75 Questions
What is the reason behind pregnant women being able to tolerate blood loss remarkably well?
Hyperdynamic circulation
Why might maternal tachycardia be the only sign of hypovolaemia in pregnant women experiencing significant blood loss?
Hyperdynamic circulation
How does pre-existing level 4 maternal anaemia impact the tolerance to blood loss in pregnant women?
Affects blood loss tolerance negatively
Why is intervention often delayed in cases of concealed bleeding during pregnancy?
Underestimation of blood loss
What is the optimal initial management recommended for maternal collapse according to guidelines?
Use the standard ABCDE approach with some modifications
Why should maternal collapse resuscitation include relief of aortocaval compression?
To account for maternal physiology
What is the recommended action in cases of cardiac arrest in pregnant women over 20 weeks of gestation?
Displace the uterus to the left to relieve aorto-caval compression
Why are adaptations made to the resuscitation process from 20 weeks of gestation onwards?
Changes in maternal physiology require adjustments for resuscitation
Why is manual displacement of the uterus to the left recommended in pregnant women experiencing aorto-caval compression?
To allow effective chest compressions during cardiac arrest
Why have authors modified the Resuscitation Council (UK) algorithm for advanced life support?
Due to constraints in algorithmic and poster availability
At what gestational age should an emergency call be made for obstetric, obstetric anaesthetic, and neonatal resuscitation teams according to the text?
> 20 weeks
What permits effective chest compressions in the supine position during aorto-caval compression relief?
Displacement of the uterus to the left
In pregnant women above 20 weeks' gestation, what is the recommended method to relieve aortocaval compression?
Manual displacement of the uterus to the left
What action should be taken if there is no peripheral venous access in pregnant women experiencing major trauma?
Consider intraosseous access or venous cutdown
What is the recommended angle for the left lateral tilt of a pregnant woman to relieve aortocaval compression?
15–30o
When should intubation be performed in an unconscious pregnant woman with a cuffed endotracheal tube?
Immediate intubation before any other intervention
What is the primary intervention if the airway is clear but there is no breathing in a pregnant woman?
Commencement of chest compressions
What should be used for chest compressions in a pregnant woman who requires them?
Left lateral tilt
What is recommended for women with acute coronary insufficiency?
Thrombolysis
What allows accurate diagnosis and definitive therapy in cardiac disease management?
Percutaneous angioplasty
How should septic shock be managed according to the Surviving Sepsis Campaign guidelines?
In accordance with the guidelines
What influences the outcome of severe sepsis according to the text?
Speed and appropriateness of therapy in the initial hours
Which medical professionals are mentioned as being part of the multidisciplinary team approach required for managing cardiac disease?
Midwives, intensivists, anaesthetists
What should be exercised during the perioperative period when administering thrombolysis to women with acute coronary insufficiency?
Caution
What is the focus of the publication by Kundra et al. in Anaesthesia 2007?
Manual displacement of the uterus during Caesarean section
What is the topic of the publication by Jeejeebhoy and Morrison in Emerg Med Int 2013?
Maternal cardiac arrest
According to Neumar et al. in Circulation 2015, what do the American Heart Association Guidelines focus on in special situations?
Cardiac arrest management in pregnancy
In the context of obstetrics, what does the publication by Mhyre and Healy in Aneth Analg 2011 discuss?
Unanticipated difficult intubation
According to Kim et al. in Resuscitation 2013, what was the focus of their study on chest compressions?
Maternal cardiac arrest
What is the subject of the publication by Watkinson et al. in Anaesthesia 2006?
Continuous electronic physiological monitoring
Which study introduced a modified early warning score for earlier detection of critical illness on a general surgical ward?
Jacques et al. in Resuscitation 2006
Which publication compared antecedents to cardiac arrests, deaths, and emergency intensive care admissions in different countries?
Kause et al. in Resuscitation 2004
Which team introduced the concept of the medical emergency team in their publication?
Lee et al.
Which publication proposed an early warning scoring system for detecting developing critical illness?
Watkinson et al. in Anaesthesia 2006
Which study evaluated the effect of modified early warning scores for detecting critical illness?
Stenhouse et al. in Br J Anaesth 2000
How should fluid resuscitation be guided in critically ill patients according to the text?
By considering steroids after adequate fluid resuscitation
What is the preferred method to determine fluid status in critically ill patients?
Transoesophageal Doppler
In obstetric practice, which drug antidote is recommended for magnesium toxicity?
10 ml 10% calcium gluconate
What should be considered if a pregnant woman's hemoglobin level is less than 70 g/l?
Immediate transfusion
If a critically ill patient is unresponsive to adequate fluid resuscitation and vasopressor therapy, what additional treatment may be considered?
Considering steroids
What is the recommended oxygen saturation level for critically ill patients?
More than 94%
What is the purpose of the MERIT study mentioned in the text?
Introducing the medical emergency team system in hospitals
What is the focus of the National Early Warning Score (NEWS) 2 mentioned in the text?
Standardizing the assessment of acute-illness severity
In which publication does Gopalan PD and Muckhart DJ discuss critically ill obstetric patients?
Int J Obstet Anesth 2004
What is the main objective of the National Institute of Health and Care Excellence Clinical Guideline No. 50?
Recognition of and response to acute illness in adults in hospital
What is the key outcome associated with the ASSIST screening tool mentioned in the text?
Identifying at-risk patients on general medical wards
What is the main focus of the Royal College of Physicians' NEWS 2 report mentioned in the text?
Standardizing the assessment of acute-illness severity in NHS hospitals
Why is it important to use an obstetric modified early warning score chart for all women undergoing observation?
To allow early identification of women at risk of impending collapse
What contributes to the increased risk of aspiration in pregnant women during resuscitation?
Heightened diaphragmatic splinting
Which factor significantly reduces cardiac output from 20 weeks of gestation onwards?
Aortocaval compression
What makes ventilation more challenging in pregnant women during resuscitation?
Decreased lung function
In cases of collapse assumed to be due to anaphylaxis, which diagnostic measure can be helpful according to the text?
High mast cell tryptase levels
Why are pregnant women at an increased risk of becoming hypoxic more readily?
Increased oxygen consumption
What is the recommended antidote for magnesium toxicity?
Calcium gluconate
What is the recommended dose of adrenaline for treating anaphylaxis according to the text?
1:1000 adrenaline 250 micrograms (0.5 ml) intramuscularly
Who should be included in the team during cases of maternal collapse according to the text?
Senior Midwife, Obstetrician, Obstetric Anaesthetist
In cases of collapse secondary to local anesthetic toxicity, what treatment should be used?
Lipid rescue
What is crucial in all cases of maternal collapse according to the text?
Incident documentation
What is the optimal management for septic shock?
Following Surviving Sepsis Campaign guidelines
What type of training is recommended for maternity staff according to the text?
Annual multidisciplinary CPR training
What is the primary focus of managing amniotic fluid embolism?
Supportive care
What is the antidote for local anaesthetic toxicity?
Intralipid 20%
When should the neonatal team be called during a maternal collapse event?
If delivery is likely after 22+0 weeks of gestation
What should be done to all cases of maternal collapse according to the text?
Reviewed through clinical governance process
Why might caesarean section be indicated in cases of massive placental abruption?
To deliver the baby promptly
When should perimortem caesarean section (PMCS) be considered in the management of maternal collapse?
If there is no response to correctly performed CPR within 4 minutes of maternal collapse
What should be the angle for the left lateral tilt of a pregnant woman to relieve aortocaval compression?
15-30 degrees
What should be used if peripheral venous access is not possible in pregnant women during resuscitation?
Early consideration of intraosseous access or venous cutdown
What should be the approach to volume replacement during resuscitation in pregnant women?
Aggressive approach
What is the recommended action regarding defibrillation energy levels in pregnant women experiencing cardiac arrest?
No alteration in energy levels compared to nonpregnant women
In which case is manual displacement of the uterus to the left recommended?
In cases of concealed haemorrhage
When should supplemental high flow oxygen be administered in maternal collapse resuscitation?
As soon as possible to counteract rapid deoxygenation
What is the first action recommended if the airway is clear and there is no breathing in a pregnant woman experiencing cardiac arrest?
Initiate chest compressions immediately
What should be done ideally if there is no response to correctly performed CPR within 4 minutes of maternal collapse?
Perform perimortem caesarean section (PMCS) to assist maternal resuscitation
What action should be taken after manual displacement of the uterus for aortocaval compression in pregnant women?
Initiate chest compressions
Learn about the manual displacement of the uterus to the left and the left lateral tilt technique to relieve aortocaval compression in pregnant women. This knowledge is crucial for effectively managing cardiac arrest situations in pregnant patients.
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