Cardiac Arrest Resuscitation in Pregnancy
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A brief presentation delivered at Conceptos UC Emergency Medicine Conference in Chile, September 2017.
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Cardiac arrest in pregnancy
This document discusses the management of critically ill pregnant patients and cardiac arrest in pregnancy. It recommends placing pregnant patients in the left lateral decubitus position for oxygen delivery and intravenous access above the diaphragm. For cardiac arrest, it advises starting chest compressions supine and considering perimortem cesarean delivery after 4 minutes without signs of recovery. Common causes of maternal arrest include anesthesia complications, bleeding, cardiovascular issues, embolism, infection, and preeclampsia.
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This document discusses resuscitation in pregnancy. It covers the anatomical and physiological changes that occur during pregnancy and how they impact resuscitation efforts. The goals are to understand how to perform basic and advanced life support for pregnant patients. Key modifications for CPR include positioning the patient with left uterine displacement and slightly higher chest compressions. Reversible causes of cardiac arrest in pregnancy such as hemorrhage, embolism, anesthesia complications, and preeclampsia are also reviewed.
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This document provides guidance on maternal resuscitation. It outlines the goals of understanding maternal collapse, learning proper resuscitation techniques, and achieving competence in maternal resuscitation. It describes potential causes of maternal collapse including hypovolaemia, hypoxia, electrolyte imbalances, hypothermia, and thromboembolism. The document then details the steps of the ABCDE approach to maternal resuscitation - assessing responsiveness, opening the airway, checking breathing, performing high-quality chest compressions, providing ventilations, and addressing any reversible causes. It highlights challenges such as difficult intubation and aortocaval compression during CPR in pregnant women, and provides guidance on performing a resuscitative hyster
Maternal resuscitation
This document provides guidance on maternal resuscitation. It outlines the goals of understanding issues related to maternal collapse, learning proper resuscitation techniques, and achieving competence in resuscitation skills. Common causes of maternal collapse include thromboembolism, amniotic fluid embolism, anaphylaxis shock, hypovolemic shock, and heart failure. The guidelines recommend assessing the patient's response and airway, providing chest compressions and rescue breaths if not breathing, and continuing resuscitation efforts until advanced life support arrives. Perimortem cesarean section may be considered after 5 minutes of unsuccessful resuscitation to relieve aortocaval compression.
Anaesthetic management of obstetric emergencies
This document discusses the anesthetic management of obstetric emergencies such as major obstetric hemorrhage and fetal compromise. It covers the challenges in managing obstetric hemorrhage including difficulty in estimating blood loss and early diagnosis of shock due to masking of signs by normal pregnancy physiology. The management approach "ORDER" is outlined which includes organization, resuscitation, defective coagulation, evaluation of response, and remedying the cause of bleeding. General anesthesia techniques for cesarean sections in hemorrhage emphasize rapid sequence induction, cricoid pressure, and hemodynamic support through fluid resuscitation and blood product transfusion to maintain coagulation.
Epidural analgesia for labour
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The document discusses obstetric emergencies including massive obstetric hemorrhage, antepartum hemorrhage from placenta previa or abruption, uterine rupture, and postpartum hemorrhage. It provides definitions, risk factors, diagnostic criteria, management guidelines, and anesthetic considerations for each of these conditions. Prevention and treatment involve careful monitoring, IV access, blood products, oxytocic medications, and timely delivery when indicated to stabilize both mother and fetus.
Bleeding disorders in pregnancy
Prof. M.C.Bansal discusses physiological changes in coagulation during pregnancy that result in a hypercoagulable state and increased risk of venous thrombosis. Several coagulation factors are increased while others like protein S are decreased. Inherited and acquired bleeding disorders may also develop or be exacerbated during pregnancy. Careful screening and management is required for safe delivery.
Recommended
Cardiac arrest in pregnancy
This document discusses the management of critically ill pregnant patients and cardiac arrest in pregnancy. It recommends placing pregnant patients in the left lateral decubitus position for oxygen delivery and intravenous access above the diaphragm. For cardiac arrest, it advises starting chest compressions supine and considering perimortem cesarean delivery after 4 minutes without signs of recovery. Common causes of maternal arrest include anesthesia complications, bleeding, cardiovascular issues, embolism, infection, and preeclampsia.
Resuscitation in pregnancy dr.krushna patel
This document discusses resuscitation in pregnancy. It covers the anatomical and physiological changes that occur during pregnancy and how they impact resuscitation efforts. The goals are to understand how to perform basic and advanced life support for pregnant patients. Key modifications for CPR include positioning the patient with left uterine displacement and slightly higher chest compressions. Reversible causes of cardiac arrest in pregnancy such as hemorrhage, embolism, anesthesia complications, and preeclampsia are also reviewed.
Maternal Resuscitation 2018
This document provides guidance on maternal resuscitation. It outlines the goals of understanding maternal collapse, learning proper resuscitation techniques, and achieving competence in maternal resuscitation. It describes potential causes of maternal collapse including hypovolaemia, hypoxia, electrolyte imbalances, hypothermia, and thromboembolism. The document then details the steps of the ABCDE approach to maternal resuscitation - assessing responsiveness, opening the airway, checking breathing, performing high-quality chest compressions, providing ventilations, and addressing any reversible causes. It highlights challenges such as difficult intubation and aortocaval compression during CPR in pregnant women, and provides guidance on performing a resuscitative hyster
Maternal resuscitation
This document provides guidance on maternal resuscitation. It outlines the goals of understanding issues related to maternal collapse, learning proper resuscitation techniques, and achieving competence in resuscitation skills. Common causes of maternal collapse include thromboembolism, amniotic fluid embolism, anaphylaxis shock, hypovolemic shock, and heart failure. The guidelines recommend assessing the patient's response and airway, providing chest compressions and rescue breaths if not breathing, and continuing resuscitation efforts until advanced life support arrives. Perimortem cesarean section may be considered after 5 minutes of unsuccessful resuscitation to relieve aortocaval compression.
Anaesthetic management of obstetric emergencies
This document discusses the anesthetic management of obstetric emergencies such as major obstetric hemorrhage and fetal compromise. It covers the challenges in managing obstetric hemorrhage including difficulty in estimating blood loss and early diagnosis of shock due to masking of signs by normal pregnancy physiology. The management approach "ORDER" is outlined which includes organization, resuscitation, defective coagulation, evaluation of response, and remedying the cause of bleeding. General anesthesia techniques for cesarean sections in hemorrhage emphasize rapid sequence induction, cricoid pressure, and hemodynamic support through fluid resuscitation and blood product transfusion to maintain coagulation.
Epidural analgesia for labour
dr rajesh burjeel Pregnancy Delivery Pain during labour Epidural analgesia for labour Drugs Complications Epidural information card
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The document discusses obstetric emergencies including massive obstetric hemorrhage, antepartum hemorrhage from placenta previa or abruption, uterine rupture, and postpartum hemorrhage. It provides definitions, risk factors, diagnostic criteria, management guidelines, and anesthetic considerations for each of these conditions. Prevention and treatment involve careful monitoring, IV access, blood products, oxytocic medications, and timely delivery when indicated to stabilize both mother and fetus.
Bleeding disorders in pregnancy
Prof. M.C.Bansal discusses physiological changes in coagulation during pregnancy that result in a hypercoagulable state and increased risk of venous thrombosis. Several coagulation factors are increased while others like protein S are decreased. Inherited and acquired bleeding disorders may also develop or be exacerbated during pregnancy. Careful screening and management is required for safe delivery.
Intrapartum fetal monitoring for undergraduate
The document discusses various factors that can impact the fetus during labor, including uterine contractions, cord accidents, and head compression. It also reviews different methods for intrapartum fetal monitoring, such as cardiotocography (CTG), to detect hypoxia and acidosis in the fetus so timely interventions can be provided. The goal of fetal monitoring is to improve perinatal outcomes by identifying any non-reassuring signs on the CTG tracing and addressing potentially correctable causes to prevent fetal asphyxia and injury.
Intrapartum sonography
Intrapartum sonography can be used to more accurately assess fetal head position, station, descent, and rotation during labor compared to digital examination alone. It also helps predict success of induction of labor and instrumental delivery. The document outlines the basic technique, objectives, and various clinical applications of intrapartum sonography during different stages of labor.
Cpr guideline in pregnacy
This document discusses cardiac arrest in pregnancy. It begins with an introduction and covers the epidemiology, causes, changes in pregnancy, and modifications to resuscitation guidelines. Maternal mortality from cardiac arrest is high in developing countries. Potential causes include cardiac diseases, hemorrhage, amniotic fluid embolism, and pre-eclampsia. Resuscitation techniques require some adjustments for pregnancy such as slightly higher chest compressions and early use of AED. Overall, mastery of basic life support skills and awareness of guidelines is important for survival in cardiac arrest situations involving pregnant women.
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1) Placenta accreta spectrum disorders occur when the placenta invades and is inseparable from the uterine wall, posing risks of heavy bleeding. The incidence has increased 10-fold in recent decades due to rising c-sections.
2) Risk factors include placenta previa, prior c-sections, and other uterine surgeries. Early diagnosis using ultrasound and MRI is important for management planning.
3) Management involves a multidisciplinary approach, with the goal of minimizing blood loss through techniques like arterial embolization and hysterectomy if needed. Conservative management is sometimes attempted but carries risks if failed.
labour dystocia.pptx
The document defines labour and its stages. It summarizes the diagnosis and management of normal labour as well as potential interventions. It also discusses definitions and management of delayed labour, including assessing contractions and cervical change. Risk factors for delayed labour are provided, as well as treatments like hydration, positioning, amniotomy and oxytocin augmentation. Definitions and management of delayed pushing in the second stage are also summarized.
Resuscitation techniques in pregnancy
This document provides an overview of resuscitation techniques that are modified for pregnant patients. It discusses the following key points:
1. Cardiac arrest is rare in pregnancy but can be caused by conditions like sepsis, heart disease, hemorrhage or amniotic fluid embolism.
2. Changes in pregnancy like increased blood volume can lead to hypotension and cardiac arrest if the uterus impinges on blood vessels.
3. Modifications to resuscitation include placing the patient on their left side to relieve pressure, good ventilation, IV fluids, slightly higher chest compressions, early expert intubation, and rapid caesarean delivery if needed.
4. Managing reversible causes, being prepared
Maternal collapse by dr alka mukherjee &; dr apurva mukherjee
Not all maternal deaths are preceded by an identifiable collapse, and not all maternal collapses result in death. Maternal collapse occurs any time during pregnancy, up to 42 days following delivery and is an acute event involving cardiorespiratory systems and/or brain, resulting in impaired consciousness or death.1
Maternal deaths are generally quantified as a maternal mortality ratio (MMR), expressed as the number of maternal deaths per 100,000 women giving birth. It includes deaths that occur due to complications of the pregnancy (direct deaths), and those resulting from worsening of other disease processes due to the pregnancy (indirect deaths). Deaths that occur from causes completely unrelated to pregnancy or birth are termed When faced with an acute maternal collapse, it is helpful to think of potential causes as falling into five categories, or the 5 Hs for simplicity:4
Head including eclampsia, stroke, epilepsy, vasovagal
Heart including myocardial infarction, arrhythmia, cardiomyopathy, thoracic aortic dissection
Hypoxia including pulmonary embolus, pulmonary oedema, anaphylaxis, asthma
Haemorrhage including abruption, uterine atony, genital tract trauma, uterine rupture, uterine inversion, ruptured aortic aneurysm
wHole body and Hazards amniotic fluid embolus, hypoglycaemia, trauma, anaesthetic complications, drug reactions (illicit or prescribed), sepsis
The likelihood of any one of these being causative will obviously depend somewhat on the timing of the collapse – early or late pregnancy, intrapartum, immediately postpartum, remotely postpartum.
Maternal cardiac arrest represents a small subset of women affected by maternal collapse. The incidence is approximately 1 in 30,000 ongoing pregnancies, with a high likelihood of death for both the mother and the fetus. The vast majority of us will never need to attend a maternal cardiac arrest, and doing so is uniquely stressful. For these reasons, it is important to have a framework in mind of how to deal with a maternal cardiac arrest, and to have practised the response to this situation.
incidental deaths, and are not included in calculation of the MMR.
• Several other risk factors for maternal death are recognised. These include:
• Maternal age 35 and older
• Obesity
• Lower socioeconomic status
• Pre-existing mental health issues, substance use and domestic violence, all of which may be exacerbated by pregnancy and the puerperium
• Medical co-morbidities, particularly asthma, autoimmune diseases, inflammatory and atopic disorders, haematological disorders, essential hypertension, infections and musculoskeletal disorders
One of the important developments in improving identification of a pregnant or postnatal patient at risk of collapse during hospital admission has been the development of maternity-specific Early Warning Charts.
Maternal collapse
This the updated maternal collapse guideline 2019 discussed last week in our obs and gyn department teaching session. focusing on definitions timing and diagnosis
Placenta accreta for post graduate
- Decompression of the abdominal compartment by
opening the abdomen and leaving it open with a
temporary abdominal closure device.
- Aggressive fluid resuscitation should be avoided to prevent dilutional coagulopathy and increased intra-abdominal pressures. Early administration of platelets and fresh frozen plasma in a 1:1:1 ratio with packed red blood cells can help achieve hemostasis earlier.
- Cesarean hysterectomy is usually required for placenta accreta, though in select stable cases a conservative approach retaining the placenta may be attempted with strict follow up given high morbidity.
Fetal monitoring for undergraduate
Undergraduate course lectures in PB&GYNE prepared by Dr Manal Behery ,Professor of OB&GYNE .Faculty of medicine ,Zagazig University
Clinical pelvimetry and Forceps Assisted Vaginal Delivery
This document discusses clinical pelvimetry and forceps-assisted vaginal delivery. It begins by outlining the objectives and key anatomical features assessed in a clinical pelvimetry exam. It then discusses the different types of forceps, indications for their use, application techniques, and complications. It emphasizes the importance of training residents on forceps use through lectures, workshops and opportunities to apply different forceps during cesarean deliveries in order to graduate with skills for operative vaginal delivery.
trauma and pregnancy
This document discusses trauma during pregnancy, its types and management. It begins by describing common causes of trauma like motor vehicle accidents, falls, burns and domestic violence. It then discusses complications of trauma during specific periods of pregnancy. Trauma increases risks of abortion, preterm birth, placental abruption and fetal distress. Motor vehicle crashes are a leading cause while falls commonly occur at home. Management involves stabilizing the mother through aggressive resuscitation since fetal outcomes depend on maternal condition. Investigations may be conducted after weighing risks to fetus from radiation exposure.
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This document discusses the history and physiology of labor analgesia. It provides an overview of the controversy around pain relief during labor and outlines both non-pharmacological and pharmacological options. Regional techniques like epidural analgesia are highlighted as the most effective methods with minimal effects on the fetus when used properly. The goals of labor analgesia and factors to consider when selecting drugs and techniques are also summarized.
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CTG.pdf
CTG - Cardiotocography or Non stress test
A nonstress test is a screening test used in pregnancy to assess fetal status by means of the fetal heart rate and its responsiveness.
A cardiotocograph is used to monitor the fetal heart rate and presence or absence of uterine contractions. The test is typically termed "reactive" or "nonreactive".
Intrauterine growth restriction
This document discusses fetal growth disorders including intrauterine growth restriction (IUGR). It defines key terms like SGA, discusses causes and risk factors for IUGR like placental insufficiency. It outlines methods for detecting and monitoring IUGR fetuses including ultrasound measurements and Doppler assessments. It also presents a staging system for managing IUGR pregnancies based on ultrasound and Doppler findings with recommendations for surveillance and timing of delivery.
Labor analgesia
The document discusses the history and current practices of pain management during childbirth. It notes that historically, childbirth pain was seen as divine punishment. Non-pharmacological techniques like acupuncture and hypnosis were used. Queen Victoria popularized using chloroform for pain relief in the 1800s. Now, over 90% of women receive some form of analgesia, mainly neuraxial techniques like epidurals that are considered very safe when administered properly. The document provides details on various analgesic options and their risks and benefits.
Post Partum Hemorrhage (PPH)
Postpartum hemorrhage (PPH) is defined as blood loss greater than 500 mL following vaginal birth or 1000 mL following c-section. It can occur within 24 hours (primary PPH) or 24 hours to 12 weeks (secondary PPH) postpartum and is a leading cause of maternal mortality. The 4 T's of PPH include tonicity (uterine atony), tissue (retained placental fragments), trauma, and thrombin abnormalities. A case is presented of a woman with risk factors of preeclampsia and prolonged labor who develops PPH. Her management involves IV fluids, uterotonics, uterine massage, and monitoring for signs of deterioration requiring additional interventions like embolization
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1) Shock is defined as the inability to maintain homeostasis and tissue perfusion, resulting in cellular respiration failure, local tissue hypoxia, and multi-organ failure.
2) There are four main types of shock - distributive, cardiogenic, hypovolemic, and obstructive.
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The document summarizes a case presentation on acute kidney injury (AKI) given at the ACE Dumaguete Doctors, Inc. Department of Internal Medicine Grand Rounds. It presents the case of a 77-year-old female who presented with hypogastric pain and was found to have mild anemia, leukocytosis, elevated serum creatinine and was diagnosed with chronic kidney disease. Her kidney function deteriorated after she underwent a right hemicolectomy for a colonic mass and she developed sepsis, leading to AKI. The discussion defines AKI, reviews its prevalence in hospital and ICU patients, and categorizes the etiologies of AKI into prerenal, intrinsic renal, and post
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1) Placenta accreta spectrum disorders occur when the placenta invades and is inseparable from the uterine wall, posing risks of heavy bleeding. The incidence has increased 10-fold in recent decades due to rising c-sections.
2) Risk factors include placenta previa, prior c-sections, and other uterine surgeries. Early diagnosis using ultrasound and MRI is important for management planning.
3) Management involves a multidisciplinary approach, with the goal of minimizing blood loss through techniques like arterial embolization and hysterectomy if needed. Conservative management is sometimes attempted but carries risks if failed.
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The document defines labour and its stages. It summarizes the diagnosis and management of normal labour as well as potential interventions. It also discusses definitions and management of delayed labour, including assessing contractions and cervical change. Risk factors for delayed labour are provided, as well as treatments like hydration, positioning, amniotomy and oxytocin augmentation. Definitions and management of delayed pushing in the second stage are also summarized.
Resuscitation techniques in pregnancy
This document provides an overview of resuscitation techniques that are modified for pregnant patients. It discusses the following key points:
1. Cardiac arrest is rare in pregnancy but can be caused by conditions like sepsis, heart disease, hemorrhage or amniotic fluid embolism.
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3. Modifications to resuscitation include placing the patient on their left side to relieve pressure, good ventilation, IV fluids, slightly higher chest compressions, early expert intubation, and rapid caesarean delivery if needed.
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Maternal collapse by dr alka mukherjee &; dr apurva mukherjee
Not all maternal deaths are preceded by an identifiable collapse, and not all maternal collapses result in death. Maternal collapse occurs any time during pregnancy, up to 42 days following delivery and is an acute event involving cardiorespiratory systems and/or brain, resulting in impaired consciousness or death.1
Maternal deaths are generally quantified as a maternal mortality ratio (MMR), expressed as the number of maternal deaths per 100,000 women giving birth. It includes deaths that occur due to complications of the pregnancy (direct deaths), and those resulting from worsening of other disease processes due to the pregnancy (indirect deaths). Deaths that occur from causes completely unrelated to pregnancy or birth are termed When faced with an acute maternal collapse, it is helpful to think of potential causes as falling into five categories, or the 5 Hs for simplicity:4
Head including eclampsia, stroke, epilepsy, vasovagal
Heart including myocardial infarction, arrhythmia, cardiomyopathy, thoracic aortic dissection
Hypoxia including pulmonary embolus, pulmonary oedema, anaphylaxis, asthma
Haemorrhage including abruption, uterine atony, genital tract trauma, uterine rupture, uterine inversion, ruptured aortic aneurysm
wHole body and Hazards amniotic fluid embolus, hypoglycaemia, trauma, anaesthetic complications, drug reactions (illicit or prescribed), sepsis
The likelihood of any one of these being causative will obviously depend somewhat on the timing of the collapse – early or late pregnancy, intrapartum, immediately postpartum, remotely postpartum.
Maternal cardiac arrest represents a small subset of women affected by maternal collapse. The incidence is approximately 1 in 30,000 ongoing pregnancies, with a high likelihood of death for both the mother and the fetus. The vast majority of us will never need to attend a maternal cardiac arrest, and doing so is uniquely stressful. For these reasons, it is important to have a framework in mind of how to deal with a maternal cardiac arrest, and to have practised the response to this situation.
incidental deaths, and are not included in calculation of the MMR.
• Several other risk factors for maternal death are recognised. These include:
• Maternal age 35 and older
• Obesity
• Lower socioeconomic status
• Pre-existing mental health issues, substance use and domestic violence, all of which may be exacerbated by pregnancy and the puerperium
• Medical co-morbidities, particularly asthma, autoimmune diseases, inflammatory and atopic disorders, haematological disorders, essential hypertension, infections and musculoskeletal disorders
One of the important developments in improving identification of a pregnant or postnatal patient at risk of collapse during hospital admission has been the development of maternity-specific Early Warning Charts.
Maternal collapse
This the updated maternal collapse guideline 2019 discussed last week in our obs and gyn department teaching session. focusing on definitions timing and diagnosis
Placenta accreta for post graduate
- Decompression of the abdominal compartment by
opening the abdomen and leaving it open with a
temporary abdominal closure device.
- Aggressive fluid resuscitation should be avoided to prevent dilutional coagulopathy and increased intra-abdominal pressures. Early administration of platelets and fresh frozen plasma in a 1:1:1 ratio with packed red blood cells can help achieve hemostasis earlier.
- Cesarean hysterectomy is usually required for placenta accreta, though in select stable cases a conservative approach retaining the placenta may be attempted with strict follow up given high morbidity.
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This document discusses trauma during pregnancy, its types and management. It begins by describing common causes of trauma like motor vehicle accidents, falls, burns and domestic violence. It then discusses complications of trauma during specific periods of pregnancy. Trauma increases risks of abortion, preterm birth, placental abruption and fetal distress. Motor vehicle crashes are a leading cause while falls commonly occur at home. Management involves stabilizing the mother through aggressive resuscitation since fetal outcomes depend on maternal condition. Investigations may be conducted after weighing risks to fetus from radiation exposure.
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This document discusses the history and physiology of labor analgesia. It provides an overview of the controversy around pain relief during labor and outlines both non-pharmacological and pharmacological options. Regional techniques like epidural analgesia are highlighted as the most effective methods with minimal effects on the fetus when used properly. The goals of labor analgesia and factors to consider when selecting drugs and techniques are also summarized.
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Obstetric emergency which can kill instantly !! - PPH presenting to ED, so what is the role of Emergency Dept ? The most basic presentation of Obstetric emergency and how to tackle it? Being an emergency physician, obstetrics is always challenging! Keep yourself updated with Obstetric emergency.
CTG.pdf
CTG - Cardiotocography or Non stress test
A nonstress test is a screening test used in pregnancy to assess fetal status by means of the fetal heart rate and its responsiveness.
A cardiotocograph is used to monitor the fetal heart rate and presence or absence of uterine contractions. The test is typically termed "reactive" or "nonreactive".
Intrauterine growth restriction
This document discusses fetal growth disorders including intrauterine growth restriction (IUGR). It defines key terms like SGA, discusses causes and risk factors for IUGR like placental insufficiency. It outlines methods for detecting and monitoring IUGR fetuses including ultrasound measurements and Doppler assessments. It also presents a staging system for managing IUGR pregnancies based on ultrasound and Doppler findings with recommendations for surveillance and timing of delivery.
Labor analgesia
The document discusses the history and current practices of pain management during childbirth. It notes that historically, childbirth pain was seen as divine punishment. Non-pharmacological techniques like acupuncture and hypnosis were used. Queen Victoria popularized using chloroform for pain relief in the 1800s. Now, over 90% of women receive some form of analgesia, mainly neuraxial techniques like epidurals that are considered very safe when administered properly. The document provides details on various analgesic options and their risks and benefits.
Post Partum Hemorrhage (PPH)
Postpartum hemorrhage (PPH) is defined as blood loss greater than 500 mL following vaginal birth or 1000 mL following c-section. It can occur within 24 hours (primary PPH) or 24 hours to 12 weeks (secondary PPH) postpartum and is a leading cause of maternal mortality. The 4 T's of PPH include tonicity (uterine atony), tissue (retained placental fragments), trauma, and thrombin abnormalities. A case is presented of a woman with risk factors of preeclampsia and prolonged labor who develops PPH. Her management involves IV fluids, uterotonics, uterine massage, and monitoring for signs of deterioration requiring additional interventions like embolization
Shock in the obstetric patient, bill schnettler md
1) Shock is defined as the inability to maintain homeostasis and tissue perfusion, resulting in cellular respiration failure, local tissue hypoxia, and multi-organ failure.
2) There are four main types of shock - distributive, cardiogenic, hypovolemic, and obstructive.
3) Initial management of shock in obstetric patients includes airway control, IV access, monitoring, fetal monitoring, identifying the cause and type of shock through labs and imaging, and IV fluid boluses. Management is then tailored to the specific type of shock.
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FETAL GROWTH RETARDATION In Modern Practice –Made Simple
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Cardiac Arrest Resuscitation in Pregnancy
- 1. CARDIAC ARREST IN PREGNANCYF E L I P E T E R A N M D D I V I S I O N O F E M E R G E N C Y U L T R A S O U N D & C E N T E R F O R R E S U S C I T A T I O N S C I E N C E D E P A R T M E N T O F E M E R G E N C Y M E D I C I N E U N I V E R S I T Y O F P E N N S Y L V A N I A @FTeranMD
- 4. N O PA L PA B L E P U L S E U N R E S P O N S I V E A P N E I C
- 6. 4:18pm INTUBATION ATTEMPT EPI GIVEN OB GYN CALLED
- 7. 4:21pm ULTRASOUND PERFOMED OB INTERN RECEIVES MESSAGE
- 8. 4:24pm OB INTERN AT THE BEDSIDE TEAM SEARCHING FOR KIT 3RD INTUBATION ATTEMPT ANESTHESIA CALLED
- 9. 4:32pm INTUBATED OB GYN TEAM AND ANESTHESIA ARRIVE
- 10. 4:34pm PERIMORTEM C-SECTION PERFORMED NO NEONATAL RESUS KIT AROUND
- 11. 4:45pm TPA CONSIDERED FOR PE CONTINUES IN REFRACTORY PEA
- 12. 4:50pm TPA GIVEN ETCO REMAINS LOW
- 13. 5:02pm RHYTHM IS NOW ASYSTOLE BABY REMAINS UNRESPONSIVE
- 14. 5:15pm
- 17. CARDIAC ARREST IN PREGNANCY
- 18. 1:12000 ADM DELIVERIES 14 / YEAR (US) CARDIAC ARREST IN PREGNANCY
- 19. RARE, BUT YOU MUST BE READY SURVIVAL 58% WITH PERIMORTEM C SECTION
- 20. US 1986 (KATZ) UK 2014 (CAPS STUDY) RARE, BUT YOU MUST BE READY
- 21. 1. PHYSIOLOGY 2. UNIQUE ASPECTS RESUSCITATION 3. PERIMORTEM C SECTION 4. RESUS TEAM PREPAREDNESS
- 22. 1. PHYSIOLOGY 2. UNIQUE ASPECTS RESUSCITATION 3. PERIMORTEM C SECTION 4. RESUS TEAM PREPAREDNESS
- 26. CARDIAC OUTPUT CARDIAC ARREST DOWNTIME HIGH QUALITY CPR ROSC LOW FLOW (20-30%) NORMAL FLOW NO FLOW
- 27. RESPIRATORY CHANGES FRC DECREASES 10-25% OXYHB CURVE SHIFTS RIGHT VO2 INCRESES
- 28. 1. PHYSIOLOGY 2. UNIQUE ASPECTS RESUSCITATION 3. PERIMORTEM C SECTION 4. RESUS TEAM PREPAREDNESS
- 29. CHEST COMPRESSIONS UNCHANGED HAND POSITIONING MECHANICAL CPR NOT RECOMMENDED
- 30. POSITION SUPINE LEFT UTERINE DISPLACEMENT
- 32. 1. PHYSIOLOGY 2. UNIQUE ASPECTS RESUSCITATION 3. PERIMORTEM C SECTION 4. RESUS TEAM PREPAREDNESS
- 33. LIFE, LIMB & SIGHT SAVING PROCEDURES EMERGENCY MEDICINE THORACOTOMY PERIMORTEM CS SURGICAL AIRWAY CANTHOTOMY
- 34. PERIMORTEM C-SECTION GOAL IS TO RESUSCITATE BOTH PATIENTS RECOMMENDATION: BEGIN AT 4 MIN, DELIVER BY 5 INDICATED > 20 WEEKS
- 35. WHY 20 WEEKS?
- 36. EQUIPMENT
- 39. TECHNIQUE SKIN INCISION CONTINUE CPR SMALL OPENING UTERUS EXTEND UTERINE INCISION
- 40. TECHNIQUE DELIVER BABY CONTINUE CPR DELIVER PLACENTA WAIT OF OB
- 41. THE MOST DIFFICULT PART OF THE PROCEDURE IS THE DECISION TO DO THE PROCEDURE
- 42. UNDER PRESSURE WE DON’T RAISE TO THE OCCASION WE SINK TO OUR LEVEL OF TRAINING Archilocus
- 43. 1. PHYSIOLOGY 2. UNIQUE ASPECTS RESUSCITATION 3. PERIMORTEM C SECTION 4. RESUS TEAM PREPAREDNESS
- 44. MATERNAL CARDIAC ARREST TEAM ADULT RESUSCITATION OBSTETRICS (MD + RN) ANESTHESIA NEONATOLOGY I . E . “ M AT E R N A L C O D E B LU E ”
- 47. HAVE A CHECKLIST
- 48. 2 LIVES ITS OUR DUTY TO BE READY A RARE EVENT