1. transfer of patient in SHOCK THE LIFE WRAP NASG GARMENT

SIMPLE LIFE SAVING DEVICE

WHERE TO GET IT ..CALL 09897099333 MR RAKESH

1. TRANSFER OF
PATIENT
WITH PPH
PROF GOMATHY NARAYANAN
PROF NARAYANAN R
PROF SHEELA V MANE
PPH Module

2. When to transfer the patient with
PPH?
From PHC to First Referral unit:
Clinical assessment Class I / Retained placenta /
Traumatic PPH
From Nursing home with OT to Hospital with
HDU & ICU:
Uncontrolled Class II
From Labor room to OT:
Class II / Retained placenta / Traumatic PPH
(Do not wait till Class III & IV)

3. Prerequisites for Transfer
Informed consent
Anti shock Garment (NASG)
Check availability of bed/Doctor in the referral
hospital
Referral documents
Indwelling catheter with Urosac
Vaginal pack in traumatic PPH
Tamponade in atonic PPH
Record presence of Pack/Tamponade – Do not
remove until destination

4. Referral Documents
Antenatal Record with risk factors
Intranatal events:
Delivery notes: Vaginal/Instrumental /
Caesarean section
Time of delivery of Baby/Placenta
Episiotomy/Vaginal laceration/Cervical tear
Investigation results
Sequence of events
Medication administered with time & dose
Fluids administered
Condition on Transfer

5. On transfer
Nasal Oxygen on flow
Two IV lines (#16/18) with fluid on flow
Nurse or Doctor & Patient’s able attendant
to accompany

6. Non-Pneumatic Anti Shock Garment
(NASG)

7. NASG (Life Wrap)
It applies pressure on the legs & abdomen
Blood returns to vital organs curbing internal
bleed
Stabilizes BP until patient reaches appropriate
hospital
Easy to apply
Application time takes < 60 seconds in trained
hands

8. How does NASG work?
It is a First Aid
Controls bleeding through direct pressure
Auto transfusion of blood in upward
direction
Ball in abdominal segment applies focused
pressure to uterus
Circumferential pressure on lower half of
the body reduces the total vascular space
Vital organs get increased blood supply &
oxygenation
Stabilization of patient during transport

9. How does NASG work?

10. About NASG
NASG is light weight (1500 G)
Compression suit made of Neoprene
Six segments enclosing ankle, calves, thigh,
pelvis & abdomen
Velcro fastenings to keep garment tight
A small foam ball in the abdominal segment
applies pressure on the uterus
Markings on the sections show how to apply

11. About NASG
Correct tight application supplies 20 to 40 mm
Hg of circumferential pressure to lower body
effectively reversing hypovolemic shock
Can be easily packed back into carry bag

12. NASG (Life wrap)

13. Applying NASG
Step 1:
Place NASG under the woman with the top at
the level of lowest rib
Close segment 1 tightly around ankle on both
sides
Snap it until you hear a sharp sound
Step 2:
Close segment 2 around calf muscle
Leave the knee joint free

14. Applying NASG
Step 3:
Apply segment 3 around the thighs
Step 4:
Apply segment 4 all around the woman with
the lower edge at the level of pubic bone

15. Applying NASG
Step 5:
Place segment 5 with pressure ball directly
over umbilicus
Close the NSAG using segment 6
Only one person should close segment 4 &
5
Should not be too tight to
restrict breathing

16. Applying NASG
Step 6:
Ensure patient is breathing normally after the
application
In case of uterine atony administer uterotonics
& massage the uterus without removing the
NASG
NASG is flexible enough to allow the
massaging

17. Vaginal Procedures with NASG in
situ
Pelvic examination
Lithotomy position
Repair of episiotomy /
Perineal tear / Vaginal
laceration / Cervical tear
MRP
Bimanual compression
D&C / D&E / MVA

18. Surgery with NASG in situ
Laparotomy (Keep segments 1,2&3 in situ and
open pelvic & abdominal segments 4,5&6 just
prior to incision)
Steep Trendelenberg position
Operate quickly
Replace segment 4, 5 & 6 after procedure

19. Special situations
Obese women
Short stature
Need for defecation
Replacing soiled NASG

20. Questions to ask the patient
Are you comfortable?
Any breathing difficulty?
Is it hot inside NASG?
Do you feel itchy?

21. When to remove NASG?
Patient must be stable for 2 hours
Bleeding <50 ml/hr
Pulse <100 BPM
Systolic BP 90-100 mm Hg
Hb >7G%
Patient conscious & aware

22. How to remove NASG?
Remove segment 1 & wait for 15 mts
Check pulse & BP
If pulse rate increases >20 BPM or BP falls by
20 mm Hg: Reapply segment 1
If vitals stable remove segment 2
Follow same principles till removal of segment
6

23. Do not remove NASG before all
vital signs are restored
Early removal of NASG can be
dangerous or even fatal

24. Caution
If BP falls by 20 mm Hg or Pulse increases by
20 BPM after removal of any segment, rapidly
replace all segments
Consider need for crystalloids / Blood
If recurrent bleeding, determine source and
arrest

25. Storing NASG
Clean NASG with running water & disinfectant
and dry
Keep folded NASG in a clear plastic bag
Store NASG in a place where it is visible &
accessible
Always store at the same place
Ensure every one knows place of storage
Storage place should be displayed prominently
The referral center must send a replacement
NASG after receiving the patient

26. Relative contraindications
Cardiac failure
Pre existing Mitral stenosis / Pulmonary edema
Advanced pregnancy with live fetus (APH)
Abdominal evisceration
Open pelvic fracture

27. Principles to be observed
One person alone can apply NASG
Two persons needed when patient is
unconscious
Urine output should be measured
Ensure airway protection & Prevent aspiration
Ensure one on one nursing care

28. Advantages of NASG
50-78% Reduction in blood loss
50-55% Reduction in Maternal Mortality &
related Morbidity
WHO includes NASG in recommendations
Cost effective
Reusable

29. World Scenario 2013
Used in 16 Countries
UK & USA
Remote Rural areas
Jehova’s witness
Zambia &
Zimbabwe
Peri urban
centers
Tamil Nadu
All levels
Ambulance
#108