Undifferentiated post-delivery deterioration

30-year-old woman approximately 45 minutes following a vaginal delivery at home. She has become increasingly unwell since delivery and is now pale, clammy and feeling faint. Baby is reported to be well.

ATMIST

A — 30-year-old woman
T — vaginal delivery approximately 45 minutes ago
M — medical deterioration following recent delivery
I — no trauma identified
S — HR 126, BP 88/52, RR 25, SpO₂ 97% on air, GCS 15, BM 5.8
T — two large-bore IV cannulae inserted; supportive treatment
ETA — 5 minutes

ETA 5 minutes. She is not in the bay. The monitor stays off until she arrives.

Decision 1 of 20

Which approach is most appropriate while awaiting the patient's arrival?

• AActivate the Major Haemorrhage Protocol, obtain emergency blood and prepare the rapid infuser because occult postpartum haemorrhage should be assumed
• BPrepare for immediate ABCDE assessment and resuscitation, request Obstetric attendance, and ensure haemodynamic monitoring, IV treatment and active warming are available
• CRequest Obstetrics, Anaesthetics and ICU and prepare for immediate transfer to theatre
• DPrepare bedside ultrasound before targeted treatment
• EPrepare 500 mL 0.9% sodium chloride and metaraminol before determining the cause of shock