ABC and maternal resuscitation Aims Understand primary survey

ABC and maternal resuscitation

Aims • • Understand primary survey Airway, Breathing, Circulation, Disability Assess and treat in this order To develop and gain competence in the skills needed for maternal Cardiopulmonary Resuscitation

Airway, Breathing Circulation • Why in this order? • Assess and treat each before progressing onto the next

Ensure safety • Make sure you are not endangering yourself first • Is it safe to approach the patient?

First of all…. • Is the patient just asleep? • Shake and Shout! (remember they might be deaf!)

Call for help • Place patient in tilt, preferably left lateral, 15 to 30 degrees

Assessment • • Airway: LOOK for chest movement LISTEN for breath sounds, noisy or quiet FEEL

Airway • Absent or noisy breath sounds? • Open airway • Head tilt and chin lift or jaw thrust

Maintain airway • Measure for and insert Guedel’s airway

Breathing • Is the patient breathing? • What is the respiratory rate? • Too fast or two slow, treat with oxygen

Circulation • • Pulse Blood Pressure Skin Conscious level Fetal heart Urine output Colour high? low? cold, hot, sweaty? Aggressive, not alert? fast, slow, absent? reduced? pale, grey?

Circulation • Insert two wide bore lines • Take bloods • Give fluids • Think: Why is there a C problem? • Secondary survey and treat cause

If not breathing. . . . • Assume cardiac arrest, unless cessation of breathing observed • Commence CPR • 100 -120/minute • 30/2 compressions to breaths

Chest compressions • Place heel of hand on lower part of sternum • Place other hand on top and lock fingers • Keep arms straight, lean from shoulders • Depress sternum by 5 -6 cms • Rate 120/minute • Very tiring, take turns if possible • 30: 2 compressions to breaths

Reassess • Has the cause for the arrest been addressed? • When to stop? • Consider peri-mortem caesarean section • Intended to save mother • Bloodless procedure, do there and then, mother is dead anyway if you don’t

Any questions?

Recap • • • Assess and treat A then B then C TILT patient Always ensure open airway Give Oxygen if available Establish IV lines Secondary survey