OB Critical Care Training: Amniotic Fluid Embolism, Massive Transfusion Protocol & Cesarean Delivery



Hi Roxanne,
[INAUDIBLE] How are you doing? I don't feel good at all. This is totally different
thank how I felt [CROSSTALK]. I feel hot and
panicked [CROSSTALK]. No, no, no, you don't understand
that's not it [INAUDIBLE]. >> She is feeling very hot. >> Okay, all right. I'm gonna give you some oxygen. >> [INAUDIBLE] [CROSSTALK]. >> We're gonna take [CROSSTALK]. >> Okay,
let's get you some oxygen. [CROSSTALK]. >> 70/30. Her heart rate is 160. [CROSSTALK] 87 on
the [CROSSTALK] >> Can you please [INAUDIBLE] somebody? >> The abrupt change in
vitals with desaturation and tachycardia prompt concern for an embolic event,
clinical support is called. [CROSSTALK] [INAUDIBLE]
Look at this, why is she being like this? She looks terrible. She's dead. >> She lost consciousness. Roxanne, Roxanne. [CROSSTALK]
>> All of a sudden she just collapsed. [INAUDIBLE] Make space. She's hypotensive. [CROSSTALK]
>> He needs to be called right now. Can we put the pads on her? >> When a code is called, roles are quickly assigned as
the code team is called chest. Chest compressions
start immediately. >> Breath.
On three we're going to roll her to put on the back lead and
put her on to the back board. One, two, three, four, five,
six, seven, eight, nine, thirty. Roll. One two three. [CROSSTALK]
>> Efforts should be made to minimize intervals
between chest compressions. [CROSSTALK] I need some more
nurses in here for help. 13, 14, 15. >> Mark, you're going to
be next for compressions. Rosemary, I need 1mg of
epinephrine drawn up. Shannon, you're our scribe. >> I am. >> Andy, you're our timekeeper. >> Yes, I am. >> Okay. >> Assigning roles is
important in a code situation, chest compressions are performed
at 30:2 with rescue breaths, pending an advanced airway. >> One minute. >> Great. >> Hey, what's going on in here? >> Hi, she suddenly
lost consciousness and she has no pulse. >> Communication with new
members to the code such as anesthesia is important. Chest compressors should rotate
at least every two minutes to avoid fatigue. >> Epinephrine drawn up. >> Okay, continue to run
the [CROSSTALK] no we shouldn't, she's too unstable right now. >> Two minutes. >> Okay, all right [INAUDIBLE]
>> Obstetrics delivery is not considered in a code situation
until time is approaching four minutes, and the patient should
not be moved as this would compromise maternal
resuscitation. >> [INAUDIBLE]
>> Activity. We're continuing contractions. >> Okay. >> During a code, heart rhythm
should be evaluated every two minutes to consider
shock administration. >> Okay. >> Looks like she's
bleeding a lot. Can we activate
Massive Transfusion Protocol? >> [INAUDIBLE] Activate
Massive Transfusion protocol. >> Transfusion Protocol, got it. >> A Massive Transfusion
Protocol is essential in the resuscitation of a rapidly
hemorrhaging obstetric patient. One should be familiar with
their own institutional protocol. >> Breathe. >> 1, 2, 3, 4, 5,
6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16. >> With the placement
of an advanced airway, chest compressions thereafter
are continuous with six to eight mechanical breaths per minute. >> How many minutes
has it been now? >> Four minutes. >> [CROSSTALK] Section everybody
we have to move towards the section. >> Cesarean delivery is
mobilized when a non-perfusable rhythm persists
after four minutes. Maternal resuscitative efforts
should not be hindered in the process.
>> Five minutes. >> All right. We're starting the c-section. >> Vertical [INAUDIBLE]
during the session. Very good, Sarah. With cesarean delivery
during a code chest compressions continue. The code continues, and a vertical incision
facilitates rapid delivery. >> All right,
I'm gonna take the baby out. >> Go ahead and drop another
milligram of [INAUDIBLE]. >> [INAUDIBLE]
You're right behind? >> Okay. >> One of the lines
are [INAUDIBLE] >> Yep, right here. [INAUDIBLE] Okay, baby's out. [CROSSTALK]
>> Pediatrics should be available for a potentially
viable but compromised neonate. >> [INAUDIBLE]. We're gonna do a pulse check,
stop stop check the pulse. Let's check the rhythm. >> Okay great. >> Okay [INAUDIBLE] rhythm so
we'll go [INAUDIBLE]. >> Yep I think it's
where they come in. >> Do not touch the patient,
please wait. >> Stand clear, of shock. We'll need shock her,
okay clear. I'm clear. I'm clear. >> Okay. >> Okay, just talking. >> [INAUDIBLE]
>> All right. >> Seven minutes. >> All right [INAUDIBLE]
>> [CROSSTALK] >> [INAUDIBLE] Belly and get ready. >> Following delivery, the
incisions are rapidly closed or packed so as to not interfere
with the ongoing code >> Okay it's time for another pulse check on
the next switch go ahead and we'll check for a pulse. >> All right. [INAUDIBLE]
>> Step back check for a pulse. >> I feel a pulse. >> I've got a pulse as well. >> Okay so
we've got a pulse back. >> Following successful
resuscitation, steps are taken to optimize
post cardiac arrest care after the return of
spontaneous circulation. Let's run his blood
pressure here. Blood pressure, still pretty
low, so let's go ahead and start an Epi infusion. We'll continue the massive
transfusion protocol. Can you go ahead and
hang another round of blood and FFP as well? >> Okay. >> I think we're gonna
send some labs off. >> Sure. >> If you want him to
draw some labs for me. And then we'll be
heading to the ICU soon. Sounds good.
>> Okay? >> Mm-hm.
>> Management of the gravid patient in a code situation is
similar to any other patient. Bedside cesarean delivery should
be pursued during a code lasting five minutes, if the gestational
age is greater than 20 weeks. Efforts spent on delivery should
not detract from other efforts in the ongoing code. Mobilization of adequate team
and resources can be critical. Awareness of your institution's
Massive Transfusion Protocol will help facilitate timely
management in an emergency.

12 Replies to “OB Critical Care Training: Amniotic Fluid Embolism, Massive Transfusion Protocol & Cesarean Delivery”

  1. Participated in one after baby was out in the OR. Thank goodness anesthesia treated it as an allergic reaction (which it is)! Mom survived with no known sequelae.

  2. The Code Leader should be more specific when she states she needs "more nurses." I've been in codes where everybody & there cousin responds & the situation becomes a Zoo. Less often equals more.

  3. it is a very good video for institutions those who were practicing continuing medical education training in their hospitals

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