Anaphylaxis - amniotic fluid embolism

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  • 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 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.

Wrong answer

Wrong! Patient collapsed, her cardiovascular system is not stable. She needs to be stabilized immediately and a peripheral venous catheter must be placed, only then she can be transferred to the operation theatre. Atropine is a medication of the choice for bradycardiac situation, not at all to use it in this tachycardiac-hypotense cardiovascular collapse.


Back

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.

Wrong answer

Wrong! You had a good idea, that this emergency case must me treated urgently. However, can’t you think of some better way, how to treat a pregnant patient? Small help: following the newest guidelines, you shouldn't apply norepinephrine before the labour.


Back

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.

Wrong answer

Wrong! This is an absolute emergency, the patient's life is in danger, any delay decreases her chance for survival.


Try again Bury the patient

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.

Correct answer

Correct! Patient needs to be stabilized first. Following the newest guidelines, ephedrine can be applied before labour, noradrenaline only afterwards.


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RR

33 bpm

HR

131 bpm

SpO2

40 %

BP

80/40 mmHg

ECG

not available

Examination:
From history of the patient there were two physiological deliveries, one spontaneous abortion and cardiovascular disease in a family.

Gly

not available

ABG

not available

CBC

not available

biochemistry

not available