1. OBSTETRICS RED ALERT DRILL
DR LEE OI WAH
PENGARAH HOSPITAL CHANGKAT
MELINTANG

2. CASE SCENARIO
Patient History
 Patient is a 32 year old G1P0 female with no prenatal care
who presents in labor. She is crowning and ready for delivery.
 Patient History, continued
 PMH: Asthma
 PSH: None
 Meds: MDI Salbutamol 2 puffs BID prn
 Allergy : bee stings
 SHx: married; husband is rushing from work.
 FHx: none
 ROS: labor started about 2 hours ago. Water broke 45
minutes ago; clear liquor

3. CASE SCENARIO
Physical examination
 Cardiac: tachycardic otherwise normal
 Lungs: clear bilaterally
 BP : 90/60 mm Hg
 PR : 100/min
 RR: 20/min
 Sat: 98%
Labs:
 CBC : Hct 35% Platelets 235; WBC 8.2
 PT/PTT 9.5/126 seconds

4. CASE SCENARIO
 The patient will present with the fetal head crowning;
she will be wanted to push. The baby was delivered OA
without complications. By ward Sister. Immediately after
the placenta is removed, blood come from the vaginal
opening. On palpation, the uterus was soft. It remain so
despite medications. The blood pressure drop from the
initial readings over the next 10 minutes to 70/40.
Oxytocics will not cause uterine contraction.
 When Hemabate was given, the patient complain of
shortness of breath and her sats drop to 80%. When
the lungs are auscultated, ronchi will be evident.
 Rise in blood pressure will depend on replacement of
volume. If large bore IVs are placed rapidly and put on
pressure bags, the pressure will initially improve to
80/45 but will slowly (over five minutes) decrease back
to the 70ʼs.

5. RED ALERT DRILL
 Time : 9.15 am – 9.55 am
 Observers : Dr Lee Oi Wah
Sr Asmahan
Sr Latipah
Sr Zulina
 Evaluation : modified Kaiser form

6. RED ALERT DRILL
 Role of 1˚ MO or 1st call MO
 Recognizes the need to activate the RED ALERT protocol
and ensures its immediate activation
 Updates nursing team and the team leader of
i) blood products needed.
ii) current situation of patient
iii) need for referral
 Obtains transfusion consent (if needed)
 Cancels the red alert protocol as indicated

7. RED ALERT DRILL
 Role of Staff Nurse I/C or team leaders
 Assesses the patient, source of bleeding, color, amount
 Cont. monitor VS
 Stays with the patient at all times
 Performs all nursing interventions
 Call MO using SBAR format
 Initiates the obstetrics red alert protocol per MO order
 Ensures IV access patent
 Ensures collection of a Blood Bank specimen and other
laboratory investigation.
 Explains all procedures to patient
 Arranges transportation to referral hospital
 Ensures cancellation of the protocol, as directed per policy and
prompt return of unused blood products to the Blood Bank

8. RED ALERT DRILL
 Role of Hospital Operator
 Ensures immediate activation by informing 1st and 2nd call
MO, MLT on call and PPP I/C casualty.
 Inform Sister IC or Sister on call (after office hour)
 Cancels the red alert protocol as indicated

9. RED ALERT DRILL
 Role of MLT on call
 Report to labour room immediately.
 Accept blood specimen from Staff Nurse IC.
 Process sample in laboratory including cross-matching.
 Send result of investigations to labour room.
 Bring blood products to labour room and release it at the
labour room.
 Documentation of release procedure in book.
 When protocol is cleared/cancelled: complete paperwork and
update patient’s computer record
 Restores unused blood products in the computer and the
refrigerator

10. RED ALERT DRILL
 Role of PPP IC casualty
 To arrange for driver and ambulance to stand-by.
 To ensure equipment and oxygen supply in ambulance
adequate.
 To assist in the resuscitation and stabilization of patient.

11. RED ALERT DRILL
 Role of 2nd call MO
 To assist in the resuscitation and stabilization of patient.
 To assist in the transportation of patient to referral hospital.