Relieving Aortocaval Compression in Pregnancy
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Questions and Answers

What is the reason behind pregnant women being able to tolerate blood loss remarkably well?

  • Pre-existing level 4 maternal anaemia
  • Decreased cardiac output
  • Hyperdynamic circulation (correct)
  • Increased clotting efficiency

Why might maternal tachycardia be the only sign of hypovolaemia in pregnant women experiencing significant blood loss?

  • Concealed bleeding
  • Hyperdynamic circulation (correct)
  • High clotting efficiency
  • Low cardiac output

How does pre-existing level 4 maternal anaemia impact the tolerance to blood loss in pregnant women?

  • Enhances cardiac output
  • Affects blood loss tolerance negatively (correct)
  • Improves clotting efficiency
  • Decreases the risk of hypovolaemia

Why is intervention often delayed in cases of concealed bleeding during pregnancy?

<p>Underestimation of blood loss (A)</p> Signup and view all the answers

What is the optimal initial management recommended for maternal collapse according to guidelines?

<p>Use the standard ABCDE approach with some modifications (C)</p> Signup and view all the answers

Why should maternal collapse resuscitation include relief of aortocaval compression?

<p>To account for maternal physiology (A)</p> Signup and view all the answers

What is the recommended action in cases of cardiac arrest in pregnant women over 20 weeks of gestation?

<p>Displace the uterus to the left to relieve aorto-caval compression (D)</p> Signup and view all the answers

Why are adaptations made to the resuscitation process from 20 weeks of gestation onwards?

<p>Changes in maternal physiology require adjustments for resuscitation (C)</p> Signup and view all the answers

Why is manual displacement of the uterus to the left recommended in pregnant women experiencing aorto-caval compression?

<p>To allow effective chest compressions during cardiac arrest (A)</p> Signup and view all the answers

Why have authors modified the Resuscitation Council (UK) algorithm for advanced life support?

<p>Due to constraints in algorithmic and poster availability (C)</p> Signup and view all the answers

At what gestational age should an emergency call be made for obstetric, obstetric anaesthetic, and neonatal resuscitation teams according to the text?

<p>&gt; 20 weeks (B)</p> Signup and view all the answers

What permits effective chest compressions in the supine position during aorto-caval compression relief?

<p>Displacement of the uterus to the left (D)</p> Signup and view all the answers

In pregnant women above 20 weeks' gestation, what is the recommended method to relieve aortocaval compression?

<p>Manual displacement of the uterus to the left (D)</p> Signup and view all the answers

What action should be taken if there is no peripheral venous access in pregnant women experiencing major trauma?

<p>Consider intraosseous access or venous cutdown (D)</p> Signup and view all the answers

What is the recommended angle for the left lateral tilt of a pregnant woman to relieve aortocaval compression?

<p>15–30o (C)</p> Signup and view all the answers

When should intubation be performed in an unconscious pregnant woman with a cuffed endotracheal tube?

<p>Immediate intubation before any other intervention (A)</p> Signup and view all the answers

What is the primary intervention if the airway is clear but there is no breathing in a pregnant woman?

<p>Commencement of chest compressions (D)</p> Signup and view all the answers

What should be used for chest compressions in a pregnant woman who requires them?

<p>Left lateral tilt (C)</p> Signup and view all the answers

What is recommended for women with acute coronary insufficiency?

<p>Thrombolysis (A)</p> Signup and view all the answers

What allows accurate diagnosis and definitive therapy in cardiac disease management?

<p>Percutaneous angioplasty (D)</p> Signup and view all the answers

How should septic shock be managed according to the Surviving Sepsis Campaign guidelines?

<p>In accordance with the guidelines (D)</p> Signup and view all the answers

What influences the outcome of severe sepsis according to the text?

<p>Speed and appropriateness of therapy in the initial hours (B)</p> Signup and view all the answers

Which medical professionals are mentioned as being part of the multidisciplinary team approach required for managing cardiac disease?

<p>Midwives, intensivists, anaesthetists (B)</p> Signup and view all the answers

What should be exercised during the perioperative period when administering thrombolysis to women with acute coronary insufficiency?

<p>Caution (C)</p> Signup and view all the answers

What is the focus of the publication by Kundra et al. in Anaesthesia 2007?

<p>Manual displacement of the uterus during Caesarean section (C)</p> Signup and view all the answers

What is the topic of the publication by Jeejeebhoy and Morrison in Emerg Med Int 2013?

<p>Maternal cardiac arrest (D)</p> Signup and view all the answers

According to Neumar et al. in Circulation 2015, what do the American Heart Association Guidelines focus on in special situations?

<p>Cardiac arrest management in pregnancy (C)</p> Signup and view all the answers

In the context of obstetrics, what does the publication by Mhyre and Healy in Aneth Analg 2011 discuss?

<p>Unanticipated difficult intubation (D)</p> Signup and view all the answers

According to Kim et al. in Resuscitation 2013, what was the focus of their study on chest compressions?

<p>Maternal cardiac arrest (A)</p> Signup and view all the answers

What is the subject of the publication by Watkinson et al. in Anaesthesia 2006?

<p>Continuous electronic physiological monitoring (A)</p> Signup and view all the answers

Which study introduced a modified early warning score for earlier detection of critical illness on a general surgical ward?

<p>Jacques et al. in Resuscitation 2006 (D)</p> Signup and view all the answers

Which publication compared antecedents to cardiac arrests, deaths, and emergency intensive care admissions in different countries?

<p>Kause et al. in Resuscitation 2004 (B)</p> Signup and view all the answers

Which team introduced the concept of the medical emergency team in their publication?

<p>Lee et al. (C)</p> Signup and view all the answers

Which publication proposed an early warning scoring system for detecting developing critical illness?

<p>Watkinson et al. in Anaesthesia 2006 (C)</p> Signup and view all the answers

Which study evaluated the effect of modified early warning scores for detecting critical illness?

<p>Stenhouse et al. in Br J Anaesth 2000 (A)</p> Signup and view all the answers

How should fluid resuscitation be guided in critically ill patients according to the text?

<p>By considering steroids after adequate fluid resuscitation (D)</p> Signup and view all the answers

What is the preferred method to determine fluid status in critically ill patients?

<p>Transoesophageal Doppler (C)</p> Signup and view all the answers

In obstetric practice, which drug antidote is recommended for magnesium toxicity?

<p>10 ml 10% calcium gluconate (A)</p> Signup and view all the answers

What should be considered if a pregnant woman's hemoglobin level is less than 70 g/l?

<p>Immediate transfusion (A)</p> Signup and view all the answers

If a critically ill patient is unresponsive to adequate fluid resuscitation and vasopressor therapy, what additional treatment may be considered?

<p>Considering steroids (B)</p> Signup and view all the answers

What is the recommended oxygen saturation level for critically ill patients?

<p>More than 94% (D)</p> Signup and view all the answers

What is the purpose of the MERIT study mentioned in the text?

<p>Introducing the medical emergency team system in hospitals (B)</p> Signup and view all the answers

What is the focus of the National Early Warning Score (NEWS) 2 mentioned in the text?

<p>Standardizing the assessment of acute-illness severity (D)</p> Signup and view all the answers

In which publication does Gopalan PD and Muckhart DJ discuss critically ill obstetric patients?

<p>Int J Obstet Anesth 2004 (D)</p> Signup and view all the answers

What is the main objective of the National Institute of Health and Care Excellence Clinical Guideline No. 50?

<p>Recognition of and response to acute illness in adults in hospital (A)</p> Signup and view all the answers

What is the key outcome associated with the ASSIST screening tool mentioned in the text?

<p>Identifying at-risk patients on general medical wards (B)</p> Signup and view all the answers

What is the main focus of the Royal College of Physicians' NEWS 2 report mentioned in the text?

<p>Standardizing the assessment of acute-illness severity in NHS hospitals (C)</p> Signup and view all the answers

Why is it important to use an obstetric modified early warning score chart for all women undergoing observation?

<p>To allow early identification of women at risk of impending collapse (A)</p> Signup and view all the answers

What contributes to the increased risk of aspiration in pregnant women during resuscitation?

<p>Heightened diaphragmatic splinting (C)</p> Signup and view all the answers

Which factor significantly reduces cardiac output from 20 weeks of gestation onwards?

<p>Aortocaval compression (A)</p> Signup and view all the answers

What makes ventilation more challenging in pregnant women during resuscitation?

<p>Decreased lung function (A)</p> Signup and view all the answers

In cases of collapse assumed to be due to anaphylaxis, which diagnostic measure can be helpful according to the text?

<p>High mast cell tryptase levels (B)</p> Signup and view all the answers

Why are pregnant women at an increased risk of becoming hypoxic more readily?

<p>Increased oxygen consumption (B)</p> Signup and view all the answers

What is the recommended antidote for magnesium toxicity?

<p>Calcium gluconate (A)</p> Signup and view all the answers

What is the recommended dose of adrenaline for treating anaphylaxis according to the text?

<p>1:1000 adrenaline 250 micrograms (0.5 ml) intramuscularly (B)</p> Signup and view all the answers

Who should be included in the team during cases of maternal collapse according to the text?

<p>Senior Midwife, Obstetrician, Obstetric Anaesthetist (C)</p> Signup and view all the answers

In cases of collapse secondary to local anesthetic toxicity, what treatment should be used?

<p>Lipid rescue (A)</p> Signup and view all the answers

What is crucial in all cases of maternal collapse according to the text?

<p>Incident documentation (B)</p> Signup and view all the answers

What is the optimal management for septic shock?

<p>Following Surviving Sepsis Campaign guidelines (C)</p> Signup and view all the answers

What type of training is recommended for maternity staff according to the text?

<p>Annual multidisciplinary CPR training (B)</p> Signup and view all the answers

What is the primary focus of managing amniotic fluid embolism?

<p>Supportive care (A)</p> Signup and view all the answers

What is the antidote for local anaesthetic toxicity?

<p>Intralipid 20% (C)</p> Signup and view all the answers

When should the neonatal team be called during a maternal collapse event?

<p>If delivery is likely after 22+0 weeks of gestation (C)</p> Signup and view all the answers

What should be done to all cases of maternal collapse according to the text?

<p>Reviewed through clinical governance process (D)</p> Signup and view all the answers

Why might caesarean section be indicated in cases of massive placental abruption?

<p>To deliver the baby promptly (A)</p> Signup and view all the answers

When should perimortem caesarean section (PMCS) be considered in the management of maternal collapse?

<p>If there is no response to correctly performed CPR within 4 minutes of maternal collapse (A)</p> Signup and view all the answers

What should be the angle for the left lateral tilt of a pregnant woman to relieve aortocaval compression?

<p>15-30 degrees (B)</p> Signup and view all the answers

What should be used if peripheral venous access is not possible in pregnant women during resuscitation?

<p>Early consideration of intraosseous access or venous cutdown (D)</p> Signup and view all the answers

What should be the approach to volume replacement during resuscitation in pregnant women?

<p>Aggressive approach (A)</p> Signup and view all the answers

What is the recommended action regarding defibrillation energy levels in pregnant women experiencing cardiac arrest?

<p>No alteration in energy levels compared to nonpregnant women (D)</p> Signup and view all the answers

In which case is manual displacement of the uterus to the left recommended?

<p>In cases of concealed haemorrhage (B)</p> Signup and view all the answers

When should supplemental high flow oxygen be administered in maternal collapse resuscitation?

<p>As soon as possible to counteract rapid deoxygenation (D)</p> Signup and view all the answers

What is the first action recommended if the airway is clear and there is no breathing in a pregnant woman experiencing cardiac arrest?

<p>Initiate chest compressions immediately (C)</p> Signup and view all the answers

What should be done ideally if there is no response to correctly performed CPR within 4 minutes of maternal collapse?

<p>Perform perimortem caesarean section (PMCS) to assist maternal resuscitation (C)</p> Signup and view all the answers

What action should be taken after manual displacement of the uterus for aortocaval compression in pregnant women?

<p>Initiate chest compressions (A)</p> Signup and view all the answers
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