tailieunhanh - Critical Care Obstetrics part 12

Critical Care Obstetrics part 12 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 | Cardiopulmonary Resuscitation in Pregnancy In cases of a witnessed respiratory arrest when the airway is known to be clear but the victim is not breathing the airway must be protected from aspiration and kept patent and the BLS ACLS algorithms begun. Endotracheal intubation by direct laryngoscopy is the preferred method for maintaining airway patency for the gravid arrest victim. Alternative techniques for airway management include endotracheal intubation by light stylet esophageal tracheal combitube laryngeal mask airway and transtracheal ventilation. Tracheal intubation offers advantages of securely protecting the airway facilitating oxygenation and ventilation and providing a route for drug administration during a cardiac arrest. In the hospital setting immediate confirmation of the tracheal tube is typically done using non-physical examination techniques such as end-tidal ET carbon dioxide indicators. The presence of ET CO2 is a reliable measure of pulmonary perfusion and therefore can measure the efficacy of CPR. Esophageal detector devices may also be used to confirm tracheal tube placement but false-negative results may be obtained in women in late gestation. False-negative results are due to decreased functional residual capacity FRC and tracheal compression in late pregnancy. Consequently the gold standard for confirmation in the pregnant women remains repeat direct visualization 23 . Even with advanced airway techniques airway access and maintenance can be difficult in pregnancy due to enlarged breasts and increased pharyngeal edema. Rescuers may find it necessary to use a slightly smaller endotracheal tube than normal 24 . Also progesterone relaxes the smooth muscle of the lower esophageal sphincter and increases the propensity of the gravida to reflux and aspirate. Breathing Rescue breathing may occur mouth-to-mouth mouth-to-nose mouth-to-mask bag valve-to-mask or ultimately by endotracheal intubation. The current guidelines call for a ratio of 2 .