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Resuscitation techniques in pregnancy

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First series for Resuscitation in difficult situations.

First series for Resuscitation in difficult situations.

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    • 1. RESUSCITATION TECHNIQUES IN PREGNANCY BYANUGOM EMEKA M B B C H , D I P. P H , A D V. D I P. O C C M E D , I G C N E B O S H
    • 2. WELCOME & INTRODUCTIONS Logistics Emergency exits Restrooms 2
    • 3. AGENDA Introduction Epidemiology Causes of Cardiac Arrest in Pregnancy Changes in Pregnancy Modifications To Resuscitation in Pregnancy Conclusion References Q&A 3
    • 4. INTRODUCTION Various difficult situations may arise that lead to cardiac arrest. The skill of bystanders is paramount for outcome of survival.[1] Resuscitation will need to be modified in these situations depending on their peculiarities and reversible causes. Early recognition and proper management of Airway Breathing Circulation Disability and Exposure (ABCDE) is very important for survival.[2] Image: http://www.sundaymercury.net/news/midlands -news/2011/01/16/poor-maternity-care-blamed-for-deaths-of-21- west-midlands-babies-66331-27993368/ 4
    • 5. INTRODUCTION This presentation is a review based on 2010 Guidelines by American Heart Association and European Resuscitation Council. Prior Knowledge of current BLS/ACLS guidelines or resuscitation is assumed. I m a g e : h t t p : // www. t h e b a b yp l a n n e r s . c o . u k/ b i r t h i n g - c h o i c e s - p r i va t e - h o s p i t a l s 5
    • 6. EPIDEMIOLOGY Maternal mortality is rare in developed nations, with a prevalence of 1:30,000 maternities and a maternal mortality rate of 13.95 deaths per 100,000maternities in developing nations.[3,4,5] Image: http:// www.byregi on.net/c gibin/us ers /profiles.pl?s ubdomai n=bebebirth 6
    • 7. CAUSES OF CARDIAC ARREST IN PREGNANCY The following can lead to cardiopulmonary collapse in pregnancy: Sepsis Cardiac disease Haemorrhage, Amniotic fluid embolism Ectopic pregnancy Pre-eclampsia and Eclampsia etc.[2,3,4] Image 2: http://www.sc ribd.com/doc /45492814/Resus citation -of-the- Pregnant -Pati ent 7
    • 8. CHANGES IN PREGNANCY There are increases in: - cardiac output - blood volume and - oxygen consumption, However with increase in uterine size up to 20weeks gestational age, impinging on iliac and abdominal vessels this leads to - hypotension and - cardiac arrest.[3,4] Image 1: http://www.quantummetta.co.uk/?p=tab&s=courses&f=cpd Image 2: http://www.ebmedicine.net/topics.php?paction=showTopicSeg&topic_id=21&seg_id=345 8
    • 9. MODIFICATIONS TO RESUSCITATION IN PREGNANCY In cardiopulmonary arrest certain modifications are made to the BLS/ACLS guidelines for the pregnant woman.[2,3,4,5] Image 1: http://www.sciencedirect.com/science/article/pii/S096880800627229X Image 2: http://www.dailymail.co.uk/health/article -2034160/Do-resuscitate-Theyre-fateful-words- 9 meaning-doctors-wont-try-save-you-collapse-hospital.html
    • 10. MODIFICATIONS TO RESUSCITATION IN PREGNANCY 1. Ask for expert help immediately - To rule out and treat cause or - Decide on caesarean section if required.[3,4,5] 2. Put in left lateral position at 15 to 30 degrees either on the rescuer’s knee or using a wedgeor Displace the uterus manually and gently left laterally while lying supine(This enables better chest compression than when inthe left lateral tilt position)to relieve obstruction on the iliac and abdominalvessels .[3,4,5] Image 1 & 2: Stephen Morris,Mark Stacey ABC of Resuscitation:Resuscitation in pregnancy;BMJ 2003;327,1278 10
    • 11. MODIFICATIONS TO RESUSCITATION IN PREGNANCY 3. - Good ventilation with bag valve mask and high flow oxygen, - Suctioning to keep the airway clear.[3,4,5] 4. IV Fluid bolus to correct: - hypotension or - hypovolaemia,while monitoring the oxygen saturation.[3,4,5] Image 1: http://www.scienceandsensibility.org/?tag=midwife Image 2: http://drhem.com/2012/04/02/intern -report-5-20/ 11
    • 12. MODIFICATIONS TO RESUSCITATION IN PREGNANCY 5. Chest compressions are done slightly higher on the sternum as abdominal contents and diaphragm are elevated.Use of AED if indicated is still under reviewbut is not discouraged if required.[3,4,5] I m a g e 1 : h t t p : / / www. s c i e n c e d i r e c t .c o m / sc i e n c e / a r t i c l e / p i i / S 0 3 0 0 9 5 7 2 1 2 0 0 2 9 8 5 12
    • 13. MODIFICATIONS TO RESUSCITATION IN PREGNANCY 6. Endotracheal intubation should be: - Done early and - By an expertBecause the upper airway narrows in third trimesterand so it gets more difficult to intubate, - Apply cricoid pressure to avoid aspiration that has a higher risk of occurrence in pregnant women due to gastro-esophageal sphincter insufficiency.[3,4] I m a g e : h t t p : // www. s c i e n c e d i r e c t . co m/ s ci e n c e / a r t i c l e /p i i / S 0 3 0 0 9 5 7 2 11 0 0 0 8 3 9 13
    • 14. MODIFICATIONS TO RESUSCITATION IN PREGNANCY 7. Manage all reversible causes as they present. If non-responsive to resuscitation  Plan emergency caesarean section - within 4minutes of determining the cardiac arrest and - delivery of fetus within 5minutes of initiating resuscitation.  Therapeutic hypothermia may also be used for comatose patients as indicated for regular non- pregnant patients.[3,4,] Image 1: http://www.sciencedirect.com/science/article/pii/S0300957211000839 Image 2: http://circ.ahajournals.org/content/102/suppl_1/I -229.full 14
    • 15. CONCLUSION Difficult situations may arise or lead to need for resuscitation. Modifications and consideration of reversible factors, including importance of making early decisions to- initiate resuscitation- invite expert and- manage the patient accordingly is paramount to survival in these situations. Image: http://www.alsg.org/en/files/MOET_Ch3_CPR.pdf 15
    • 16. CONCLUSION Mastery and awareness of the basic techniques and guidelines for BLS/ACLS by everyone is crucial to success in resuscitation in theses situations. Get Trained to save lives. Image: http://healthyhous tonkids .com/2011/07/how -to-choos e -bes t - infant-cpr-class -for/ 16
    • 17. REFERENCES 1. J.R Casal Codesido, y M.J. Vazquez Lima, 2007; Out-of Hospital Cardiopulmonary Resuscitation: Where are We now? Emergencias 2007;19:295-297. 2. Australian Resuscitation Council; New Zealand Resuscitation Council, 2011; Guideline 11.10 Resuscitation in Special Circumstances: 1-14 3. Jasmeet Soar et al,2010, European Resuscitation Council Guidelines for 2010 Section 8. Cardiac arrest in special circumstances: Electrolyte abnormalities, poisoning, drowning, accidental hypothermia, hyperthermia, asthma,anaphylaxis, cardiac surgery, trauma, pregnancy, electrocution; Elsevier Ireland Ltd, Resuscitation 81(2010)1400-1433, doi:10.1016/j.resuscitation.2010.08.015 4. Terry L. Vanden Hoek et al, 2010, Cardiac Arrest in Special Situations: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care; Circulation.2010:122:S829-S861; doi:10.1161/CIRCULATIONAHA.110.971069; Online ISSN:1524-4539 5. OGCCU, 2010, 11.1 Resuscitation in Late Pregnancy, Section B, Clinical Guidelines. King Edward Memorial Hospital Perth Western Australia. DPMS Ref: 5334 17
    • 18. . I m a g e : h t t p : / / h a n d s o n b l o g . o r g / 2 0 11 / 0 1 / 2 6 / e i g h t - t i p s - f o r - w r i t i n g - t h e - p e r f e c t - t h a n k - 18 you-note/
    • 19. QUESTIONS I m a g e : h t t p : / / w w w. o p e n b k a u t o l o a n s . c o m / w p - c o n t e n t / u p l o a d s / 2 0 1 2 / 0 4 / q u e s t i o n - 19 and-answers-bad-credit-car-financing.jpg