Module 2. BLS + Maternal collapse Flashcards
(6 cards)
Causes of maternal collapse
Head - eclampsia, epilepsy, CVA
Heart - MI. Arrhythmia. CHD. Peripartum cardiomyopathy. Dissection of thoracic aorta
Hypoxia - PE. Pulmonary oedema. Anaphylaxis.
Haemorrhage - Abruption. Perineal trauma. Uterine atony. Uterine inversion. Ruptured thoracic aortic aneurysm. DIC?
Whole body hazards - hypoglycaemia. Septicaemia. Amniotic fluid embolus. Trauma. Complications of anaesthesia
Primary obstetric survey
Head - AVPU. Seizing?
Heart - Cap refill. HR + rhythm. Murmur?
Chest - AE b/l? BS. Trachea - central?
Aldo - Acute? tender (uterine/non-uterine) fetus alive? need for laparotomy or delivery?
Vagina - Bleeding? Stage of labour? inverted uterus?
Secondary obstetric survey
History: revisit events + PMHx . collateral
Examine: rpt primary head to toe
Investigate: as prev
Monitor:
Pause and think further: consider further Ix e.g. CT/MRI scans and ECHO. Liase w experts
DIC
Occurs: secondary to massive bleeding, severe infection, Amniotic fluid embolism or anaphylaxis
Patho: excessive consumption plus, clotting factors resulting in prolonged clotting time, low plus and low fibrinogen and haemorrhage.
Spontaneous blessing - IVC, Epidural sites, vaginal, gums
Ix: FBC, cross-matching, clotting, fibrinogen, d-dimers
CONSULT HAEMATOLOGY
Amniotic fluid emobolism
Amniotic fluid enters maternal system –> cardiac arrest often.
Often conscious at Sx onset - acute. shivering, sweating, anxiety, coughing then resp distress + CVS collapse (hypotension, tachycardia and possible arrhythmias). DIC can then occur –> massive maternal haemorrhage.
Rx: supportive - resp and CVS + correct clotting abnormalities.
HAEMATOLOGY consult
Air embolism
Occurs following ruptured uterus, during IVC admin, blood products under pressure, placental manipulation at c-sec.
Sx: chest pain + collapse.
Auscultation: waterwheel murmur over precordium
