maternal collapse due to pe
Post on 08-Apr-2018
221 Views
Preview:
TRANSCRIPT
-
8/7/2019 Maternal collapse due to PE
1/17
PowerPoint
Template
Dr Unnikrishnan PDr Unnikrishnan P
P.G.StudentP.G.Student
Medical College, TrivandrumMedical College, Trivandrum
Maternal CollapseMaternal Collapse
due to Embolismdue to Embolism
-
8/7/2019 Maternal collapse due to PE
2/17
THROMBOEMBOLISMTHROMBOEMBOLISM
AMNIOTIC FLUID EMBOLISMAMNIOTIC FLUID EMBOLISM
VENOUS AIR EMBOLISMVENOUS AIR EMBOLISM
Anaestesiologist is often involved in theAnaestesiologist is often involved in the
resuscitation of patients with embolicresuscitation of patients with embolic
disordersdisorders
IMPORTANT CAUSESIMPORTANT CAUSES
-
8/7/2019 Maternal collapse due to PE
3/17
VENOUS
.
THROMBO EMBOLISM
.
-
8/7/2019 Maternal collapse due to PE
4/17
Deep Vein Thrombosis [DVT] & PulmonaryDeep Vein Thrombosis [DVT] & Pulmonary
Thrombo Embolism [PTE] are the importantThrombo Embolism [PTE] are the important
manifestationsmanifestations
DVT is the most common etiology forDVT is the most common etiology for
Pulmonary Thrombo EmbolismPulmonary Thrombo Embolism
1515--24% of women with untreated DVT24% of women with untreated DVT
experience a pulmonary embolusexperience a pulmonary embolus
PTE accounts for 15% of direct maternalPTE accounts for 15% of direct maternal
mortalitymortality
VENOUS THROMBOEMBOLISMVENOUS THROMBOEMBOLISM
CHESTNTS OBSTETRIC ANESTHESIA, 4/e[2009],p:837,838
-
8/7/2019 Maternal collapse due to PE
5/17
-
8/7/2019 Maternal collapse due to PE
6/17
Venous stasisVenous stasis
Vascular damage: caesarean > vaginalVascular damage: caesarean > vaginal
Obstetric conditions:Obstetric conditions:PIHPIH
Multiple pregnancyMultiple pregnancy
AETIOLOAETIOLO
VIRCHOWS TRIAD : HYPERCOAGULABILITY, STASIS, ENDOTHELIAL INJURY
-
8/7/2019 Maternal collapse due to PE
7/17
Increasing ageIncreasing age
Prolonged immobilizationProlonged immobilization
ObesityObesity
ThrombophiliaThrombophilia
Previous thromboembolismPrevious thromboembolism
Cesarean deliveryCesarean delivery
RISK FACTORSRISK FACTORS
ASRA GUIDELINES [THIRD EDITION];Reg Anesth Pain Med 2010
-
8/7/2019 Maternal collapse due to PE
8/17
PATHOPH SIOLOPATHOPH SIOLO
-
8/7/2019 Maternal collapse due to PE
9/17
PATHOPH SIOLOPATHOPH SIOLO
PaO
P(A-a)O
IMPAIRED GAS EXCHANGE
[DEAD SPACE,SHUNT,HYPOXEMIA,DECREASED DIFFUSION]
V/Q MISMATCH
ALVEOLAR HYPER VENTILATION
AIRWAY RESISTANCE
COMPLIANCE[EDEMA, HEMORRHAGE,LOSS OF SURFACTANT]
ATELECTASIS
-
8/7/2019 Maternal collapse due to PE
10/17
CLINICAL FEATURES: S MPTOMSCLINICAL FEATURES: S MPTOMS
DYSPNOEAPALPITATION
ANXIETY
CHEST PAIN [PLEURITIC]
COUGH
HEMOPTYSIS
SYNCOPE
COLLAPSE
-
8/7/2019 Maternal collapse due to PE
11/17
CLINICAL FEATURES: SI NSCLINICAL FEATURES: SI NS
TACHYPNOEA
CREPITATION
ED BREATH SOUNDS
FEVER
TACHYCARDIA
ACCENTUATED S
JUGULAR VENOUS DISTENSION
LEFT PARASTERNAL HEAVE
HEPATIC ENLARGEMENT
THROMBOPHLEBITIS/ FEATURES OF DVT
-
8/7/2019 Maternal collapse due to PE
12/17
The Wells score clinically suspected DVT - 3.0 points
alternative diagnosis is less likely than PE - 3.0 points
Tachycardia - 1.5 points
immobilization/surgery in previous four weeks - 1.5 points
history ofDVT or PE - 1.5 points
hemoptysis - 1.0 points
malignancy (treatment for within 6 months, palliative) - 1.0 points
Traditional interpretation
Score >6.0 - High
Score 2.0 to 6.0 - Moderate
Score 4 - PE likely. Consider diagnostic imaging.
Score 4 or less - PE unlikely. ConsiderD-dimerto rule out PE.
-
8/7/2019 Maternal collapse due to PE
13/17
ECEC
DIA NOSTIC EVALUATIONDIA NOSTIC EVALUATION
RV STRAIN PATTERN
RIGHT AXIS DEVIATION
P-PULMONALET INVERSION IN V-V
SUPRAVENTRICULAR ARRHYTHMIAS
SQT PATTERN:
DEEP S IN L DEEP Q IN L T INVERSION IN L
-
8/7/2019 Maternal collapse due to PE
14/17
CHEST XCHEST X--RARA
DIA NOSTIC EVALUATIONDIA NOSTIC EVALUATION
BLANCHING / OLIGEMIC AREA
WESTERMARKS SIGN
HAMPTONS HUMP
ELEVATED HEMIDIAPHRAGM
FOCAL INFILTRATES
PLEURAL EFFUSIONATELECTASIS
-
8/7/2019 Maternal collapse due to PE
15/17
HAMPTONS HUMP
-
8/7/2019 Maternal collapse due to PE
16/17
INVASIVE HEMOD NAMIC MONITORININVASIVE HEMOD NAMIC MONITORIN
ARTERIAL BLOOD AS ANAL SISARTERIAL BLOOD AS ANAL SIS
ELISA FOR DELISA FOR D--DIMERDIMER
DIA NOSTIC EVALUATIONDIA NOSTIC EVALUATION
NORMAL TO LOW PULMONARY ARTERY OCCLUSSION
PRESSURE
INCREASED MEAN PULMONARY ARTERY PRESSURE
INCREASED CVP
WIDENED P(A-a)O
REDUCED PaO
REDUCED PaCO
HIGH SENSITIVITY ESPECIALLY WHEN COMBINED WITH A USG
OF LEG
LOW SPECIFICITY, SINCE D-DIMER APPEARS IN NORMAL
PREGNANCY SINCE SECOND TRIMESTER
-
8/7/2019 Maternal collapse due to PE
17/17
VENTILATION PERFUSION SCANVENTILATION PERFUSION SCAN
top related