Module 3 Maternal cardiac arrest and ALS

Question 1

Causes of cardiac arrest - obstetric and anaesthetic during pregnancy and postpartum

Answer 1

Haemorrhage
Pre-eclampsia/Eclampsia
PE
Amniotic fluid embolism
Septicaemia
Total spinal anaesthesia
Local anaesthetic toxicity
Magnesium overdose

Question 2

Correct Hs and Ts

Answer 2

Hypovolemia
Hypoxia
Hypo/Hyperkalemia/metabolic
Hypothermia
Thromboembolism
Toxins
Tamponade - cardiac
Tension pneumothorax

Question 3

Optimum - CPR

Answer 3

Supine
Manual displacement of uterus to left
If on OT table: tilt table to left 30degress.
If not successful after 5mins –> deliver baby. if fully dilated - vaginal instrumental otherwise perimortem c-sec. Improves survival rates mothers and baby.

Question 4

During CPR

Answer 4

• high quality CPR. depth. rate. recoil
• Plan actions prior to interrupting CPR
• Oxygen
• Consider advanced airway and capnography
• Continous chest compressions when advanced airway in place
• IVC or inter-osseous
• Adrenaline:
  
  • Shockable: 1mg IV after 2nd shock (and then every 2nd cycle). Amiodarone 300mg after 3rd shock
  • Non-shockable: 1mg IV immediately (then every 3-5 mins)

Question 5

Drugs for Cardiac arrest

Answer 5

Adrenaline: 1mg IV - if shockable, after 2nd shock and every 2nd shock.
If non-shockable: immediately then Q3-5mins

Question 6

Drugs for VT/VF

Answer 6

300mg amiodarone IV after 3rd shock

Question 7

Drugs for opiate overdose

Answer 7

0.4-0.8mg naloxone IV

Question 8

Magnesium toxicity

Answer 8

1g (10ml of 10% sol) over 5-10mins IV ??calcium

Question 9

Bupivacaine toxicity

Answer 9

1.5ml/kg intralipid 20% IV initially

Question 10

Management of maternal cardiac arrest:

HELP

Answer 10

1) Shout help
2) Hospital emergency number -> “maternal cardiac arrest” + location
3) Request arrest trolley, perimortem c-sec pack, resuscitate
4) Call neonatal team if pregnant
5) Blood bank + haematology urgent bloods

Question 11

Management of maternal cardiac arrest:

POSITIONING

Answer 11

• BED FLAT
• assistant - manual displacement of uterus to left. tilt bed 30 degrees
• move bed to centre room
• take head end off bed.

Question 12

Management of maternal cardiac arrest:

BLS

Answer 12

• open airway
• 30 compressions
• 2 breaths
• rate 30:2

Question 13

Management of maternal cardiac arrest:

EQUIPMENT

Answer 13

• Defibrillator - apply pads. view rhythm. continue compressions
• shock if appropriate. cont compressions
• perimortem delivery pack - open . disposable scalpel or instrumental set. prepare to deliver in 5 mins if unsuccessful.
• turn on resuscitaire

Question 14

Management of maternal cardiac arrest:

Ix

Answer 14

• IVC asap
• FBC, UEC, LFTs, Coags, Cross match, CMP
• Arterial blood gas _ K, Na, Ca, glucose, pH, pa02, paco2

Question 15

Management of maternal cardiac arrest:

ALS

Answer 15

• T/L appointed
• minimal CPR interruptions even during c-sec
• anaesthetist - airway and tubing. capnography
• shocks W2 mins if VF/pulseless VT
• Adrenaline 1mg IV flushed with 20ml water after 2nd shock and every following 2nd shock.

Question 16

Management of maternal cardiac arrest:

DELIVER BABY

Answer 16

• If not successful by 5mins -> quickest delivery means
• CPR continue throughout
• Neonatal team in attendance
• Time keeper

Question 17

Defib pads

Answer 17

right shoulder - red
left shoulder - yellow
left pec/spleen - green

Question 18

VT

Answer 18

broad complex regular tachycardia –> decreased CO –> can cause sudden deterioration to VF

Question 19

Shocking

Answer 19

survival falls 7-10% each min that shock not delivered for shockable pulseless VT or VF
- voltage: 200J

Question 20

Non-shockables

Answer 20

PEA - absence of cardiac output despite cardiac activity (may be normal) - e.g. exsanguination (no circulating blood)
Systole - wandering flat line. ** check leads