Week 5- cardiac arrest during pregnancy

Question 1

What are the physiological changes that occur to airways during pregnanacy?

Answer 1

More likley to be difficult to manage
Enlarging pelvic cavity causes upward displacment of thoracic structures
Swollon tissues to upper airway
Increased breast tissue- difficult larynx visilisation
higher airway pressures
Priorotise ETT

Question 2

What are the physiological changes to the renal system during pregnanacy?

Answer 2

Increased kidney size
dilation of renal pelvis and ureters
Increased blood flow 60-75%
increased glomerular fitration 50%
increased renal plasma flow 50-80%
increased clearance most substances
decreased plasma creatinine, urea and urate

Question 3

how many pregnancies does trauma comlicate?

Answer 3

5% of pregnancies

Question 4

what is most commonly the cause of trauma in pregnancy?

Answer 4

Domestic violence/murder
MVA
Falls

Question 5

what percentage of traumatic injuries that are minor lead to foetal losses?

Answer 5

60-70% foetal losses due to minor trauma

Question 6

what are the potential complications due to trauma?

Answer 6

placental abruption
cardiorespiritory arrest
labour and birth
preterm labour
spontaneous abortion
uterine rupture
pelvic fractures
heamorrage and shock 
premature birth weight

Question 7

How long can it take for a placental abruption occur after tauma?

Answer 7

Up to 3-4 days after the incident

Question 8

is it normal to have vaginal bleeding post trauma in pregnancy?

Answer 8

Any vaginal bleeding is a red flag post trauma

Question 9

What is the managment for trauma in pregnancy?

Answer 9

DRABCDE
eft lateral tilt
Oxygen
Early consult with PIPER/Midwife
2 large bore IVs
transport to major trauma centre

Question 10

what is the golden rule in pregnancy for trauma?

Answer 10

Resus of the mother facilitates resus of foetus

Question 11

where should pts be transported if they are pregnanant and sustain trauma?

Answer 11

ideally Royal melbouren

if >45min then hopsital both with trauma and obstetric facilities

Question 12

what are some of the causes of maternal cardiac arrest?

Answer 12

BEAUCHOPS
bleeding/DIC
Embolisim- cardiac/pulomary/amniotc fluid
Anaethsia complications
Uterine atony
cardiac disease
Hypertension/pre-eclampsia/eclampsia
other- Hs/Ts
Placental abruption
Sepsis

Question 13

what are the ANZCOR recommendations?

Answer 13

• no randomised controll trial
• insufficent evidence to support or refute specalised techniques
  -although concern for vability- focus on mother to optomise foetal outcome
  -

Question 14

what are the additional factors that ANZCOR reccoments for pregnant cardiac arrests?

Answer 14

• get help early
• manage cardiac arrest as you would a normal one
  Manually displace uterus to the lest- angle with left lateral tilt
  consider prep for emergency c-section

Question 15

what is the golden rule regarding ROSC in a cardiac arrest pregnant paitnet?

Answer 15

window to achive ROSC is <4 mins untill c section preformed

if on road- load and go and perform CPR enroute

Question 16

what are the difference in considering Airway, breathing and circulation in a pregnant cardiac arrest?

Answer 16

Airway- difficult- need ETT if avaliable use LMA untill MICA

Breathing talor ventialtion to provide effective oxygenation

Circulation- higher compression site due to anatomical changes

Question 17

what are the most common causes of death during pregnancy?

Answer 17

cardiovascular, amniotic fluid embolism, spesis, suicide

Question 18

what are the 4 hs and 4 ts for cardiac arrest?

Answer 18

hypoxia, hypothermia, hyperkalemia, hypovoleia

tension pneumothroax, toxins, throbosis, tamponade

Question 19

what age group of people are more likley to die in associateion with childbirth?

Answer 19

under 20 and over 35- more commonly under 20