This text is a comprehensive review in normal and abnormal pregnancy physiology, the most common etiologies of maternal medical emergencies, recognition of maternal deterioration and pending cardiopulmonary arrest, modifications to cardiopulmonary resuscitation in pregnant and postpartum patients, special procedures that can assist in diagnosing and treating maternal medical emergencies tailored to the setting (e.g., point-of-care ultrasound, resuscitative cesarean delivery, extracorporeal cardiopulmonary resuscitation), treatment of trauma/stroke in pregnancy, and postpartum maternal medical emergencies. There are streamlined algorithms and cognitive aids designed to improve a team’s ability to successfully implement techniques unique to treating maternal medical emergencies and cardiac arrest.
*Offers a practical guide to treating complex and challenging maternal medical emergencies
*Equips the entire team responding to a maternal cardiac arrest with the current evidence-based approaches and techniques
*Presents a thorough review, detailed algorithms, and a consolidated discussion of the practical aspects of implementation
Author(s): Andrea Shields, Jacqueline Vidosh, Laurie Kavanagh, Peter Nielsen, Brook Thomson
Publisher: CRC Press
Year: 2023
Language: English
Pages: 211
City: Boca Raton
Cover
Half Title
Title
Copyright
Dedication
Contents
Acknowledgments
Obstetric Life Support Course Overview
0.1 Course Description
0.2 Course Objectives
0.3 Course Design
0.4 Course Prerequisites
0.5 Successful Course Completion Requirement
0.6 Course Materials
0.7 Manual Organization
0.8 Terminology
0.9 Highlighted Boxes
0.10 OBLS Algorithms, Cognitive Aids, and Checklists
1 Background on Maternal Cardiac Arrest
1.1 Introduction
1.2 Learning Objectives
1.3 Maternal Mortality
1.4 Epidemiology of Maternal Cardiac Arrest
1.5 The Role of Bias
1.6 Preventing Maternal Cardiac Arrest
1.7 Planning and Preparation
Chapter 1. Practice Questions
Chapter 1. Answers
Chapter 1. References
2 Anatomic and Physiologic Adaptations of Pregnancy
2.1 Introduction
2.2 Learning Objectives
2.3 Cardiovascular Anatomic and Physiologic Adaptations in Pregnancy
2.4 Respiratory Anatomic and Physiologic Adaptations in Pregnancy
2.5 Neurophysiologic Adaptations in Pregnancy
2.6 Hematologic Physiologic Adaptations in Pregnancy
2.7 Gastrointestinal Anatomic and Physiologic Adaptations in Pregnancy
2.8 Genitourinary Anatomic and Physiologic Adaptations in Pregnancy
2.9 Anatomic and Physiologic Impact on Medications in Pregnancy
2.10 Endocrine Anatomic and Physiologic Adaptations in Pregnancy
2.11 Immune System Adaptations in Pregnancy
Chapter 2. Practice Questions
Chapter 2. Answers
Chapter 2. References
3 Prevention of Maternal Cardiac Arrest
3.1 Introduction
3.2 Learning Objectives
3.3 Obstetric Early Warning Systems
3.4 Institutional Planning for Critically Ill Pregnant and Postpartum Patients
3.5 Communication
Chapter 3. Practice Questions
Chapter 3. Answers
Chapter 3. References
4 Common Causes of Maternal Cardiac Arrest
4.1 Introduction
4.2 Learning Objectives
4.3 BAACC TO LIFE: Bleeding
4.4 BAACC TO LIFE: Anesthesia
4.5 BAACC TO LIFE: Amniotic Fluid Embolism
4.6 BAACC TO LIFE: Cardiovascular
4.7 BAACC TO LIFE: Peripartum Cardiomyopathy
4.8 BAACC to LIFE: Clot/Cerebrovascular Pulmonary Embolism
4.9 BAACC TO LIFE: Trauma
4.10 BAACC TO LIFE: Overdose
4.11 BAACC TO LIFE: Acute Lung Injury/Acute Respiratory Distress
4.12 BAACC TO LIFE: Ions (Glucose, K+)
4.13 BAACC TO LIFE: Fever
4.14 BAACC TO LIFE: Emergency Hypertension/Eclampsia
Chapter 4. Practice Questions
Chapter 4. Answers
Chapter 4. References
5 Review of Cardiopulmonary Resuscitation Modifications for Pregnant Patients in Basic Life Support
5.1 Introduction
5.2 Learning Objectives
5.3 Review of Basic Life Support
5.4 Basic Life Support Changes in Pregnancy
5.5 Chest Compressions and Ventilation
5.6 Automated Chest Compression Devices
5.7 Defibrillation
5.8 Left Uterine Displacement
5.9 Basic Life Support in the Reproductive-Age Female with Unknown Pregnancy Status
5.10 Vascular Access
5.11 Point-of-Care Ultrasound
Chapter 5. Practice Questions
Chapter 5. Answers
Chapter 5. References
6 Review of Cardiopulmonary Resuscitation Modifications for Pregnant Patients in Advanced Cardiac Life Support and Advanced Life Support
6.1 Introduction
6.2 Learning Objectives
6.3 Review of Advanced Cardiac Life Support
6.4 Interpretation of Cardiac Rhythms
6.5 Shockable Rhythms: Ventricular Fibrillation and Pulseless Ventricular Tachycardia
6.6 Refractory Ventricular Fibrillation and Ventricular Tachycardia
6.7 Nonshockable Rhythms: Pulseless Electrical Activity and Asystole
6.8 Differential Diagnosis
6.9 Advanced Cardiac Life Support Changes in Pregnancy
6.10 Obstetric Life Support Cognitive Aid
6.11 Airway Management: Basic
6.12 Airway Management: Advanced
6.13 Anti-Arrhythmic Drugs
6.14 Fetal Monitoring
6.15 Resuscitative Cesarean Delivery
6.16 Vaginal Delivery
6.17 Factors That Could Decrease the Effectiveness of Advanced Cardiac Life Support and Cardiopulmonary Resuscitation in Pregnancy
6.18 Maternal Cardiac Arrest Team
Chapter 6. Practice Questions
Chapter 6. Answers
Chapter 6. References
7 Special Procedures in Obstetric Life Support
7.1 Introduction
7.2 Learning Objectives
7.3 Resuscitative Cesarean Delivery
7.4 OBLS in a Low-Resource Setting
7.5 Point-of-Care Ultrasound
7.6 Obesity and Maternal Cardiac Arrest
7.7 Extracorporeal Cardiopulmonary Resuscitation
7.8 Transport and Emergency Medical Staff Providers
Chapter 7. Practice Questions
Chapter 7. Answers
Chapter 7. References
8 Traumatic Maternal Cardiac Arrest
8.1 Introduction
8.2 Learning Objectives
8.3 Traumatic Cardiac Arrest Review
8.4 Approach to Reproductive-Age Females with Cardiac Arrest in Association with Trauma
Chapter 8. Practice Questions
Chapter 8. Answers
Chapter 8. Reference
9 Postpartum Cardiac Arrest
9.1 Introduction
9.2 Learning Objectives
9.3 Causes of Postpartum Maternal Cardiac Arrest
9.4 Management of Postpartum Cardiac Arrest by Cause
Chapter 9. Practice Questions
Chapter 9. Answers
Chapter 9. References
10 Maternal Stroke and Acute Cerebrovascular Disease
10.1 Introduction
10.2 Learning Objectives
10.3 Timing
10.4 Recognizing Warning Signs and Symptoms of Maternal Stroke
10.5 Out-of-Hospital Evaluation and Transport of Maternal Stroke
10.6 Obstetric Stroke Protocol
10.7 Maternal Stroke Team Composition
10.8 Stroke Code
10.9 Intracranial Hemorrhage
10.10 Subarachnoid Hemorrhage
10.11 Reversal of Coagulopathy in Intracranial Hemorrhage and Subarachnoid Hemorrhage
10.12 Elevated Intracranial Pressure in Intracranial Hemorrhage and Subarachnoid Hemorrhage
10.13 Delivery in Intracranial Hemorrhage and Subarachnoid Hemorrhage
10.14 Post-Stroke Care
10.15 Cerebral Venous Sinus Thrombosis
Chapter 10. Practice Questions
Chapter 10. Answers
Chapter 10. References
11 Post-Arrest Care
11.1 Introduction
11.2 Learning Objectives
11.3 Importance of Post-Arrest Care
11.4 Standard Post-Return of Spontaneous Circulation Checklist after Maternal Cardiac Arrest
11.5 Airway
11.6 Breathing
11.7 Circulation
11.8 Disability
11.9 Extracorporeal Cardiopulmonary Resuscitation
11.10 Etiology
11.11 Fetus
11.12 Gather
11.13 Head
11.14 When to Cease Resuscitation Efforts
11.15 Determination of Death and Organ Procurement
Chapter 11. Practice Questions
Chapter 11. Answers
Chapter 11. References
12 Communication during Maternal Cardiac Arrest
12.1 Introduction
12.2 Learning Objectives
12.3 Guiding Principles of Team-Based Care
12.4 Maternal Cardiac Arrest Team Structure
12.5 Situation, Background, Assessment, and Recommendation/Request
12.6 Call-Outs
12.7 Check-Backs
12.8 Situation-Background-Assessment-Recommendation and Call-Outs for the Maternal Team Entering a Maternal Cardiac Arrest Event—The 5A's
12.9 Communication of Maternal Cardiac Arrest and Outcomes to the Family
12.10 Debriefing the Team after Maternal Cardiac Arrest
Chapter 12. Practice Questions
Chapter 12. Answers
Chapter 12. References
13 Putting It All Together
13.1 Introduction
13.2 Scenario One
13.3 Scenario Two
13.4 Scenario Three
13.5 Scenario Four
Chapter 13. Reference
Appendix A: Abbreviations
Appendix B: OBLS Mnemonics
Appendix C: Resources
Appendix D: American Heart Association Opioid-Associated Emergency Algorithm for Healthcare Providers
Appendix E: Post-ROSC Care Checklist IH
Appendix F: Post-ROSC Care Checklist OH
Appendix G: Venous Thromboembolism Prophylaxis Following Stroke
Appendix H: Megacode Checklist OH Basic
Appendix I: Megacode Checklist OH Advanced
Appendix J: Megacode Checklist IH
Appendix K: Institutional Preparedness
Appendix L: OBLS Drug List
