resuscitation in pregnancy

27 Feb

via a nice recent post at emDocs.  Click through for the whole read, but if you only have 30 seconds to spare…

QUICK PEARLS:

put your IV above the diaphragm (uterus compresses IVC)

 

remove fetal monitoring equipment prior to defib

 

if you need to RSI, etomidate + succinylcholine is safe

  • (Epocrates lists both as pregnancy “C”, though if you need an airway, benefit probably outweighs risk)
  • “Etomidate will cross the placental barrier, but causes less fetal respiratory suppression than other medications, and succinylcholine does not cross the placental membrane.”

 

peri-mortem c-section: by 4 MINUTES INTO CODE

 

IF YOU HAVE ANOTHER 30 SECONDS:

extra-thinking mnemonic for pregnant code: BEAU-CHOPS

B=Bleeding/DIC

E=Emboli: coronary, pulmonary, amniotic fluid

A=Anesthetic Complications (aspiration, local anesthetic toxicity)

U=Uterine Atony

C=Cardiac Disease i.e. cardiomyopathy, aortic dissection

H=Hypertensive disease i.e. preeclampsia-eclampsia

O=Other-think about the Hs and Ts

P=Placental abruption, previa

S=Sepsis

References: emDocs post, peri-mortem c-section refresher; picture

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