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Cardiopulmonary Resuscitation: Considerations in third trimester of pregnancy

Cardiopulmonary Resuscitation: Considerations in third trimester of pregnancy. Promoting multiprofessional education and development in Scottish maternity care. Cardiopulmonary Resuscitation. BLS (Basic Life Support) ALS (Advanced Life Support)

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Cardiopulmonary Resuscitation: Considerations in third trimester of pregnancy

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  1. Cardiopulmonary Resuscitation: Considerations in third trimester of pregnancy Promoting multiprofessional education and development in Scottish maternity care

  2. Cardiopulmonary Resuscitation • BLS (Basic Life Support) • ALS (Advanced Life Support) • Role of caesarean section in cardiopulmonary resuscitation in late pregnancy.

  3. Cardiopulmonary Resuscitation • Physiological changes of pregnancy • Adaptations of CPR in pregnancy • Indications for peri-arrest caesarean section.

  4. Ensure pregnantpatient is placed in a lateral tilt

  5. Ensure pregnantpatient is placed in a lateral tilt

  6. SHOCKABLE Ventricular Fibrillation Ventricular Tachycardia

  7. Non-Shockable NON SHOCKABLE Asystole NON SHOCKABLE PEA - Complete Heart Block NON SHOCKABLE PEA narrow complex Tachycardia

  8. Causes of Cardiac Arrest • 4 Hs 4 Ts • Hypoxia Thromboembolism • Hypovolaemia Toxic (? Magnesium Sulphate) • Hypo/hyperkalaemia Tamponade • Hypothermia Tension pneumothorax • and also • ECLAMPSIA

  9. CPR with Adaptations • WHY?

  10. Because … • Physiological changes of pregnancy • Aorto-caval compression by gravid uterus impedes venous return and reduces cardiac output. • Increased risk of aspiration of stomach contents. • More likely to be difficult to intubate. • Lower gastric pH- chemical pneumonitis more likely than in the non-pregnant.

  11. How is CPR adapted?

  12. CPR Adaptations • Tilt patient to the left or manually displace uterus. • Apply cricoid pressure and intubate early. • Involve senior appropriate member of staff immediately or as early as possible.

  13. Caesarean section in maternal resuscitation in late pregnancy • Part of the resuscitation technique. • Decision by four minutes of unsuccessful CPR • Performed by FIVE minutes if CPR is unsuccessful. • Makes CPR more efficient.

  14. CPR Post Caesarean Section • Increases venous return • Improves ease of ventilation • CPR can be carried out in the supine position • Decreased oxygen requirement after delivery.

  15. Caesarean section in maternal resuscitation in late pregnancy • Continue maternal CPR throughout • Incision • Equipment (scalpel, artery forceps) • Potentially good fetal outcome if delivery occurs by 5 minutes of cardiac arrest.

  16. Other Considerations • Effective spinal or epidural will make chest compression LESS effective: larger doses of epinephrine may be required. • If cardiac arrest is due to intravenous bupivacaine, prolonged CPR will be required.

  17. Any Questions?

  18. Summary • Differences in CPR in pregnant and non-pregnant patients. • Strategies used to overcome these physiological differences. • Caesarean section is part of maternal resuscitation in late pregnancy.

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