View Full Version : If you *REALLY* need some oxytocin and don't have it...
This one is a Q) for the docs - or I guess anyone that can answer... Yes, if possible call in ALS and get some. I'm talking about if they are too far away, or can't be contacted quickly. Even if you scoop and run, the girl usually doesn't make it if you're a ways out. Soooo.... given this senario and assuming "watch her die" is an unexceptable outcome, what could you do about this situation?
T. - I assume that you are using oxytocin for postpartum hemorrhage, but please specify so that we can address this.
exactly! - postpartum hemorrhage, the uncontrollable (w/ pressure or bandages) type...
Well, this may not sound to appetizing but the placenta is loaded with oxytocin, that is one reason that animals scarf up the placenta after they deliver. But, most post partum hemorrhage is caused by retained placenta, so you may not have one. I don't know if cooking it would deactivate the oxytocin. Proabably most women would rather bleed to death than eat the thing raw. Actually, massaging the uterus vigorously is usually fairly effective.
Sorry,
Jag
I actually ran into that situation in the early 70's when I was an EMT in Iowa. There are two thing to do, and both hurt like hell.
#1. Isolate the Uterus, it will feel like a big softball, Press your hand down on the abd at the fundus, keep pushing in until you feel the posterior side of the fundus. With your free hand, press down hard on the anterior area of the fundus and massage vigorously with the heel of the palm of your hand.
That usually works, but the mother will be screeming very loud.
If it doesn't work.
#2. Using a steril kling or Kirlex, pack the Uterus tightly and repeat stept one.
Hard to control Vag Bleeding is a true emergency, so scoop and swoop. Big bore IVs, Legs up, mast trousers, O2 ....anything and everything you got.
Also the alternative to Pitocin is Methergine IM or IV, or Hemabate IM(this can be injected directly into the Uterus if needed)
Well what do you think?
later
DA
Sorry, as you can tell I'm new to the board. I went ahead and answered before reading the next post by Resqdoc. Please forgive me.
thanks
DA
Oral oxytocin is inactivated by stomach acid. Most things animals do associated with birth have sound a rational to them - so perhaps some does get through, if you eat enough. A doc I worked with from the Soloman islands (third world - only occasional oxytocin) said pressure always worked - eventually - provided the placenta was out. He was talking bimanual pressure - a fist wrapped in gauze in the vagina and fundal pressure - got the uterine relaxation + cervical and vaginal lacerations. Unpleasent but potentially life saving. I would suggest packing the uterus in a survival situation is asking for serious infection.
Craig
I kind of wondered about the deactivation by the stomach acids but like so many other drugs if you give enough, some gets through. Still, all in all, it sounds pretty disgusting. I am sure there are some other reasons that animals eat the placenta as well.
Jag
Iron - the other reason.
Merry christmas - it already is here in NZ
In a survival situation infection is a secondary consideration. Having someone bleed out in front of you is the primary consideration. Remember the ABC's. One of the previous posters suggest nipple stimulation, which is actually natural way of using the bodys own system. I think I would still pack the uterus if the other methods failed, after all we are talking about clean/sterile gauze, not bed sheets.
Hope you all have a Merry Christmas and Happy new year. We just got a young women in who wants to be induced on Christmas day. I wonder what she's going to name her child?
catch ya later
DA
Pregnancy in pre-hospital days cared a very high mortality. I think in the mid 1800's mortality was around 40%.
JAG
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