You are working on a double-crewed ambulance (DCA) as a paramedic. You are working alongside a newly qualified member of staff who is not clinically trained (ECSW/ECA/UCS) on a night shift out of your local ambulance station which is within the geographical boundaries of England.
You are called at 0100 to a 24-year-old female reporting significant abdominal pain and vaginal bleeding. The message from control is that the patient is distressed, and the call is difficult to manage, however, there are no concerns for the crew’s safety.
On arrival you are met by the patient’s partner and are led to the bathroom. Your patient is over the toilet with a large volume of blood collected in the pan. She is visibly distressed and obtaining information is difficult. The partner explains she believes she is 8/40 gestation with her first pregnancy which was unplanned. She has decided to not progress with the pregnancy and has accessed a telemedicine abortion service to manage this.
She has taken a pill provided by this service two days ago and today took the 2nd dose as prescribed by the service. She took the first dose this evening and has been uncomfortable since with low level abdominal pain that she has been managing with over-the-counter medications. She then took a 2nd dose as prescribed at around 10pm. At midnight there was a large “gush” of PV bleeding associated with severe lower abdominal pain. This has caused significant distress and led to the patient contacting 999.
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What are your first priorities within this case
Utilising an ABCD approach, you discover the following:
A – Clear and patent, no concerns imminently
B – Slightly elevated respiration rate (21rpm) but SpO2 at 99%. No other concerns.
C – Heart rate elevated and blood pressure elevated. 115bpm 140/89mmHg
D – GCS15, Blood sugars 5.9mmol-1, temperature 37.3C
Within the geographical boundaries of England and Wales, it is illegal to access home abortion services. True or False
What would indicate an unsafe abortion
The patient and her partner explain that she believes herself to be 8 weeks gestation. To access abortion care within England and Wales, how must gestational age be determined
Within the UK, to complete the termination of pregnancy, 2 drugs are utilised. What are they
What are the actions of Mifepristone
What are the actions of misoprostol within this scenario
After some reassurance from yourself and your crewmate, the patient’s anxiety begins to ease. Her baseline observations all return towards a normal level. The patient apologises for wasting your time and thinks that she over-reacted to the level of blood and pain she was experiencing. She says she could not remember all the advice given to her by the doctor supervising her care about when to seek further help.
What information would have been given to the patient about when to seek further care
The patient then begins to get herself dressed and clean up. It is now approaching 4am after your arrival. She continues to bleed relatively heavily into her sanitary towel and has changed one since she has gotten dressed.
Which 2 of the following would be the recommended course of action for this patient
Would Tranexamic acid be indicated for this patient
You are unable to access the out of hours provision for the region and therefore convey the patient to hospital for review. She is seen by the obstetric/gynaecology team and discharged later that morning when her symptoms have settled.
There have been multiple concerns raised over a potential increased number of “coercive abortions” that may be occurring following the change in legislation to allow home abortion services. What defines a coercive abortion
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