I SEE YOU
What are the leading causes for admission to the ICU for pregnant patients?
Hemorrhage
Hypertensive Disorders
Dysregulated inflammatory response leading to end organ damage
True or false , respiratory rate increases in pregnancy?
False
What do you need for a perimortem c-section?
A scalpel
What hormone is responsible for expansion of the maternal chest wall ?
Relaxin
True
When do you consider a patient with sepsis to be in septic shock?
1. When patient is persistently hypotensive despite adequate fluid replacement requiring vasopressor initiation to maintain MAP > 65 mmHg
2. Lactate > 2 mmol/L
When does BP normally nadir in pregnancy?
End of second trimester : 22-24 weeks
Begins to rise again at cusp of third trimester at 28 weeks.
Above the diaphragm
How do you calculate MAP?
2 X DBP + SBP / 3
What are the 3 criteria that compose the Q-SOFA ?
1. Respiratory rate: > 22 RR/min
2. Blood Pressure: SBP <100 mm/Hg
3. Mental Status: Altered Mental Status
What should be done when a patient is diagnosed with sepsis ?
1. Vitals
2. Obtain lactate, CBC, Coags, CMP
3. Initiate fluid resuscitation
4. Collect Blood Cultures
5. Ensure IV access is adequate
6. Place Foley catheter to monitor for oliguria and strict I/O
7. Initiate broad spectrum antibiotic therapy
What is the normal pH range for pregnant patients in their second or third trimester?
7.40-7.49 ; respiratory alkalosis
The gravid uterus must be MANUALLY displaced leftwards to relieve aortocaval compression during maternal code to allow for improved CPR. This manual dislocation of the uterus must continue even after ROSC is achieved to optimize return of circulation.
How many mL is 1 unit PRBC?
250 mL to 300 mL
What are the main components of mechanical ventilation settings?
1. Respiratory Rate
2. Tidal Volume
3. PEEP
4. I/E ratio
5. Fi02
The most common pathogens in obstetric sepsis cases are?
1. E. Coli
2. GBS
3. GAS
What pulmonary function parameter decreases in pregnancy?
What does this make pregnant women more prone to develop?
Apnea and Hypoxia may more rapidly develop in pregnant patients
What rhythms are shockable and which are not shockable?
What amount of joules will you set the defibrillator to if you are preparing to defibrillate the patient?
1. V-fib and V-tach are both shockable rhythms
2. 120-200J initial biphasic shock
What does cryoprecipitate include?
Fibrinogen
vWF
Factor VIII , XIII
What are the diagnostic criteria for ARDS ?
1. Timing: Diagnosis made within 1-week of insult or worsening symptoms
2. Chest Imaging: Bilateral lung opacities
3. Origin of Edema: Respiratory failure not explained by cardiac failure or fluid overload
4. Oxygenation mismatch : Pa02/Fi02
Distributive shock
What coagulation factors increase in pregnancy?
What factor decreases in pregnancy?
What factors do not change?
Protein S decreaSes
Protein C does not C-hange , factor V does not change, factor II, does not change AT-III does not change
At what time should a resuscitative hysterotomy be performed and what is the purpose of performing it?
1. Generally speaking at 4-5 minutes after initiation of maternal code without ROSC. However, this can be individualized to the scenario and may be done earlier.
2. The ultimate purpose is for maternal benefit to remove oxygen and blood demands of the uterus to benefit maternal circulation and cardiac function, reduce aortocaval compression from the gravid uterus, allow improved respiration of the pregnant patient by relieving the diaphragm of the mass effect of the gravid uterus increasing FRC and compliance
What coagulation factors increase in pregnancy?
Fibrinogen (factor I)
Factor II, VII, VIII, IX , XII, vWF