chapter 12 pt5 Flashcards
what is maternal cardiac arrest ?
cardiac arrest which occurs in any stage of pregnancy and 6 weeks after pregnancy
maternal cardia arrest caused by?
many cardiovascular problems caused by compression of inferior vena cava and aorta by a gravid uterus esp after 20 weeks gestation
cardiac disease congenital and acquired
embolism
amniotic - usually in time of delivery
pulmonary
epilepsy = eclampsia and stroke
sepsis
bleeding
malignancy
management of cardiac arrest in pregnancy?
place pt in leal position , or manually displace the uteri to the left
high flow oxygen
seek expert obstetric, aesthetic and neonatal specialist
due to potential IVC compression IV and IO access should be above the diaphragm
add lateral tilt of 15-30 degrees if possible when doing cupric not possible maintain left uterine displacement
prepare emergency c section
increased risk of pulmonary aspiration of gastric content - early intubation is key
look for 4h and 4 T, abdominal US
causes for hemorrhage in pregnancy?
placental abruption
placenta previa
uterine rupture
abnormal placental insertion - placenta accrete and increta
management of haemorrhage in pregnancy ?
rapid fluid resus
tranexemic acid
oxytocin , ergometrine , uterine massage
uterine compression sutures and uterine packs and intra uterine balloon
interventional radiology
drug overdose in pregnancy ?
cause - magnesium sulphate for eclampsia - give calcium to treate magnesium toxicity
central neural blockade -nsympathetic block - hypotension and bradycardia
atypical features of pregnant women having ischemic heart disease ?
epigastric pain and vomiting
refectory arrest of others management ?
delivery of fetes
if fetes 24- 25 weeks gestation - delivery within 5 min
at which gestational age is viability the fetes ?
24 weeks
post resus care in maternity ?
targeted temp management
which type of cardioresp arrest has the best NEUROLOGICAL outcome ?
traumatic
what is commotio cordis ?
actua or near cardiac arrest caused by blunt object being impacted to the chest wall over the heart.
management of traumatic cardio resp arrest ?
permissive hypotension - fluid resuscitation only to feel a radial pulse until surgical hemostaisi may be achieved
duration of hypotensive resus should not exceed more than 60
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non compressible hemorrhage :
Tranexemic acid - loading 1g IV over 10 mins followed by 1g ver 8h
do not delay it maximum by more than 4 hours after the trauma
use splints
blood products ,iv fluids
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focussed ultrasound - for hemoperitoneum , hemopneumothorax , cardiac tamoinade etc
survival of traumatic cardiac arrest depends on ?
duration of CPR
duration in pre hospital setting
presence of reactive pupils
resp activity
organised ECG rhythm
in what cases are chest compression not as effective ?
hypotension , cardia tamponade and tension pneumothorax - chest compression in these situations have a lower priority than correction of reversible causes - such as thoracotomy , consoling hemorrhage etc
treatment for patients with uncontrollable infra-diaphragmatic torso haemorrhage
immediate aortic occlusion - resuscitative thoracotomy and cross clamping of the aota or use of an intravascular occlusion device
clinical features of neurogenic shock ?
warm , vasodilator peripheries , loss f reflex below the injured segment , hypotension with low heart rate
during cpr what is the percentage of oxygen needed ?
100 percent
PERI ARRST 94 PERCENT AND ABOVE
cause and treatment of cardiac tamponade ?
penetrating trauma or cardiac surgery
immediate decompression of the pericardium
needle aspiration tamponade with or without US is unreliable as pericardium full of clots
management of penetrating trauma to the chest or epigastrium
immediate resuscitative thoracotomy - clam shell incision - opening of the pericardium
usually 15 mins has not elapsed since vital signs was lost
candidates of immediate resus thoracotomy ?
pt with no pulse after penetrating chest or cardiac injuries arrive at hospital in short period of time with witnessed signs of life or ECG
causes of tension pneumothorax ?
trauma , asthma , clinical procedure such as central venous catheter
traumatic cardiac arrest people 13 percent of them have tension pneumothorax
diagnosis of tension pneumothorax ?
clinical - resp depression or hypoxia
absent breath sounds on auscultation
subcut emphysema
tracheal deviation
jugular venous distention
or point of care US
