WORKPLACE NURSES LLC

PRIMARY AND SECONDARY ABCD SURVEYS

MODIFICATIONS FOR PREGNANCY

2005 ECC Guidelines

PRIMARY ABCD SURVEY

Airway - no modifications necessary

Breathing - no modifications necessary

Circulation

·         Place patient on her left side with her  neck angled back  approximately 15 to 30 degrees back from the left lateral position. Then start chest compressions.

OR

·         Place a wedge under her right side to tilt her to her left  side

OR

·         Have one rescuer kneel next to the woman’s left side and pull her gravid uterus laterally. This maneuver is designed to relieve pressure on her inferior vena cava .

Defibrillation

·         No modifications to dose or pad placement

·         Defibrillation shocks transfer no significant  current to the fetus.

·         Be sure to remove any fetal or uterine monitors before shock delivery.

·         Assure that all team members are clear of patient before delivering defibrillation shock.

SECONDARY ABCD SURVEY

Airway

·         Insert advanced airway early in the resuscitation attempt to reduce the risk of aspiration and regurgitation.

·         Airway edema and swelling may reduce the diameter of the trachea. Be prepared to use a tracheal tube that is slightly smaller than the one you would normally use on a non-pregnant woman of similar size.

·         Monitor for excessive bleeding following insertion of any tube into the oropharanx or  nasopharanx.

·         No modifications to intubation techniques. A provider experienced in intubation should insert the tracheal tube.

·         Effective pre-oxygenation is critical because  hypoxia can develop quickly.

·         Rapid Sequence intubation (RSI) with continous cricoid pressure is the preferred technique.

·         Anesthesia or deep sedation medications should by selected to minimize hypotension

Breathing

·         No modifications of confirmation of tube placement. Note that the esophageal detector may suggest esophageal placement despite correct placement .

·         The gravid uterus elevates the diaphragm:

·          Patients can develop hypoxemia if either oxygen demand or pulmonary function is compromised. They  have less reserve because residual capacity and functional residual volume are decreased. Minute ventilation and tidal volume are increased.

·          Tailor ventilatory support to produce effective oxygenation and ventilation.

Circulation

·         Follow standard ACLS  recommendations for administration of all resuscitation medications.

·         DO NOT  use the femoral vein or other lower extremity sites for venous access. Drugs administered through these sites may not reach the maternal heart unless or until the fetus is delivered.

Differential Diagnosis and Decisions

1.      Decide whether to perform emergency hysterectomy.

2.      Identify and treat reversible causes of the arrest. Consider pregnancy related causes and those considered for all ACLS patients, e.g. 6 H’s & 6 T’s.