In postpartum hemorrhage with systolic blood pressure below 90 mmHg, which treatment is indicated per protocol?

• A. Tranexamic Acid 1 g in 100 mL NS over 10 minutes IV/IO
• B. Epinephrine 0.3 mg
• C. Normal saline bolus
• D. Oxygen by non-rebreather

Answer: (A)

The main idea is to rapidly control bleeding in postpartum hemorrhage by addressing the coagulation problem directly. Tranexamic acid works by inhibiting fibrinolysis, helping clots stay stable and reducing ongoing hemorrhage. The protocol calls for giving 1 g IV (or IO) over about 10 minutes, with the possibility of a second 1 g dose if bleeding continues. This is prioritized because it directly targets the mechanism driving the hemorrhage and can improve survival when given early. Oxygen and fluids are important for stabilization, but they do not stop the bleeding; epinephrine isn’t indicated for this situation unless there’s a different trigger like anaphylaxis.