chapter 12 pt5

Question 1

what is maternal cardiac arrest ?

Answer 1

cardiac arrest which occurs in any stage of pregnancy and 6 weeks after pregnancy

Question 2

maternal cardia arrest caused by?

Answer 2

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

Question 3

management of cardiac arrest in pregnancy?

Answer 3

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

Question 4

causes for hemorrhage in pregnancy?

Answer 4

placental abruption

placenta previa

uterine rupture

abnormal placental insertion - placenta accrete and increta

Question 5

management of haemorrhage in pregnancy ?

Answer 5

rapid fluid resus

tranexemic acid

oxytocin , ergometrine , uterine massage

uterine compression sutures and uterine packs and intra uterine balloon

interventional radiology

Question 6

drug overdose in pregnancy ?

Answer 6

cause - magnesium sulphate for eclampsia - give calcium to treate magnesium toxicity

central neural blockade -nsympathetic block - hypotension and bradycardia

Question 7

atypical features of pregnant women having ischemic heart disease ?

Answer 7

epigastric pain and vomiting

Question 8

refectory arrest of others management ?

Answer 8

delivery of fetes
if fetes 24- 25 weeks gestation - delivery within 5 min

Question 9

at which gestational age is viability the fetes ?

Answer 9

24 weeks

Question 10

post resus care in maternity ?

Answer 10

targeted temp management

Question 11

which type of cardioresp arrest has the best NEUROLOGICAL outcome ?

Answer 11

traumatic

Question 12

what is commotio cordis ?

Answer 12

actua or near cardiac arrest caused by blunt object being impacted to the chest wall over the heart.

Question 13

management of traumatic cardio resp arrest ?

Answer 13

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

Question 14

survival of traumatic cardiac arrest depends on ?

Answer 14

duration of CPR
duration in pre hospital setting
presence of reactive pupils
resp activity
organised ECG rhythm

Question 15

in what cases are chest compression not as effective ?

Answer 15

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

Question 16

treatment for patients with uncontrollable infra-diaphragmatic torso haemorrhage

Answer 16

immediate aortic occlusion - resuscitative thoracotomy and cross clamping of the aota or use of an intravascular occlusion device

Question 17

clinical features of neurogenic shock ?

Answer 17

warm , vasodilator peripheries , loss f reflex below the injured segment , hypotension with low heart rate

Question 18

during cpr what is the percentage of oxygen needed ?

Answer 18

100 percent

PERI ARRST 94 PERCENT AND ABOVE

Question 19

cause and treatment of cardiac tamponade ?

Answer 19

penetrating trauma or cardiac surgery

immediate decompression of the pericardium

needle aspiration tamponade with or without US is unreliable as pericardium full of clots

Question 20

management of penetrating trauma to the chest or epigastrium

Answer 20

immediate resuscitative thoracotomy - clam shell incision - opening of the pericardium

usually 15 mins has not elapsed since vital signs was lost

Question 21

candidates of immediate resus thoracotomy ?

Answer 21

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

Question 22

causes of tension pneumothorax ?

Answer 22

trauma , asthma , clinical procedure such as central venous catheter

traumatic cardiac arrest people 13 percent of them have tension pneumothorax

Question 23

diagnosis of tension pneumothorax ?

Answer 23

clinical - resp depression or hypoxia
absent breath sounds on auscultation
subcut emphysema
tracheal deviation
jugular venous distention

or point of care US