Overview
The Bedside Sequence: Perfusion Before the Checklist
BUBBLE HE is useful only when it helps the nurse notice deterioration.
BUBBLE-HE is useful only when it helps the nurse notice deterioration. It is not a substitute for looking at the patient first. Begin with appearance, vital signs, pain, respiratory effort, level of consciousness, and the amount of vaginal bleeding. A patient who is pale, dizzy, tachycardic, hypotensive, or increasingly weak may be developing significant blood loss even before the fundal assessment is complete. Call for help, quantify the blood loss, reassess vital signs, and follow the postpartum-haemorrhage protocol while correcting the likely cause. The uterus, bladder, and bleeding must then be interpreted together. A uterus that is soft and displaced laterally is not simply an abnormal fundal measurement. It may be poorly contracted because a full bladder is pushing it out of alignment. A uterus that remains boggy after the bladder is emptied suggests inadequate uterine tone and a higher haemorrhage risk. Document findings with enough detail to show change over time: fundal tone and position, lochia colour and amount, clots, pain, perineal appearance, voiding, mobility, and emotional status. In Canadian practice, the exact assessment schedule and escalation pathway vary...