tailieunhanh - Critical Care Obstetrics part 54

Critical Care Obstetrics part 54 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 | Overdose Poisoning and Envenomation During Pregnancy Figure a Guidelines for evaluation and management of pregnant patients with a known or suspected toxic exposure. b Guidelines for the evaluation of the unconscious pregnant patient with a known or suspected toxic exposure. During 1999 1085 suicidal toxic exposures among pregnant women were reported to American Poison Control Centers. This represents 12 of the toxic exposures reported during pregnancy for that year and less than 1 of the suicide attempts by poisoning reported to the American Association of Poison Control Centers. The substances most frequently involved were acetaminophen alone or in combination with decongestants and antihistamines nonsteroidal anti-inflammatory drugs selective serotonin-reuptake inhibitors SSRIs and benzodiazepines . May require restraints sedation and Foley catheterization. ACLS advanced cardiac life support AWY airway CPR cardiopulmonary resuscitation C S cesarean section EKG electrocardiogram F U follow-up GA gestational age H P history and physical OD overdose. Reproduced with permission from Gei AF Saade GR. Poisoning during pregnancy and lactation. In Yankowitz J Niebyl J. Drug Therapy in Pregnancy 3rd edn. Philadelphia Lippincott Williams and Wilkins 2001. Some patients would require observation and management in an intensive care setting see Table . Toxic i dentification The collection of samples for toxicology is of paramount importance in the identification of the toxic agent s causing the exposure to predict the severity and to implement and monitor specific treatment antidotes. As a general rule at least one sample of all biologic fluids should be obtained and saved for toxicology analysis see Tables and . Depending on the clinical circumstances these will include blood urine saliva vomit gastric lavage fluid feces cerebrospinal fluid 519 Chapter 39 Figure Continued. amniotic fluid if collected and meconium if the patient .