Maternal Resuscitation
Maternal Resuscitation
Non-shockable (asystole or PEA)
Hello Mrs Tilt! If no response - Call for HELP (Shake & shout)
- C - assess carotid pulse for 10 seconds. If no signs of life start chest compressions
- A - assess and stabilise airway (remove obstructions, head tilt-chin lift/jaw thrust, oxygen, consider intubation)
- B - assess and stabilise breathing (assess if need respiratory support)
"Call a CAB"
(C-assess & stabilise circulation (confusion, heart rate, BP, urine output, skin perfusion, colour, blood loss, IV access, fluid replacement))
CPR key points
- Left lateral tilt
- 30:2 compression-ventilation ratio
- Rate 100 compressions/minute
- Compression depth 5cm and allow complete recoil
- Apply pads/cardiac monitor
- Alternate compressors/ventilators every 5 cycles or 2 minutes
Shockable (VF or VT)
- Defibrillate at 360J (monophasic) or 200J (biphasic)
- Continue CPR cycle
- No drugs required
- Reassess after 2 minutes
Non-shockable (asystole or PEA)
- CPR
- 1mg adrenaline IV (repeat every 3-5 minutes)
- Reverse underlying cause
Improved outcomes with:
- Early chest compressions
- Early defibrillation
Reversible causes:
Fours Hs
- Hypoxia
- Hypovolaemia
- Hyper K
- Hypothermia
Four Ts
- Thromboembolism
- Toxicity
- Tension pneumothorax
- Cardiac Tamponade
Advanced airway management
Indications
- Unable to protect airway
- Ventilation inadequate
Options
- Laryngeal mask
- Endotracheal tube
For intubation
- Pre-oxygenate with 100% O2
- No drugs required if cardiac/respiratory arrest
CPR with continuous chest compressions (100:10) with advanced airway in place
Remember:
"Shake & Shout"
"Call a CAB"
"Big 5"
"Forgotten 4"
"Core 1"
At >24 weeks gestation perform Caesarean section if CPR with properly positioned patient is not successful after 5 minutes (to aid resuscitation of mother by increasing venous return)