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