You can see that the haemorrhage is continuing. From what the dad has explained, the baby was delivered without issue and began crying immediately. You tell dad to wrap the baby up, and you attend to the mum. The cord is still intact, what do you do within this situation

You explain you are going to clamp and cut the cord so you can have space to work with mum. On release, you have access to be able to treat, moving dad and baby to one side. You quickly update control for immediate back up. You quickly think through PPH management and ask whether the patient has delivered the placenta yet. The patient reply’s she hasn’t. She also confirms that it is a single baby, no twins. What next action can you look at to stem the haemorrhage

You start conducting fundal massage but also look to what medication you have. If you were to have all available, which of the following would you administer first, given no contra-indications

For the administration of the medication you need some quick observations. Blood pressure is 149/96, heart rate 124, respirations 23, SPo2 94% on air. Given these observations, are you able to Syntometrine

Given the blood pressure is above 140/90, it is advised you give misoprostol. For this situation, what is the dosage required

The patient is alert and has a patent airway. What route do you give the misoprostol

Checking there are no contra-indications, you give the misoprostol sublingually and explain the effects the medication will have on the patient to help stop the bleeding. You explain it can take a bit of time come into effect. What is misoprostol’s average onset of action

You continue your primary survey of the patient, you apply O2 due to the haemorrhage and lowish SPo2, you quickly assess all other aspects, but no other deficits are present. You quickly gain IV access. The bleeding has slowed but continues. The blood pressure is still high, and placenta hasn’t delivered. What medication can you give to help further manage the bleeding

You administer TXA and continue to monitor the patient. The Ambulance crew arrive, and you quickly give a handover. They bring in the stretcher and you get the patient in the back of the ambulance and start transporting to hospital. The bleeding still continues, at what interval can you give a second dose of TXA

In some cases of life threatening PPH, where Paramedics have been trained to do so, can bi-manual uterine compression be used within the pre-hospital environment