Anaphylaxis - amniotic fluid embolism
A 37-years old obese patient (IV. gravida, tercipara, 38. gestational week) is admitted to hospital due to a delivery in progress. After being transferred to a delivery room she is suddenly anxious and short of breath. Blood pressure is 80/40 mmHg, tachycardia is present 130 bpm. A ''blue mask'' syndrome appears, oxygen saturation drops to 40 %, patient falls unconscious with convulsions of face muscles. The gynecologist calls the CPR team. We can see a decrease in a heart rate of a fetus from 140 to 80 bpm on cardiotocographic monitoring.
We monitor the patient. Her complications aren't serious and we expect them to improve. She can lie on her left side for more comfort.
We give an oxygen mask to the patient and place her on her left side and place a peripheral venous catheter. We use norepinephrine to treat hypovolemia. In case of inadequate blood pressure increase we give dobutamine in bolus (10-20mg). When the unconsciousness persists, an intubation is performed. In the case of asystole, we initiate CPR.
We immediately transport the patient to the theatre to perform a caesarean section and place central venous catheter. We try to stabilize the basic life functions and give the patient a bolus of atropine. When the unconsciousness persists, an intubation is performed. In the case of asystole, we initiate CPR.
We give an oxygen mask to the patient, tilt her leftwards and place a peripheral venous catheter. We administer intravenous crystalloid and colloid fluids to treat hypovolemia and hypotension. In case of inadequate increase in blood pressure we give the patient ephedrine in bolus (10-20mg) iv. When unconsciousness persists, an intubation is performed. In the case of asystole, we initiate CPR.
37
years
woman
RR
30 /min
HR
140 /min
SpO2
40 %
BP
80/40 (53) mmHg
Examination
From history of the patient there were two physiological deliveries, one spontaneous abortion and cardiovascular disease in a family.