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Gaby’s Green Top Guidelines > 2019 56 Maternal Collapse > Flashcards

2019 56 Maternal Collapse Flashcards

1
Q

What are the physiological & anatomical changes in pregnancy that affect resuscitation?

A
  1. Aortocaval compression, reducing cardiac output from 20/40
  2. Hypoxia, due to changes in lung function, increased O2 use & diaphragmatic splinting
  3. Difficult intubation
  4. Increased risk of aspiration
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2
Q

How should aortocaval compression be relieved for resuscitation?

A
  1. Manual displacement to the left
  2. Left lateral tilt 15-30•
  3. Spinal board before tilting in major trauma
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3
Q

What should remain the same in the life support algorithm?

A

ABCDE approach
Defibrillation energy levels
Drugs & doses

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4
Q

Who should decide when to discontinue resuscitation efforts?

A

Consultant obstetrician
Consultant anaesthetist
With cardiac arrest team consensus

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5
Q

When, where & how should perimortem CS be carried out?

A
  1. In women over 20/40
  2. If no ROSC within 4 mins of correct CPR
  3. Where collapse has occurred
  4. Via midline vertical or suprapubic transverse incision
  5. Scalpel & cord clamps from resus trolley
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6
Q

What is the antidote to magnesium toxicity?

A

10ml 10% calcium gluconate or
10ml 10% calcium chloride
Slow IV injection

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7
Q

What is the antidote to local anaesthetic toxicity?

A

Intralipid 20%
NB report to NHS Improvement & Lipid Rescue site

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8
Q

How should anaphylaxis be treated?

A

1) 1:1000 adrenaline 500 micrograms (0.5ml) IM
2) Repeat after 5 mins if no effect
3) Hydrocortisone 200mg
4) Chlorphenamine 10mg
5) Take mast cell triptase

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9
Q

What are the survival rates for in-hospital maternal cardiac arrest?

A

50%

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10
Q

How should maternal collapse be reported?

A
  1. Clinical incidence form for all collapse
  2. MBRRACE for all deaths
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11
Q

What is the incidence of cardiac arrest in pregnancy?

A

1:36,000

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12
Q

How are the 4Hs affected in pregnancy?

A

Hypovolaemia
Bleeding, spinal, septic or neurogenic
Hypoxia
Breathing, cardiac: cardiomyopathy, MI, aortic dissection, aneurysms
Hypo/hyperkalaemia, hyponatraemia
K no more likely, Na oxytocin use
Hypothermia
No more likely

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13
Q

How are the 4Ts affected in pregnancy?

A

Thromboembolism
AFE, PE, air embolus, MI
Toxicity
Local anaesthetic, Mg, other
Tension pneumothorax
Following trauma/suicide attempt
Tamponade
Following trauma/suicide attempt

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14
Q

What should be added to the 4Hs & 4Ts?

A

Eclampsia
Pre-eclampsia
Intracranial haemorrhage

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15
Q

How does the plasma volume change in pregnancy & impact on resus?

A

⬆️ up to 50%
Dilutional anaemia
Reduced oxygen carrying capacity

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16
Q

How does the heart rate change in pregnancy?

A

⬆️ 15-30 BPM

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17
Q

How does the cardiac output change in pregnancy?

A

⬆️ by 40%
Significantly reduced by pressure of gravid uterus on IVC

18
Q

How much of the cardiac output is directed to the uterus at term?

A

10%

19
Q

How does arterial blood pressure change in pregnancy?

A

⬇️ by 10-15 mmHg

20
Q

How does the oxygen consumption change in pregnancy?

A

⬆️ by 20%

21
Q

How does the residual capacity change in pregnancy?

A

⬇️ by 25%

22
Q

What are the GI changes in pregnancy?

A

⬇️ gastric motility
Relaxed oesophageal sphincter
⬆️ weight

23
Q

What is the incidence of major obstetric haemorrhage?

A

6:1000

24
Q

What are the causes of major obstetric haemorrhage?

A
  1. PPH
  2. Placenta praevia
  3. Placental abruption
  4. Uterine rupture
  5. Ectopic pregnancy
25
Q

What is the incidence of amniotic fluid embolism?

A

1.7 per 100,000

26
Q

How does amniotic fluid embolism present?

A

During or within 30 mins of birth
Acute hypotension
Respiratory distress
Acute hypoxia
May progress to seizures & cardiac arrest

27
Q

How does amniotic fluid embolism progress?

A
  1. Vascular occlusion
  2. Pulmonary hypertension
  3. LV dysfunction or failure
  4. Coagulopathy
  5. Massive PPH
28
Q

What is the major cardiac cause of maternal death?

A
  1. Ischaemia
  2. Sudden arrhythmia with structurally normal heart
29
Q

What are the cardiac causes of maternal death?

A
  1. Ischaemia
  2. Arrhythmia
  3. Aortic root dissection
  4. Congenital & rheumatic heart disease
  5. Cardiomyopathy
  6. Coronary artery dissection
  7. Acute LV failure
  8. Infective endocarditis
  9. Pulmonary oedema
30
Q

What are the most common causative organisms of maternal sepsis?

A
  1. Group A Strep
  2. Group B Strep
  3. Group D Strep
  4. Pneumococcus
  5. E. Coli
31
Q

What are the signs of local anaesthetic toxicity?

A
  1. Feeling inebriated & light-headed
  2. Sedation
  3. Circumoral paraesthesia & twitching
  4. Convulsions
  5. Cardiovascular collapse
  6. Arrhythmia: sinus bradycardia, conduction blocks, asystole, VT
32
Q

How should mast tryptase levels be taken?

A

3 timed samples:
1. ASAP after resus started
2. 1-2 hours after symptom onset
3. 24 hours later

33
Q

What proportion of cardiac output can be provided by chest compressions?

A

30% if not pregnant
10% if pregnant

34
Q

What proportion of circulating volume can be lost before becoming symptomatic?

A

Up to 35%

35
Q

What are the rates for CPR?

A

2 ventilation breaths 10/min
30 chest compressions 100-120/min

36
Q

How often should adrenaline be given in resus algorithm?

A

Every 3-5 mins

37
Q

What are the shockable rhythms?

A

VF
Pulseless VT

38
Q

What are the non-shockable rhythms?

A

Asystole
PEA

39
Q

What are the energy values for defibrillation?

A

200J biphasic
360J monophasic

40
Q

What drugs are considered in the resus algorithm?

A

Amiodarone
Atropine
Magnesium

Gaby’s Green Top Guidelines (16 decks)

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