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</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</p> Signup and view all the answers

    Why should maternal collapse resuscitation include relief of aortocaval compression?

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

    What is recommended for women with acute coronary insufficiency?

    <p>Thrombolysis</p> Signup and view all the answers

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

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

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

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

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

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

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

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

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

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

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

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

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

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

    What makes ventilation more challenging in pregnant women during resuscitation?

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

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

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

    What is the recommended antidote for magnesium toxicity?

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

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

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

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

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

    What is the optimal management for septic shock?

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

    What is the primary focus of managing amniotic fluid embolism?

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

    What is the antidote for local anaesthetic toxicity?

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

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

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

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