tailieunhanh - Critical Care Obstetrics part 75

Critical Care Obstetrics part 75 provides expert clinical guidance throughout on how you can maximize the chances of your patient and her baby surviving trauma. In this stimulating text, internationally recognized experts guide you through the most challenging situations you as an obstetrician are likely to face, enabling you to skillfully:Recognize conditions early-on which might prove life threatening, Implement immediate life-saving treatments in emergency situations, Maximize the survival prospects of both the mother and her fetus | 52 Biological Chemical and Radiological Attacks in Pregnancy Shawn P. Stallings C. David Adair Division of Maternal-Fetal Medicine Department of Obstetrics and Gynecology University of Tennessee College of Medicine Chattanooga TN USA Introduction It is an unfortunate reality that in many parts of the world there is an ongoing threat of terrorism against target groups that frequently include pregnant women. In addition to the concerns about injuries due to conventional weapons and explosions there is now the potential for attacks using chemical and or biological agents as exemplified by the the release of Sarin gas in a Tokyo subway system in 1995 and the anthrax- contaminated letters mailed in 2001. Pregnant women represent a unique population that differs from the populace at large both in terms of susceptibility to certain agents and in the management of any exposures. Transport and triage of the patient and her long-term management in the face of continued pregnancy must be anticipated and planned for in advance to optimize outcomes. This chapter aims to address some of the special concerns of mass casualty management for pregnant women and to review some of the potential biological chemical or radioactive agents that might be involved in an intentional event. Clinical vignette A 22 year-old primigravida at 30 weeks of gestation presented to her local hospital for evaluation due to fever chills cough and malaise. The initial work-up revealed a temperature of C but at the time she had stable respiratory status. Her chest radiograph revealed a prominent pattern of diffuse infiltration without evidence of consolidation. After evaluation by the patient s midwife and obstetrician she was placed on antibiotics for suspected community-acquired pneumonia or viral pneumonia and admitted to the antepartum-postpartum floor. Fetal testing was reassuring. Critical Care Obstetrics 5th edition. Edited by M. Belfort G. Saade M. Foley J. Phelan and G. Dildy. 2010 Blackwell