Peripartum Cardiac Arrest
Considerations
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Two patients with efforts focused on maternal resuscitation
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Pregnancy considerations (difficult intubation, aspiration, ↓ time to desaturation, aortocaval compression, 2 patients)
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Need for modified ACLS techniques:
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Supradiaphragmatic IV
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Left uterine displacement
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Chest compressions higher on sternum than usual
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Early intubation
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Prepare for peri-mortem cesarean section; if no ROSC within 4 minutes of resuscitation, aim for delivery within 5 minutes of resuscitation
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Rapid diagnosis & treatment of underlying etiology:
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BEAU-CHOPS, H'sT's, MgSO4 toxicity, local anesthetic toxicity
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Aggressive interventions for difficult resuscitation (cardiopulmonary bypass, hypothermia, internal cardiac massage)
Differential Diagnosis
BEAU-CHOPS + H'sT's:
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B leeding/DIC
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E mbolism: coronary/pulmonary/AFE
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A nesthetic complications (high spinal, aspiration, failed airway, local anesthetic toxicity)
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U terine atony
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C ardiac disease (MI/ischemia/aortic dissection/cardiomyopathy)
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H ypertension/preeclampsia/eclampsia
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O ther: differential diagnosis of standard ACLS guidelines ("H'sT's")
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Hyper-/hypokalemia, hypothermia, hypovolemia, hydrogen ion (acidosis), hypoxia
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Tension pneumothorax, tamponade (cardiac), thrombus (coronary, pulmonary), toxins
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P lacenta abruptio/previa
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S epsis
Gestational Age & Viability
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Fetal viability begins at approximately 24-25 weeks
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Estimate gestational age:
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<20 weeks: urgent cesarean section need not be considered because a gravid uterus of this size is unlikely to significantly compromise cardiac output
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20-23 weeks: consider cesarean section for maternal resuscitation NOT survival of infant
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> 24 weeks: cesarean section within 5 minutes for maternal & fetal resuscitation
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