Managing Obstetric Emergencies and Trauma: The MOET Course Manual

Description

Obstetric emergencies are unplanned and often unanticipated. Management requires a clear understanding of the life-saving and damage-limiting treatments that can be implemented. Includes four new chapters: recognising the seriously sick pregnant patient; intravenous access and fluid replacement; medical emergencies; and human factors Content has been fully updated to reflect current best-practice and treatment guidelines Essential reading for all candidates attending the Managing Obstetric Emergencies and Trauma course Reviews & endorsements 'This book is a concise, well-written, and organized compendium of diagnostic and clinical tools that can be used to assess and manage obstetric emergencies. Improving provider recognition and management of maternal emergencies is of the utmost importance, as maternal mortality remains high, with approximately 330,000 maternal deaths worldwide in 2015 alone. Despite being intended as a course manual, this book is an excellent standalone text and a good resource for perinatal providers both in the United Kingdom and the United States.' J. Bradley Bavaro, Anesthesia and Analgesia Cover......Page 1 Title Page......Page 3 Copyright Page......Page 4 Dedication......Page 5 Table of Contents......Page 7 Working Group......Page 9 About the authors......Page 11 Acknowledgements......Page 14 Abbreviations......Page 15 Section 1: Introduction......Page 19 1. Introduction......Page 21 How the Enquiries work......Page 25 Lessons from the past......Page 26 Recent lessons......Page 28 The international dimension......Page 33 Summary......Page 34 Introduction......Page 35 Summary......Page 39 Section 2: Recognition......Page 41 Introduction......Page 43 Modified early-warning systems......Page 44 Clinical symptoms that may represent underlying serious illness including red flag symptoms (from Saving Mothers’ Lives 2011):......Page 48 Summary......Page 51 Appendix 4A......Page 52 Radiology in the pregnant woman......Page 53 Introduction......Page 57 Types of shock: specific pathophysiology......Page 58 Types of shock: clinical issues and clinical management......Page 62 Summary......Page 67 Introduction and incidence......Page 69 Microbiology......Page 71 Pathophysiology of sepsis......Page 72 Clinical issues and presentation......Page 73 Monitoring and investigations......Page 74 Management......Page 75 Other therapies likely to be commenced in the ICU setting......Page 79 Summary......Page 81 Intravenous access......Page 83 Alternatives to peripheral venous access......Page 84 Intravenous fluid administration......Page 88 Types of intravenous fluid......Page 89 Guiding fluid replacement......Page 94 Advanced monitoring techniques......Page 96 Fluid administration in special circumstances......Page 97 Summary......Page 99 Section 3: Resuscitation......Page 101 Introduction......Page 103 Airway assessment......Page 104 Airway management......Page 106 Advanced airway techniques......Page 109 Management of ventilation......Page 114 Summary......Page 115 Oropharyngeal airway insertion......Page 116 Insertion of the LMA (A first generation SAD)......Page 117 Surgical cricothyroidotomy......Page 119 Needle cricothyroidotomy......Page 121 Introduction and incidence......Page 127 Management......Page 128 Follow the advanced life support algorithm......Page 132 Physiological changes in pregnancy affecting resuscitation......Page 134 Peri-arrest/perimortem caesarean section to improve chances of maternal survival......Page 135 Medico-legal concerns......Page 136 Summary......Page 137 Incidence......Page 139 Clinical manifestations......Page 140 Symptoms and signs......Page 141 Diagnosis......Page 142 Management......Page 143 Summary......Page 145 Introduction and incidence......Page 147 Clinical presentation of pulmonary embolism......Page 149 Postnatal anticoagulation and review......Page 154 Normal physiology......Page 157 Pathophysiology......Page 159 Equipment......Page 161 Resuscitation of the newborn baby......Page 167 Tracheal Intubation......Page 174 Laryngeal Mask Airway (LMA)......Page 175 Summary......Page 180 Section 4: Trauma......Page 183 13. Introduction to trauma......Page 185 The obstetrician and midwife as part of the trauma team......Page 186 Summary......Page 187 Introduction......Page 189 Domestic abuse and pregnancy......Page 190 Summary......Page 192 Introduction......Page 197 Initial assessment and management......Page 198 Summary......Page 201 Chest drain insertion......Page 202 Introduction......Page 205 Primary survey and resuscitation......Page 207 Secondary survey......Page 210 Summary......Page 211 Causes of decreased level of consciousness......Page 213 Principles of treatment......Page 214 Priorities in management to prevent secondary brain injury......Page 215 Types of head injury......Page 219 Summary......Page 223 Introduction......Page 225 Immobilisation techniques......Page 226 Principles of treatment......Page 230 Summary......Page 231 Cervical spine immobilisation......Page 232 Application of a cervical collar......Page 233 Log-rolling......Page 234 Life-threatening injuries: primary survey......Page 237 Limb-threatening injuries: secondary survey......Page 239 Summary......Page 242 Pathophysiology of burns......Page 245 Primary survey and resuscitation......Page 247 Secondary survey and definitive care......Page 249 Summary......Page 250 Section 5: Other medical and surgical emergencies......Page 251 Background and incidence......Page 253 Clinical approach to diagnosis: history, examination, investigation......Page 255 Clinical management......Page 259 Summary......Page 262 Introduction and incidence......Page 265 Acquired heart disease......Page 266 Service provision for women with heart disease......Page 271 Diabetes in pregnancy......Page 274 Hypoglycaemia......Page 275 Service provision for women with diabetes......Page 276 Headache......Page 280 Seizures......Page 284 Other causes of headache......Page 285 Summary......Page 288 Introduction......Page 291 Implications for obstetric practice......Page 294 Summary......Page 298 Section 6: Obstetric emergencies......Page 299 Introduction......Page 301 Management of severe pre-eclampsia and eclampsia......Page 302 Initial assessment of the woman......Page 303 Antepartum and intrapartum management......Page 306 Management of imminent eclampsia or eclampsia......Page 315 Summary......Page 317 Maternal mortality and incidence of major haemorrhage......Page 321 Major causes of obstetric haemorrhage (primary or secondary)......Page 322 Practical management......Page 323 Management......Page 324 Tone......Page 326 Tissue and trauma......Page 329 Anaesthetic management for obstetric haemorrhage......Page 330 Patients declining blood and blood products......Page 331 Summary......Page 333 Introduction......Page 337 Anticipating problems in specific circumstances......Page 338 Summary......Page 345 Placenta accreta......Page 349 Retained placenta......Page 353 Summary......Page 354 Recognition......Page 357 Management......Page 358 Summary......Page 360 Incidence and predisposing factors......Page 363 Summary......Page 366 Introduction......Page 371 Indications for OVD......Page 372 Ventouse/vacuum......Page 375 Forceps......Page 380 Method of delivery with traction forceps......Page 381 Supervising an instrumental delivery......Page 387 Introduction......Page 393 Clinical risks and outcomes......Page 394 Clinical approach......Page 396 Summary......Page 403 Introduction......Page 407 Clinical management......Page 408 Summary......Page 410 Introduction......Page 413 Clinical approach......Page 414 Summary......Page 416 External cephalic version......Page 419 Performance of ECV......Page 421 Vaginal breech delivery......Page 423 Conduct of labour......Page 424 Conduct of the delivery......Page 425 Failure to deliver......Page 428 Summary......Page 431 Introduction......Page 435 Presentation......Page 436 Intrapartum management of vaginal twin delivery......Page 437 Summary......Page 439 Introduction......Page 441 Repair of perineal trauma......Page 442 Summary......Page 450 Introduction......Page 455 Symphysiotomy......Page 456 Destructive procedures......Page 457 Summary......Page 460 Difficult intubations – prevention better than cure......Page 463 Regional blocks (epidural and spinal anaesthesia and analgesia)......Page 465 Summary......Page 475 Section 7: Triage and transfer......Page 477 Introduction......Page 479 Assessment of the pregnant woman......Page 481 Summary......Page 484 The ACCEPT systematic approach to patient transfer......Page 485 Summary......Page 491 Section 8 Human issues......Page 493 Introduction......Page 495 Error chains......Page 496 Communication......Page 498 Situation awareness......Page 501 Fatigue......Page 503 Decision making......Page 504 Summary......Page 505 When is consent required?......Page 507 Why is consent required? The legal and ethical considerations......Page 508 Sufficient information......Page 509 Capacity......Page 510 Lack of capacity for consent: incompetence......Page 511 The Mental Capacity Act......Page 512 Status of the fetus......Page 514 Voluntarily given consent......Page 515 Summary......Page 516 Index......Page 519