5.5 CONTINUING TREATMENT

Universal Measures

Continue monitoring the woman's vital signs, urine output, and fluids, as she could suddenly worsen and go into shock. Continue and adjust supportive treatment (oxygen, fluids, medicine) according to the guidelines below, and begin definitive treatment.

Oxygen

If available, continue as long as the patient is unstable. If possible, continue during transfer of unstable patients. As the woman stabilizes, the oxygen can be gradually shut off. However, if she begins to worsen with the oxygen turned down or off, then turn the oxygen back on, at the initial rate of 6 to 8 litres per minute.

Fluids

IV Fluids. If possible, continue during transfer of unstable patients. Once the woman has stabilized and her low fluid volume has been corrected, as indicated by systolic blood pressure of at least 100 mmHg, stabilizing heart rate (under 90), urine output of at least 100 ml per 4 hours, then adjust the rate of the IV fluids to 1 litre in 6-8 hours. See Chapter 7.

Blood transfusion. Blood transfusions may be live-saving, but they carry risk and may do harm rather than good in certain cases. If transfusion is needed, and has not already been started, follow the guidelines in Section 5.3 and in Chapter 7.

Medicines

Antibiotic therapy should already be started for ANY women with an intra-abdominal injury. If not, start antibiotics IMMEDIATELY. If pain control or tetanus toxoid and tetanus antitoxin have NOT been given, reassess the need. Follow treatment guidelines in Section 5.3 and in Chapter 7. If treatment has been started, continue according to the schedules for antibiotics and pain control in Chapter 7.