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 Cardio-pulmonary 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 high? Blood Pressure low? Skin cold, hot, sweaty? Conscious level Aggressive, not alert? Fetal heart fast, slow, absent? Urine output reduced? Colour 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