hours, maximum 5 ampoules in 24 hours
In case of not responding to oxytocin or methylergometrine or not having their availability,
Using misoprostol comes in 200 microgram tablets, the dose is 800.
micrograms, that is 4 tablets sublingually, in case of being unconscious or lethargic.
it will be rectal
In case of not having or not responding with the three main medications, use acid.
tranexamic: 1 gram is used intravenously, repeat the dose after 30 minutes.
If the patient continues to bleed, what can be done is bimanual compression of the uterus.
with the fist massage the anterior wall of the uterus, and with the other hand at the uterine fundus
Let's apply pressure by massaging the back wall of the uterus with both hands.
we performed a compression of the uterus
Perform a uterine tamponade with a hydrostatic balloon or brachial balloon
Make one with a condom and a soda #18, and I send it as urgent.
Vital
PREVENTION OF POSTPARTUM HEMORRHAGE
ACTIVE MANAGEMENT OF DELIVERY: the expulsion of the placenta increasing the
uterine contractions
The uterotonics: when the baby's anterior shoulder detaches,
administer 10 units of oxytocin, if not apply an ampoule of 0.2 mg via
intramuscular, if not use misoprostol 3 sublingual tablets
Umbilical cord pinching: it is done when it stops pulsating on average of
In the first 3 minutes of life, perform the clamping; clamping is contraindicated.
cord prematurely unless we are talking about a mother having a stop
respiratory or the baby does not breathe or HIV positive.
Controlled traction of the umbilical cord: uterine inversion causes hhp caused
death
Uterine massage: because it is contraindicated in prophylactic patients.
that use uterotonics