maternal resuscitation
TRANSCRIPT
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MATERNAL RESUSCITATION
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GOALS…
1. To understand issues related to maternal collapse
2. To learn how to do proper resuscitation
3. To achieve competence on those skills
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INTRODUCTION Cardiac arrest is fortunately a rare event in
pregnancy.
The most common direct cause of maternal death was thromboembolism, which results in cardiac arrest.
A fast & effective resuscitation will determine the outcome of both mother and fetus
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INTRODUCTION CAUSES OF COLLAPSE
THROMBOEMBOLISMAMNIOTIC FLUID EMBOLISMANAPHYLAXIS SHOCKHYPOVOLEMIC SHOCKHEART FAILURE
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NCORT
National Committee for Resuscitation Training Created by Ministry Of Health Malaysia in 2006
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Created the Guidelines on Resuscitation Training on MOH Hospitals and Health Care Facilities 2011
Based on ILCOR 2010 Suited for local cultural, economic, system differences in
practice and resources, and for ease of training
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HIGHLIGHTS
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CHALLENGES
Difficult intubation in pregnant woman
Increased risk of aspiration
Diaphragmatic splinting in pregnant woman make the ventilation difficult
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Protect self from danger including:1. Wearing PPE; mask apron, and
gloves2. Avoiding spills of body fluid, sharps
and electrical wires at bedside3. Determining unstable beds and
trolleys Protect patient from danger
Bring to safe environment for resuscitation
DANGER
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RESPONSE AROUSE PATIENT – “HELLO HOW ARE
YOU” IF NO RESPONSE, CALL FOR HELP Assessment of conscious level
A- Alert V – Respond to voice P – Respond to pain U – Unresponsive
Can also use Glasgow Coma Scale
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AIRWAY
OPEN AIRWAY HEAD TILT, CHIN LIFT OR JAW THRUST SECURE AIRWAY BY USING ORAL-PHARYNGEAL
AIRWAY OR LARYNGEAL MASK AIRWAY
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BREATHING Assessment of breathing Look for evidence of abnormal breathing or gasping Not more than 10 seconds Not for giving rescue breaths Not for LOOK, LISTEN and FEEL LOOK at chest, neck and face Absence of breathing or presence of abnormal = cardiac
arrest
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IF BREATHING…
IF BREATHING BUT UNCONCIOUS, TURN TO LEFT LATERAL AND GIVE OXYGEN
REGULARLY CHECK BP, PR, FHR
ASSESS AND TREAT CAUSE OF COLLAPSE
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RECOVERY POSITION
Recovery position is applied when victims resume normal breathing but remain unresponsive
Recovery position True lateral position Head in dependent
position Position is stable Position is safe and
comfortable to patient
SALSO 2015
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IF NOT BREATHING…..
Start chest compression in the absence of normal breathing
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CIRCULATION
High Quality chest compression Location:
Lower half of sternum No longer using inter nipple line landmark Heel of hand at center of chest with other hand on top
Keep arms straight and depress sternum, 4-5cm Rate:
At least 100 compression per minute Change the person of delivering compression to avoid getting tired
SALSO 2014
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In supine position while CPR is being carried out, an assistance displaces the uterus to the left side.
Tilt patient to the left with wedge pillow
SALSO 2015
• Perform 15-30 degree left lateral tilt
• Aim: to relieve aorto-caval compression
• Aorto-caval compression reduces the efficacy of chest compression during resuscitation
• Cardiac output improves 30-40%
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COMBINE RESCUE BREATHING WITH A RATIO OF 30 COMPRESSIONS to 2 BREATHS
CONTINUE TILL ADVANCED LIFE SUPPORT ARRIVES
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VENTILATION Ventilate using Bag Valve Mask/ ambubag Each breath given within one second inspiratory time
until a chest rise observed Mouth to mouth in areas without ambubag Use Protective devices for Mouth to mouth ventilation
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ALGORITHM
Adult BLS
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PERI MORTEM CS Is part of resuscitation Performed to try to save the mother Improves Circulation because takes weight of
baby away from vena cava Prepare for this … Carry out if resuscitation has no effect after 5
minutes
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PERI MORTEM CS
Quick!
No need to move to operating theatre
Just need a scalpel – little bleeding
Any incision …….
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QUESTIONS??