Transcript ALERT everyone in room of Shoulder Dystocia

Perinatal Critical Event Guide
DRAFT – Nov 2012 SCAL Lurvey, Retta, Osborn, Fox Lee
1: Shoulder Dystocia
Condition: Arrested delivery
Objective: Deliver infant
 ALERT everyone in room of Shoulder Dystocia
1
Note time (Press Apgar timer, or Mark on strip)
 CALL for help
 Second provider
Maneuvers
•McRoberts: hyperflex thighs & abduct hips
•Suprapubic pressure: push shoulder in direction of face
 NICU team
 More Nurses
•Woods Screw: pressure to posterior shoulder, rotate 180o
•Delivery of posterior arm: Insert hand posteriorly
& sweep arm across the chest and into vagina
•Gaskin: patient on all 4 hands and knees
 Consider Anesthesia
•Zavanelli: manually flexing and replacing head into
uterus
 Get stool for Suprapubic Pressure
 After 2 minutes, call to open OR
All reasonable precautions have been taken to verify the information contained in this publication. The responsibility for the interpretation and use of the material lies with the reader.
Perinatal Critical Event Guide
DRAFT – Nov 2012 SCAL Lurvey, Retta, Osborn, Fox Lee
3. Eclamptic Seizure
Condition: Eclamptic seizure
Objective: Stablize mother, monitor fetal heart rate, treat the
seizure
 ALERT everyone in room of Seizure
 CALL for help
 Second provider
 Anesthesia
 More Nurses
Don’t forget your ABCs
• Airway (assess and secure)
• Breathing (100% FiO2)
• Circulation (adequate IV access)
3
 ASSIGN Recorder (Charge Nurse)
 If postpartum, secure infant
 VITAL SIGNS: BP, O2, Fetal Heart Rate
 ABCs
 Position airway to keep open, Place oxygen
 Position patient on side to prevent aspiration
Fetal Heart Rate
• Expect a deceleration
• Stabilize mom first
• If bradycardia remains for 3-4 minutes
after seizure resolves, consider C-section
 Monitor Fetal heart rate, Expect a deceleration
 Magnesium, 4g loading dose
 Antihypertensives
 Labetalol 20mg, 40mg, 80mg every 10 minutes, Max 220mg
 Hydralazine 5mg, 10mg every 15-20 minutes
All reasonable precautions have been taken to verify the information contained in this publication. The responsibility for the interpretation and use of the material lies with the reader.
Perinatal Critical Event Guide
DRAFT – Nov 2012 SCAL Lurvey, Retta, Osborn, Fox Lee
Condition: Failed airway (2 unsuccessful attempts or oxygen
6: Neonatal Resuscitation
saturation less than 85%).
Objective: Establish adequate oxygenation/ventilation.
 CALL Code PINK
NRP
 Start Apgar Timer when baby out
HR <60
Chest compressions AND PPV
HR
60-100
PPV
only
ASSIGN Recorder (Charge Nurse)
 Bring in NICU Rapid Response Cart (Green)
 Stimulate, warm and dry infant for 30 sec
 VITAL Signs: HR, O2
 Not breathing/Grunting or HR <100
 Start bagging baby (Positive Pressure Ventilation)
 Make sure Bagging is effective
 If not, DON’T MOVE ON. Troubleshoot equipment and seal on baby
Reasses HR and O2 every 30 seconds
 If HR < 60, start Chest compressions and continue Bagging
 If HR between 60 and 100, Continue Bagging baby
Continue Bagging or compressions until help arrives
6
SpO2 after birth
1 min
2 min
3 min
4 min
5 min
10 min
60-65%
65-70%
70-75%
75-80%
80-85%
85-95%
All reasonable precautions have been taken to verify the information contained in this publication. The responsibility for the interpretation and use of the material lies with the reader.
Perinatal Critical Event Guide
DRAFT – Nov 2012 SCAL Lurvey, Retta, Osborn, Fox Lee
Condition: Acute massive bleeding.
8: Postpartum Hemorrhage
 ALERT everyone in room of Hemorrhage
Objective: Stop bleeding, maintain hemodynamic stability,
avoid coagulopathy and hysterectomy.
INTERVENTIONS BY PROVIDER
•Medications: Pit, Methergine, Misoprostol, Hemabate
 CALL for help
•Exam, Remove clots
 Second provider
•Bakri Balloon
 Anesthesia
•D&C
 More Nurses
•Consider Interventional Radiology
•OR Interventions (B-Lynch, O’Leary, Hysterectomy)
 ASSIGN Recorder (Charge Nurse)
 Secure baby
•If provider requests labs drawn:
 VITALS – BP, HR, O2, QBL
• CBC, Lytes, INR/PTT, Fibrinogen, Lactate
 Hemorrhage Kit/Cart and Bakri Balloon in Room
 IV Second Line, Bolus 2 NS or LR (warm fluids or warm patient)
Give Hemostatic agents, only one of each
Consider Causes of PPH
 VITALS Q 5 MINUTES, Call Out and Record
 QBL update if bleeding continues
 Foley Cath (Record initial amount of urine)
TONE: Bakri Balloon or B-Lynch IF ATONY
TISSUE: D&C IF Retained Products
TRAUMA: Repair of Laceration IF Trauma
THROMBIN: Massive Transfusion (recom factor VIIa) IF DIC
TRANSFUSION BEGINS - RATIO 4 PRBCS: 4 FFP: 1 PLTS
8
 Activate OB Hemorrhage protocol for Blood loss >1500ml or VS changes
 After 4 units PRBCs, add 4 units FFP and 1 unit platelets
 Bleeding continues: Insert Bakri Balloon
 Bleeding continues: Move to OR for surgical intervention
All reasonable precautions have been taken to verify the information contained in this publication. The responsibility for the interpretation and use of the material lies with the reader.