Clinical Signs Of Shock Research Articles

Time to first dose of antibiotics in febrile neonates.

To assess whether febrile neonates from the community received their first dose of intravenous antibiotics within 1 h from time of arrival, as per the regional paediatric sepsis pathway, at a tertiary combined adult/child emergency department in New Zealand. Retrospective data were collected from January 2018 to December 2019 with 28 patients included. Mean time to first antibiotic dose for all neonates and those with serious bacterial infection was 3h 20 min and 2h 53 min respectively. No case used the paediatric sepsis pathway. A pathogen was identified in 19/28 (67%) neonates and 16/28 (57%) had clinical signs of shock. This study adds to Australasian data on community neonatal sepsis. Antibiotic administration was delayed for neonates with serious bacterial infection, clinical signs of shock and raised lactate. The reasons for delay are examined, with a number of potential areas for improvement identified.

Pulmonary embolism prevalence in syncope patients brought to the emergency room by ambulance

Aim: Cohort studies have shown that syncope is one in four of the initial symptoms of acute pulmonary embolism. However, one in six patients who visit the emergency room for their first syncopal attack has acute pulmonary embolism. Additionally, the etiological relationship between acute pulmonary embolism and the possible prognostic impact of syncope on the early clinical course of a patient with acute pulmonary embolism remains unclear. Our research sought to detect the presence of pulmonary embolism and its contributing factors in syncope patients who were admitted to the emergency room. Material and Method: The study comprised 215 individuals who had syncope and were transported by ambulance to the emergency department between January 2020 and January 2021. The age bracket for inclusion was 18 to 75, and the presence of solitary syncope, regardless of its cause, was required. Additionally, there had to be no clinical signs of shock or hypotension, and/or absence of right ventricular dysfunction at presentation. Results: A total of 215 patients were included in the study. The mean age was 57 years and 64% of the patients were female. Pulmonary CT angiography was performed in 37 of the patients. Ventilation-perfusion examination was performed on 2 patients. Pulmonary embolism was confirmed in 14 patients, including a lower segment pulmonary embolism. Pulmonary embolism was diagnosed in 7 of 17 patients with no history of active cancer and a previous history of thromboembolism. The prevalence of pulmonary embolism was similar as predicted by the Wells score or Pulmonary Embolism Rule–Out Criteria in patients with low and moderate clinical probability. Conclusion: The results of this study confirm that pulmonary embolism is rarely found in patients admitted to the emergency department with syncope. Althoughpulmonary embolismshould be considered as a differential diagnosis, it does not need to be evaluated in all patients. Otherwise, assessment can lead to false positive results and overtreatment, thereby increasing adverse events and healthcare costs.

Plasma and rhADAMTS13 reduce trauma-induced organ failure by restoring the ADAMTS13-VWF axis

AbstractTrauma-induced organ failure is characterized by endothelial dysfunction. The aim of this study was to investigate the role of von Willebrand factor (VWF) and its cleaving enzyme, ADAMTS13 (a disintegrin and metalloproteinase with thrombospondin type 1 motifs, member 13) in the occurrence of endothelial permeability and organ failure in trauma. In an observational study in a level-1 trauma center, 169 adult trauma patients with clinical signs of shock and/or severe injuries were included. Trauma was associated with low ADAMTS13 and high VWF antigen levels, thus generating an imbalance of ADAMTS13 to VWF. Patients who developed organ failure (23%) had greater ADAMTS13-to-VWF imbalances, persistently lower platelet counts, and elevated levels of high-molecular-weight VWF multimers compared with those without organ failure, suggesting microthrombi formation. To investigate the effect of replenishing low ADAMTS13 levels on endothelial permeability and organ failure using either recombinant human ADAMTS13 (rhADAMTS13) or plasma transfusion, a rat model of trauma-induced shock and transfusion was used. Rats in traumatic hemorrhagic shock were randomized to receive crystalloids, crystalloids supplemented with rhADAMTS13, or plasma transfusion. A 70-kDa fluorescein isothiocyanate–labeled dextran was injected to determine endothelial leakage. Additionally, organs were histologically assessed. Both plasma transfusion and rhADAMTS13 were associated with a reduction in pulmonary endothelial permeability and organ injury when compared with resuscitation with crystalloids, but only rhADAMTS13 resulted in significant improvement of a trauma-induced decline in ADAMTS13 levels. We conclude that rhADAMTS13 and plasma transfusion can reduce organ failure following trauma. These findings implicate the ADAMTS13-VWF axis in the pathogenesis of organ failure.

Prospective evaluation of plasma lactate parameters for prognosticating dogs with shock.

To determine whether admission venous plasma lactate concentration, serially calculated lactate variables, or the Acute Patient Physiologic and Laboratory Evaluation (APPLEfast ) score could discriminate hospital survivors from non-survivors in dogs presenting to the emergency department with clinical signs of shock. Prospective case series performed over a 24-month period. Large urban private teaching hospital. Seventy-one dogs admitted to the ICU with initial peripheral venous plasma lactate concentration>2.5mmol/L and clinical and hemodynamic parameters consistent with shock. None. Heart rate, systolic blood pressure, temperature, initial venous plasma lactate, and APPLEfast score were recorded at admission. Lactate concentrations were serially recorded at predefined time points and used to calculate lactate variables, including lactime (time lactate>2.5mmol/L), lactate clearance ([lactateinitial - lactatedelayed ]/ lactateinitial × 100), and LACAREA (area under the lactate concentration versus time curve). Primary outcome was survival to discharge. Overall survival rate was 61%. Admission plasma lactate did not differ between groups (P=0.28). Lactime was shorter in survivors vs non-survivors (P=0.03). Lactate clearance at hours (h) 1, 4, 10, and 16 was greater in survivors vs non-survivors (P<0.05). Final plasma lactate clearance differed between groups (P<0.05). LACAREA at time intervals 1 to 4hours, 4 to 10hours, 10 to 16hours, and 16 to 24hours was larger in non-survivors vs survivors (P<0.05). Total LACAREA did not differ between groups (P=0.51). Admission APPLEfast was not different between survivors and non-survivors (P=0.16). While neither single APPLEfast nor admission plasma lactate concentration could discriminate between hospital survivors and non-survivors, measures of lactate clearance can prognosticate survival in dogs with shock.

Trends in pediatric traumatic major hemorrhage from a major trauma center.

Injury requiring management of major haemorrhage in paediatric trauma (called 'code red' at our institution) can result in critically injured children with high injury severity scores (ISS) and mortality. The rise in penetrating trauma in younger adolescents has led to an increase in major haemorrhage activations in injured children at this trauma centre. Criteria used to define a paediatric code red, at our institution, is non-compressible haemorrhage, obvious signs of bleeding, clinical signs of shock and/or cardiac arrest at scene.

Radial artery cannulation in intensive care unit patients: Does distance from wrist joint increase catheter durability and functionality?

Radial artery cannulation (RAC) is a common procedure in Intensive Care Units (ICU); radial catheters for ICU patients require increased durability to collect blood samples and to guarantee continuous hemodynamic monitoring. Failure in catheter functionality needs catheter replacement, impacting on staff workload, costs, and patient safety and discomfort. prospective non-randomised cohort study on adult ICU patients describing intensivists and critical care nurses' approach in radial artery catheterization. A sample of 103 radial artery cannulations was observed. Catheterization was performed blind in 71 patients (68.9%) and with ultrasound guidance (USG) in 32 (31.1%); majority of blind inserted RAC were at a distance between 0 and 3.9 cm from wrist joint (77.5%) while catheters inserted from 4 to 10 cm were mainly positioned with USG (84.4%). Radial catheters inserted with USG at a distance of 4 to 10 cm from wrist joint had an in-situ time double than those inserted blind (8.2 ± 7.5 vs 4.8 ± 7.3, p < 0.038). As recommended by current evidence and guidelines, USG represents a valuable support during arterial catheterization and is recommended in adult patients with clinical signs of shock, obese, swelling, and in the paediatric population. RAC in the forearm proximally, at a distance of at least 4 cm from wrist, could increase catheter durability and functionality for ICU patients. USG for cannulation in this forearm area is mandatory because of the deeper course of the radial artery.

Anatomopathological Evaluation of Fecal Peritonitis Complications in Horses Treated with Peritoneal Lavage

Background: Reproductive management in horses when performed with malpractice or by an unqualified person can cause many lesions of various degrees. When the rectum is affected it can compromise the mucous layer of the rectal ampulla and may even cause total perforation of this intestinal segment. Once the rectum ruptured, its contents gets into the abdominal cavity and generates severe abdominal infection, which may cause intense adhesions between organs and even to the abdominal wall and requires a particular intensive intervention. This work reports the use of peritoneal lavage protocol in three horses with septic peritonitis caused by rectal laceration, correlating with post-mortem findings.Cases: Three horses were referred to the Veterinary Hospital Rancho Belo Vista, in the city of Serra - ES, with an accident report during reproductive management in different properties. In all cases, blood loss and loss of continuity of the rectal mucosa were reported by the technicians. Patients were referred at different post-accident times. When they arrived at the hospital, they were examined and a sample of blood and peritoneal fluid were collected and sent to the laboratory. They presented intense apathy, mucosa coloration ranging from hyperemic to pale with halo toxemia, high cardiac and respiratory rate, reduction of globular volume and prolonged time of capillary refill. Patients were given fluid therapy support with lactated Ringer’s solution and systemic therapy protocols such as antibiotic therapy, peritoneal lavage with antibiotic containing solution and anticoagulant, and other supportive treatments were instituted. Peritoneal lavages were instituted every eight hours, in the first 48 hours and every twelve hours, until five days were completed. All patients had to be sacrificed. Euthanasia occurred at different times according to response to treatment and onset of clinical signs of shock. Significant variations were observed among patients at necropsy. The patient submitted to fewer wash cycles had severe adhesions. The other two patients who underwent more wash cycles presented less severe adhesion and less fibrin deposition in the abdominal viscera.Discussion: The use of peritoneal lavage associated with systemic treatment has been shown to be beneficial for the treatment of peritonitis since the initial condition and alteration in the results of laboratory tests. However, the time elapsed between rectal laceration and referral to a specialized technical unit was a decisive factor, together with the severity of the lesion, that were determinant for the increased response and consequent chance of treatment success and chances of survival. Although they received a combination of systemic therapy with broad-spectrum antibiotics and peritoneal lavage associated with daily washing cycles, the patients were euthanized, reiterating the lethality of the disease. At necropsy it was possible to evaluate the extent of contamination and adhesions, as well as to find the lacerated segment, the main source of contamination of the peritoneum. The difference between the degrees of adhesion is evident when compared to the patients who went through more cycles of peritoneal lavage with the ones that went through fewer cycles. Thus, it is possible to estimate that the patients who received a greater number of peritoneal lavage cycles with the drugs used in the same route presented a reduced number of adhesions between similar structures (same organs) and between the organs and the abdominal wall. There is a need for more controlled studies to evaluate the effectiveness of serial peritoneal lavage treatments in horses, as well as the application of drugs that seek to reduce abdominal inflammation, fibrin production and adhesions.

A fatal and metabolic experimental hemorrhagic shock in immature swine.

To use blood lactate (BL) as an end-point metabolic marker for the begin resuscitation of volume replacement in experimental hemorrhagic shock. Group I (n=7) was not bled (Control). Animals in Group II (n=7) were bled to a MAP of 30mmHg in thirty minutes. Hemodynamic and metabolic data were recorded at Baseline, at 30, 60 and 120 minutes after Baseline. The animals were intubated in spontaneous breathing (FIO2=0.21) with halothane. Group I all survived. In Group II all died; no mortality occurred before a BL<10mM/L. Beyond the end-point all animals exhibited severe acidemia, hyperventilation and clinical signs of shock. Without treatment all animals died within 70.43±24.51 min of hypotension shortly after reaching an average level of BL 17.01±3.20mM/L. Swine's breathing room air spontaneously in hemorrhagic shock not treated a blood lactate over 10mM/L results fatal. The predictable outcome of this shock model is expected to produce consistent information based on possible different metabolic and hemodynamic patterns as far as the type of fluid and the timing of resuscitation in near fatal hemorrhagic shock.

Hollow viscus injuries: predictors of outcome and role of diagnostic delay.

IntroductionHollow viscus injuries (HVIs) are uncommon but potentially catastrophic conditions with high mortality and morbidity rates. The aim of this study was to analyze our 16-year experience with patients undergoing surgery for blunt or penetrating bowel trauma to identify prognostic factors with particular attention to the influence of diagnostic delay on outcome.MethodsFrom our multicenter trauma registry, we selected 169 consecutive patients with an HVI, enrolled from 2000 to 2016. Preoperative, intraoperative, and postoperative data were analyzed to assess determinants of mortality, morbidity, and length of stay by univariate and multivariate analysis models.ResultsOverall mortality and morbidity rates were 15.9% and 36.1%, respectively. The mean length of hospital stay was 23±7 days. Morbidity was independently related to an increase of white blood cells (P=0.01), and to delay of treatment >6 hours (P=0.033), while Injury Severity Score (ISS) (P=0.01), presence of shock (P=0.01), and a low diastolic arterial pressure registered at emergency room admission (P=0.02) significantly affected postoperative mortality.ConclusionThere is evidence that patients with clinical signs of shock, low diastolic pressure at admission, and high ISS are at increased risk of postoperative mortality. Leukocytosis and delayed treatment (>6 hours) were independent predictors of postoperative morbidity. More effort should be made to increase the preoperative detection rate of HVI and reduce the delay of treatment.

Nonoperative management of blunt hepatic trauma: A systematic review.

Nonoperative management (NOM) has become the standard treatment in hemodynamically stable patients with blunt hepatic injuries. While the reported overall success rates of NOM are excellent, there is a lack of consensus regarding the risk factors predicting the failure of NOM. The aim of this systematic review was to identify the incidence and prognostic factors for failure of NOM in adult patients with blunt hepatic trauma. Prospective studies reporting prognostic factors for the failure of nonoperative treatment of blunt liver injuries were identified by searching MEDLINE and the Cochrane Central Register of Controlled Trials. We screened 798 titles and abstracts, of which 8 single-center prospective observational studies, reporting 410 patients, were included in the qualitative and quantitative synthesis. No randomized controlled trials were found. The pooled failure rate of NOM was 9.5% (0-24%). Twenty-six prognostic factors predicting the failure of NOM were reported, of which six reached statistical significance in one or more studies: blood pressure (p < 0.05), fluid resuscitation (p = 0.02), blood transfusion (p = 0.003), peritoneal signs (p < 0.0001), Injury Severity Score (ISS) (p = 0.03), and associated intra-abdominal injuries (p < 0.01). There is evidence that patients presenting with clinical signs of shock, a high ISS, associated intra-abdominal injuries, and peritoneal signs are at an increased risk of failure of NOM for the treatment of blunt hepatic injuries. Systematic review, level III.

English

Most of the cases of rupture of uterus occurs in the third trimester of pregnancy or during labour but here we report a thirty five year old women G3, P1+1, LCB 10 years back , mode of delivery by LSCS was admitted in MG ward of Malda medical college, West Bengal, India at 16 weeks of pregnancy with complain of acute abdominal pain, vomiting with clinical sign of shock without vaginal bleeding. Haemoperitoneum and dead fetus outside the uterus was discovered by urgent USG of whole abdomen. Emergency laparotomy was carried out and it revealed haemoperitoneum due to spontaneous rupture of uterine fundus through which fetus and placenta were extruded in peritoneal cavity. Though spontaneous fundal rupture is very rare in early second trimester of pregnancy, it should be taken into consideration in the differential diagnosis of acute abdomen

Maternal Near Miss Review: A Way Forward

Maternal Near Miss Review: A Way Forward

Das Gehirn als Meister des Herzens

We admitted a 42 year old woman with clinical signs of shock, coma, and ecg changes consistent with a ST elevation myocardial infarction to percutaneous coronary intervention. Normal coronary arteries were found. Due to the comatose state a cranial computed tomography scan was performed, where a subarachnoid hemorrhage was detected. We discuss the difficulty of diagnosing a subarachnoid hemorrhage, the pathophysiological cause of cardiac damage and ecg changes in acute neurological disease, and the differential diagnosis of ST elevation in the ecg.

Pneumothorax following ERCP: Report of Two Cases with Different Pathophysiology

In the last thirty years, the widespread use of endoscopic retrograde cholangiopancreatography (ERCP) has radically changed the management of patients with diseases of the extrahepatic biliary tract and pancreas. Pneumothorax is a rare complication of ERCP. We report two cases of pneumothorax following elective ERCP for ductal stone clearance. The first patient was a 45-year-old female, who developed respiratory distress, abdominal pain, and profoundly abdominal distention immediately after the procedure. Imaging studies revealed the presence of a right-side pneumothorax, pneumomediastinum, pneumoperitoneum, and pneumoretroperitoneum. The second patient was a 94-year-old female, who developed tension pneumothorax with clinical signs of shock during the procedure. Imaging studies revealed the presence of a right-side pneumothorax without free air in the mediastinum and retroperitoneal space. The imaging findings suggest that the occurrence of this rare complication in our patients was caused by entirely different pathophysiological mechanisms. Both patients were successfully treated with chest tube insertion, and no further intervention was required. Clinicians should be aware of this serious complication because delayed diagnosis may involve significant morbidity and mortality risks.

Rescue extracorporeal life support as a bridge to reflection in fulminant stress-induced cardiomyopathy

Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly used as rescue therapy in severe cardiogenic shock refractory to medical treatment and intra-aortic balloon pump (IABP). Yet, indications and benefits of VA-ECMO in acute heart failure remain to be fully established. Importantly, it is unclear whether major clinical uncertainties related to potential reversibility of cardiac dysfunction and contraindications for bridging to transplantation justify refusal of VA-ECMO support in an emergency setting. A 45-year-old female presented with clinical signs of shock (RR 70/ 40 mmHg, p 100 beats/ min, T 35.0 °C) and pulmonary edema (SpO2 75%)precededbya suddenonsetof acutedistress andabdominal pain in the hours before presentation. Immediate volume resuscitation and catecholamine administration were followed by the initiation of mechanical ventilation. Her past medical history revealed former cocaine abuse, thrombotic microangiopathy, diabetes mellitus, and poorly regulated hypertension. The latter was complicated by a hypertensive crisis with preserved contractility in the past, retinopathy, left ventricularhypertrophy and chronic hemodialysis for terminal renal failure. Notably, a regular hemodialysis session hours before presentationwas uneventful. The electrocardiogram (ECG) on admission (Fig. 1)

Treating uterine atony with the non-pneumatic anti-shock garment in Egypt

Objective: To determine whether the non-pneumatic anti-shock garment (NASG) reduces maternal morbidity and mortality from uterine atony. Method: Women with uterine atony (blood loss of ≥1000 ml) and one clinical sign of shock were enrolled in a pre-intervention phase (n=169) and an intervention phase (n=269) at two referral facilities in Egypt. Differences in demographics, condition on study entry, treatment, and outcomes were examined. Relative risks and 95% confidence intervals (CI) were estimated for mean measured blood loss, emergency hysterectomy, and extreme adverse outcomes (EAO)—a combination of morbidity and mortality. Results: in the intervention phase, mean measured blood loss was significantly reduced, emergency hysterectomy was significantly decreased, and there were fewer EAOs (11% to 3% in the NASG phase, relative risk=0.28, 95% CI: 0.12–0.63). A subgroup analysis of only women in severe shock demonstrated similar trends. Conclusion: The NASG shows promise for reducing blood loss, emergency hysterectomies, and EAO from obstetric haemorrhage-related shock due to uterine atony.

Assessing the Role of the Non-Pneumatic Anti-Shock Garment in Reducing Mortality from Postpartum Hemorrhage in Nigeria

Background/Aims: Postpartum hemorrhage (PPH) is the leading cause of maternal mortality. The non-pneumatic anti-shock garment (NASG), a first-aid lower-body pressure device, may decrease mortality. Methods: This pre-intervention/NASG study of 288 women was conducted in four referral facilities in Nigeria, 2004–2008. Entry criteria: women with PPH due to uterine atony, retained placenta, ruptured uterus, vaginal or cervical lacerations or placenta accreta with estimated blood loss of ≧750 ml and one clinical sign of shock. Differences in demographics, conditions on study entry, treatment and outcomes were examined. t tests and relative risks with 95% confidence intervals were calculated for primary outcomes – measured blood loss and mortality. Multiple logistic regression analysis was performed to examine independent association of the NASG with mortality. Results: Mean measured blood loss decreased by 80% between phases. Women experienced 350 ml of median blood loss after study entry in the pre-intervention and 50 ml in the NASG phase (p < 0.0001). Mortality decreased from 18% pre-intervention to 6% in the NASG phase (RR = 0.31, 95% CI 0.15–0.64, p = 0.0007). In a multiple logistic regression model, the NASG was associated with reduced mortality (odds ratio 0.30; 95% CI 0.13–0.68, p = 0.004). Conclusion: The NASG shows promise for reducing mortality from PPH in referral facilities in Nigeria.

Clinical Spectrum of Shock in the Pediatric Emergency Department

The objective of this study was to describe the clinical spectrum of patients presenting with shock or developing shock in a pediatric emergency department (ED) during an 8-year period. An observational study of all pediatric ED patients with shock between September 1998 and September 2006 was performed. Trauma activations were excluded. A structured, explicit chart review using a standardized abstraction form and case definition was completed by 3 physicians board certified in pediatric emergency medicine. Interrater reliability was monitored. A total of 147 cases of shock were identified. Septic shock was the underlying physiology in 57% of cases. A pathogen was identified in 45% of these cases. Hypovolemic shock due to gastroenteritis, metabolic disease, surgical emergencies, or hemorrhage was the cause in 24% of cases. Distributive shock represented 14% of cases. Cardiogenic shock contributed to 5% of cases. Patients with septic shock received a mean of 58 mL/kg of crystalloid or colloid versus 50 mL/kg in patients with other causes. Intubation and vasopressor use was required in 41% and 21% of cases, respectively. Clinical signs of shock developed in the ED after initially presenting without clinical signs of shock in 14% of study subjects. Nearly half of these episodes occurred after the administration of antimicrobials or performance of a lumbar puncture. Mortality was 6% overall and 5% in septic shock patients. Pediatric ED patients with shock represent a diverse population with substantial mortality. Of 147 patients, 21 presented without clinical signs of shock and deteriorated to a clinical condition meeting the definition of shock during the ED course.

Can the Non-pneumatic Anti-Shock Garment (NASG) reduce adverse maternal outcomes from postpartum hemorrhage? Evidence from Egypt and Nigeria

BackgroundPostpartum hemorrhage (PPH) is the leading cause of maternal mortality and severe maternal morbidity. The Non-pneumatic Anti-Shock Garment (NASG), a first-aid lower-body compression device, may decrease adverse outcomes from obstetric hemorrhage. This article is the first to report the effect of the NASG for PPH.MethodsThis pre-intervention/NASG study of 854 women was conducted in four referral facilities in Nigeria and two in Egypt between 2004-2008. Entry criteria were women with PPH due to uterine atony, retained placenta, ruptured uterus, vaginal or cervical lacerations or placenta accreta with estimated blood loss of ≥ 750 mL and one clinical sign of shock. Differences in demographics, conditions on study entry, treatment and outcomes were examined. The Wilcoxon rank-sum test and relative risks with 95% confidence intervals were calculated for primary outcomes - measured blood loss, emergency hysterectomy, mortality, morbidity (each individually), and a combined variable, "adverse outcomes", defined as severe morbidity and mortality. A multiple logistic regression model was fitted to test the independent association between the NASG and the combined severe morbidity and mortality outcome.ResultsMeasured blood loss decreased by 50% between phases; women experienced 400 mL of median blood loss after study entry in the pre-intervention and 200 mL in the NASG phase (p < 0.0001). As individual outcomes, mortality decreased from 9% pre-intervention to 3.1% in the NASG phase (RR 0.35, 95% CI 0.19-0.62); severe morbidity decreased from 4.2% to 1%, in the NASG phase (RR 0.24, 95% CI 0.09-0.67). As a combination, "adverse outcomes," decreased from 12.8% to 4.1% in the NASG phase (RR 0.32, 95% CI 0.19-0.53). In a multiple logistic regression model, the NASG was associated with the combined outcome of severe maternal morbidity and mortality (OR 0.42, 95% CI 0.18-0.99).ConclusionIn this non-randomized study, in which bias is inherent, the NASG showed promise for reducing blood loss, emergency hysterectomy, morbidity and mortality associated with PPH in referral facilities in Egypt and Nigeria.

A comparative study of the non-pneumatic anti-shock garment for the treatment of obstetric hemorrhage in Nigeria

Objective To determine whether the non-pneumatic anti-shock garment (NASG) can improve maternal outcome. Methods Women were enrolled in a pre-intervention phase (n = 83) and an intervention phase (n = 86) at a referral facility in Katsina, Nigeria, from November 2006 to November 2007. Entry criteria were obstetric hemorrhage (≥ 750 mL) and a clinical sign of shock (systolic blood pressure < 100 mm Hg or pulse > 100 beats per minute). To determine differences in demographics, condition on study entry, treatment, and outcome, t tests and χ 2 tests were used. Relative risk (RR) and 95% confidence interval (CI) were estimated for the primary outcome, mortality. Results Mean measured blood loss in the intervention phase was 73.5 ±93.9 mL, compared with 340.4 ± 248.2 mL pre-intervention ( P < 0.001). Maternal mortality was lower in the intervention phase than in the pre-intervention phase (7 [8.1%]) vs 21 [25.3%]) (RR 0.32; 95% CI, 0.14–0.72). Conclusion The NASG showed potential for reducing blood loss and maternal mortality caused by obstetric hemorrhage-related shock.