Seminal papers Flashcards
What is the % of normal cardiac output achieved with CPR in pregnant vs non-pregnant patietnts?
30% non pregnancy
10% in pregnancy
Should we push or pull during manual displacement of the uterus?
Pull - data suggests more effective
What 3 things does PMCS improve in arrest?
- Increases venous return to heart + therefore CO
- Allows better ventilation
- Can allow manual internal cardiac massage with diaphragm still intact against anterior chest wall
What are the targets for PMCS in arrest? (2)
- Within 4 mins or arrest
- Delivery within 5 mins of arrest
Once PMCS completed what drug should be given?
5 units syntocinon IV
If ROSC achieved what is likely to occur and why?
Uterine bleeding ++ as likely atonic uterus secondary to hypoxia
What was the survival rate of mothers undergoing PMCS in the largest case series (90 patients)?
What was the percentage thought to lead to ‘clear neonatal benefit?
- 54%
- 50%
What are the main 2 prognostic factor for survival of baby in PMCS?
- Time to procedure (>15mins looks bleak)
- Maternal survival increases chances significantly
What causes acute traumatic coagulopathy? (3)
- Protein C activation
- Fibrinogen depletion
- Platelet dysfunction
What does protein C do when activated following trauma that contributes towards ATC? (2)
- Reduces thrombin formation
- Increased fibrinolysis
What worsens ATC? (2)
- Acidosis
- Hypothermia
What are the 3 mechanisms by which physiology in haemorrhage is controlled (Littles paper)
- Arterial baroreceptors
- Cardiac c- fibres
- Arterial chemoreceptors
Describes the physiological response to haemorrhage as per Littles papers
Arterial Baroreceptor reflex:- stretch receptors in wall of aortic arch & carotid sinus stimulated less > haemorrhage = increased sympathetic activity HR & SVR
Cardiac C fibres: Located in left ventricle, stimulated by under-filled heart profound vagal bradycardia, fall in SVR & hypotension.
Arterial chemoreceptor reflex: carotid & aortic bodies respond to changes in O2 & C02 = tachycardia
