tailieunhanh - ABC OF RESUSCITATION - PART 5

Bắt giữ tuần hoàn được chẩn đoán bởi sự vắng mặt của một xung sờ thấy trong một động mạch lớn (động mạch cảnh hoặc đùi). Ép ngực ở tỷ lệ tiêu chuẩn (xem Chương 1) và tỷ lệ 15: 2 được đưa ra. Nén ngực một người phụ nữ mang thai là không dễ dàng do các xương sườn bùng, cơ hoành nâng lên, béo phì, và phì đại vú. | Resuscitation in pregnancy diaphragm by the abdominal contents. Observing the rise and fall of the chest in such patients is also more difficult. Circulation Circulatory arrest is diagnosed by the absence of a palpable pulse in a large artery carotid or femoral . Chest compressions at the standard rate see Chapter 1 and ratio of 15 2 are given. Chest compression on a pregnant woman is made difficult by flared ribs raised diaphragm obesity and breast hypertrophy. Because the diaphragm is pushed cephalad by the abdominal contents the hand position for chest compressions should similarly be moved up the sternum although currently no guidelines suggest exactly how far. In the supine position an additional factor is compression of the inferior vena cava by the gravid uterus which impairs venous return and so reduces cardiac output all attempts at resuscitation will be futile unless the compression is relieved. This is achieved either by placing the patient in an inclined lateral position by using a wedge or by displacing the uterus manually. Raising the patient s legs will improve venous return. Lateral displacement of the uterus Effective forces for chest compression can be generated with patients inclined at angles of up to 30 but pregnant women tend to roll into a full lateral position when inclined at angles greater than this making chest compression difficult. The Cardiff resuscitation wedge is not commercially available so other techniques need to be used. One technique is the human wedge in which the patient is tilted onto a rescuer s knees to provide a stable position for basic life support. Alternatively the patient can be tilted onto the back of an upturned chair. Purpose-made wedges are available in maternity units but any available cushion or pillow can be used to wedge the patient into the left inclined position. An assistant should however move the uterus further off the inferior vena cava by bimanually lifting it to the left and towards the patient s .