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Cardiac Arrest Resuscitation in Pregnancy

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Cardiac Arrest Resuscitation in Pregnancy

  1. 1. CARDIAC ARREST IN PREGNANCYF E L I P E T E R A N M D D I V I S I O N O F E M E R G E N C Y U L T R A S O U N D & C E N T E R F O R R E S U S C I T A T I O N S C I E N C E D E P A R T M E N T O F E M E R G E N C Y M E D I C I N E U N I V E R S I T Y O F P E N N S Y L V A N I A @FTeranMD
  2. 2. NO DISCLOSURES
  3. 3. JILLIAN’S STORY
  4. 4. N O PA L PA B L E P U L S E U N R E S P O N S I V E A P N E I C
  5. 5. 4:16pm ACLS BEGINS
  6. 6. 4:18pm INTUBATION ATTEMPT EPI GIVEN OB GYN CALLED
  7. 7. 4:21pm ULTRASOUND PERFOMED OB INTERN RECEIVES MESSAGE
  8. 8. 4:24pm OB INTERN AT THE BEDSIDE TEAM SEARCHING FOR KIT 3RD INTUBATION ATTEMPT ANESTHESIA CALLED
  9. 9. 4:32pm INTUBATED OB GYN TEAM AND ANESTHESIA ARRIVE
  10. 10. 4:34pm PERIMORTEM C-SECTION PERFORMED NO NEONATAL RESUS KIT AROUND
  11. 11. 4:45pm TPA CONSIDERED FOR PE CONTINUES IN REFRACTORY PEA
  12. 12. 4:50pm TPA GIVEN ETCO REMAINS LOW
  13. 13. 5:02pm RHYTHM IS NOW ASYSTOLE BABY REMAINS UNRESPONSIVE
  14. 14. 5:15pm
  15. 15. 5:20pm TIME OF DEATH
  16. 16. CARDIAC ARREST IN PREGNANCY
  17. 17. 1:12000 ADM DELIVERIES 14 / YEAR (US) CARDIAC ARREST IN PREGNANCY
  18. 18. RARE, BUT YOU MUST BE READY SURVIVAL 58% WITH PERIMORTEM C SECTION
  19. 19. US 1986 (KATZ) UK 2014 (CAPS STUDY) RARE, BUT YOU MUST BE READY
  20. 20. 1. PHYSIOLOGY 2. UNIQUE ASPECTS RESUSCITATION 3. PERIMORTEM C SECTION 4. RESUS TEAM PREPAREDNESS
  21. 21. 1. PHYSIOLOGY 2. UNIQUE ASPECTS RESUSCITATION 3. PERIMORTEM C SECTION 4. RESUS TEAM PREPAREDNESS
  22. 22. HEMODYNAMIC CHANGES AFTERLOAD CARDIAC OUTPUT
  23. 23. CARDIAC OUTPUT CARDIAC ARREST DOWNTIME HIGH QUALITY CPR ROSC LOW FLOW (20-30%) NORMAL FLOW NO FLOW
  24. 24. RESPIRATORY CHANGES FRC DECREASES 10-25% OXYHB CURVE SHIFTS RIGHT VO2 INCRESES
  25. 25. 1. PHYSIOLOGY 2. UNIQUE ASPECTS RESUSCITATION 3. PERIMORTEM C SECTION 4. RESUS TEAM PREPAREDNESS
  26. 26. CHEST COMPRESSIONS UNCHANGED HAND POSITIONING MECHANICAL CPR NOT RECOMMENDED
  27. 27. POSITION SUPINE LEFT UTERINE DISPLACEMENT
  28. 28. 1. PHYSIOLOGY 2. UNIQUE ASPECTS RESUSCITATION 3. PERIMORTEM C SECTION 4. RESUS TEAM PREPAREDNESS
  29. 29. LIFE, LIMB & SIGHT SAVING PROCEDURES EMERGENCY MEDICINE THORACOTOMY PERIMORTEM CS SURGICAL AIRWAY CANTHOTOMY
  30. 30. PERIMORTEM C-SECTION GOAL IS TO RESUSCITATE BOTH PATIENTS RECOMMENDATION: BEGIN AT 4 MIN, DELIVER BY 5 INDICATED > 20 WEEKS
  31. 31. WHY 20 WEEKS?
  32. 32. EQUIPMENT
  33. 33. TECHNIQUE SKIN INCISION CONTINUE CPR SMALL OPENING UTERUS EXTEND UTERINE INCISION
  34. 34. TECHNIQUE DELIVER BABY CONTINUE CPR DELIVER PLACENTA WAIT OF OB
  35. 35. THE MOST DIFFICULT PART OF THE PROCEDURE IS THE DECISION TO DO THE PROCEDURE
  36. 36. UNDER PRESSURE WE DON’T RAISE TO THE OCCASION WE SINK TO OUR LEVEL OF TRAINING Archilocus
  37. 37. 1. PHYSIOLOGY 2. UNIQUE ASPECTS RESUSCITATION 3. PERIMORTEM C SECTION 4. RESUS TEAM PREPAREDNESS
  38. 38. MATERNAL CARDIAC ARREST TEAM ADULT RESUSCITATION OBSTETRICS (MD + RN) ANESTHESIA NEONATOLOGY I . E . “ M AT E R N A L C O D E B LU E ”
  39. 39. MULTIDISCIPLINARY SIMULATION
  40. 40. KNOW THE EQUIPMENT
  41. 41. HAVE A CHECKLIST
  42. 42. 2 LIVES ITS OUR DUTY TO BE READY A RARE EVENT
  43. 43. REWRITE JILLIAN’S STORY
  44. 44. @FTeranMD THANK YOU FelipeTeran@gmail.com

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