Presentation is loading. Please wait.

Presentation is loading. Please wait.

ACLS-OB A Maternal Code Are You Ready?

Similar presentations

Presentation on theme: "ACLS-OB A Maternal Code Are You Ready?"— Presentation transcript:

1 ACLS-OB A Maternal Code Are You Ready?
Angie Rodriguez ARNP, CS, MSN, CNM, RNC-OB Kerry Foligno RN, BSN, CLC, CPST

2 Advanced Cardiac Life Support with an Obstetric Focus
ACLS-OB Advanced Cardiac Life Support with an Obstetric Focus

3 Why ACLS-OB Based on AHA guidelines 2010
The best hope of fetal survival is maternal survival

4 Why ACLS-OB Education, preparation and practice are the keys to delivering the safest care for mom and her baby. ACLS-OB includes AHA core cases and algorithms but utilizes specific scenarios that include modifications for pregnant and newly delivered patients.

5 ACLS-OB Can lightening strikes be prevented? Rapid response teams
Chain of survival Recognition of arrest Activation of EMS/Code Blue BLS AED/ACLS

6 Our Journey at MHW Attended National Convention- booth
Requested - Rejected, Persisted 4 staff nurses/CM’s-went to Idaho 2009 Magnet journey Brought it back and implemented the program All L&D staff attended from all three facilities Instructor trainer

7 Are arrhythmias serious?
Arrhythmias may be benign, symptomatic, life threatening or even fatal.

8 ACLS-OB the patient clinically and how are we going to treat the
The most important question is not just What is the Rhythm …but How is this rhythm affecting the patient clinically and how are we going to treat the rhythm??

9 Treatable Rhythms Shockable Nonshockable
1. Lethal (pulseless) rhythms Shockable Nonshockable 2. Non-lethal (with a pulse) rhythms

10 Lethal rhythms Shockable Non-Shockable Ventricular Fibrillation
Pulseless Ventricular Tachycardia Non-Shockable Pulseless Electrical Activity Asystole

11 Shockable Lethal Rhythms
Ventricular Tachycardia (Pulseless) Ventricular Fibrillation

12 Ventricular Tachycardia

13 Ventricular Tachycardia

14 Ventricular Fibrillation
No organized electrical activity

15 Ventricular Fibrillation
Coarse Coarse VF

16 Ventricular Fibrillation
Fine Fine VF

17 Pharmacologic Treatment of Ventricular Fibrillation & Ventricular Tachycardia (Pulseless)
Vasopressors: Epinephrine 1mg. IVP/IO – 1:10,000 solution Repeat every 3 – 5 minutes Optimizes cardiac and cerebral blood flow Vasopressin To replace 1st or 2nd dose of Epinephrine 40 Units IV/IO

18 Pharmacologic Treatment of Ventricular Fibrillation/V-Tachycardia
Antiarrhythmics – Give during CPR (before or after the shock) Amiodarone – 300 mg (recommend dilution in mL D5W) IV/IO push once, then consider additional 150mg IV/IO once , then followed by IV drip or only after perimortem delivery Lidocaine – 1 to 1.5 mg/kg first dose, then 0.5 to 0.75 mg/kg IV/IO, maximum 3 doses or 3mg/kg

19 Nonshockable Lethal Rhythms
Asystole Pulseless Electrical Activity


21 Pulseless Electrical Activity

22 Pharmacologic Treatment of PEA and Asystole
Epinephrine – 1 mg IV/IO Repeat every 3 to 5 minutes OR Vasopressin – 40 Units to replace 1st or 2nd dose of epinephrine

23 Treat the patient, not the monitor
Signs and symptoms such as: Low blood pressure Altered mental status Shortness of breath Chest pain or angina Signs of shock

24 Non-Lethal Arrhythmias (With a pulse)
Tachyarrhythmias Sinus Tachycardia Supraventricular Tachycardia Ventricular tachycardia (with a pulse) Bradyarrhythmias Sinus Bradycardia Blocks

25 Too Fast More than 100 beats per minute Stable or Unstable ??????????

26 Sinus Tachycardia

27 Supraventricular Tachycardia (SVT)

28 Pharmacologic Treatment of SVT
Narrow Complex – Regular Vagal Manuevers Adenosine 6mg IV rapid push. If no conversion then give Adenosine 12 mg IV rapid push, Synchronized Cardioversion joules

29 Ventricular Tachycardia

30 Ventricular Tachycardia
Question- is there a pulse Yes- synchronized cardioversion No- start CPR, Airway management, defibrillate and or meds

31 Too Slow Defining symptomatic bradycardia
Emphasize this point: do not treat a slow heart rate in a stable patient. Emphasize history as the way to decide if the condition is acute or chronic. Emphasize this point: treating the symptoms is the most important concept. Relative bradycardia exists when a hypotensive patient “needs” a faster heart rate, but the rate cannot accelerate due to sinus node disease, conduction system disease, or -blockers. Resting athletes may have sinus rates <40 bpm and still be completely asymptomatic. Patients with inferior MI frequently have sinus bradycardia with or without chest pain. Will the ischemia be alleviated or worsened by increasing the rate? Usually the bradycardia is not the cause of the chest pain. Treat if clearly detrimental symptoms are present (hypotension/shock, decreased level of consciousness, sudden increased pain associated with decreased rate, CHF, or adrenergic symptoms such as pallor and cool, clammy periphery).

32 Sinus Bradycardia Rhythm Regular

33 Pharmacologic Treatment of Non-Lethal Bradyarrhythmias
Symptomatic?? YES – Altered mental status, chest pain, hypotension, other signs of shock Atropine 0.5 mg IV. May repeat to a total dose of 3 mg. Prepare for transvenous pacing Set rate Set current-(MA) increase by 5 or 10 until capture

34 Review for most frequent causes
H’s and T’s Review for most frequent causes 1 Hypovolemia Hypoxia Hydrogen ion —acidosis Hyper-/hypokalemia Hypothermia Tablets” (drug OD, accidents) Tamponade, cardiac Tension pneumothorax Thrombosis, coronary (ACS) Thrombosis, pulmonary (embolism)

35 Perimortem Cesarean Kit
Knife handle with #10 blade Kelly clamos Mayo scissors Bandage scissors Tooth forceps Needle holders Sutures Laparotomy sponges Clear plastic abdominal drape IV pitocin Normal saline vials Syringes with needle

36 Highest Risk of Cardiopulmonary Arrest
Tocolytic therapy Infection Anesthesia Gestational HTN Substance abuse Thyroid storm Surgery and tissue trauma Cardiac anomalies Polyhydramnios Multiple gestation Prior uterine surgery Hemorrhage

37 Maternal Cardiopulmonary Arrest
Preexisting medical conditions Asthma Hypertension Diabetes Lupus etc Cardiac issues MVP Status post MI Atherosclerosis Preexisting structural defects

38 Maternal Cardiopulmonary Arrest
Accidents/Trauma MVA, Stabbings, Gunshot Domestic Violence Drug use/ Overdose Pregnancy related issues Preeclampsia/eclampsia Uterine placental emergencies resulting in hemorrhage Uterine atony Alterations in clotting Cardiomyopathy Anaphylactoid syndrome of pregnancy

39 Maternal Cardiopulmonary Arrest
Anesthesia incidents Intubation complications Suicidal attempts Medication issue

40 Maternal Contributing Factors BEAU-CHOPS
B-leeding/DIC E-mbolism: coronary/pulmonary/amniotic fluid A-nesthesia- complications U-terine atony C-ardiac disease- MI. cardiomyopathy/ischemia/aortic H-ypertension- preeclampsia/eclampsia O-ther: usual differential diagnosis P-lacenta: abruption/previa S-epsis

41 ACLS OB Contributing factors (A CUB HOPES)
A-nesthesia C-ardiac disease U-terine atony B-leeding H-ypertension O-ther P-lacenta E-mbolism S-epsis

42 OB Considerations Search for pregnancy specific Defibrillation
H’s and T’s Defibrillation Remove fetal monitors

43 OB Considerations Meds Vasopressors Antiarrhythmics Epi Vaso
Amiodarone-class D Lidocaine-class B Mag Sulfate-class A

44 OB Considerations Fibrinolytics
relative contraindications-pregnancy and immediate postpartum due to increased risk of bleeding Amiodarone Half life- 40 days Avoid in pregnancy- fetal hypothyroidism Use lidocaine- if weeks Ok for gestational age less than 24 weeks or postpartum

45 Modifications for Pregnancy
Higher hand placement of chest Use pulse checks to confirm efficacy of compressions Uterine displacement Timing -for perimortem C/S delivery No fibrinolytics Amiodarone- less than 24 weeks or after delivery of fetus

46 Modifications for Pregnancy
Early advanced airway Complicated intubation Jaw thrust Cricoid pressure/Sellick maneuver Smaller ETT if needed Altered location of confirmatory lung sounds

47 Modifications for Pregnancy
Increased resistance with bag mask ventilation Remove fetal monitors prior to cardioversion, defibrillation Increase paddle pressure if using paddles- use hands free is preferred Maternal Tilt

48 Potential Causes for Stroke
Hemorrhagic stroke Ischemic stroke Hypertensive encephalopathy Preeclampsia or eclampsia Intracranial mass Meningitis/encephalitis Seizure Migraine Craniocerebral/cervical trauma Metabolic conditions Hypo, hyperglycemia, drug overdose

49 Pulseless VT /VF CPR and defibrillation
Vasopressor and 2nd defibrillation Antiarrhythmic and 3rd defibrillation

50 How do I become an ACLS-OB Instructor

51 How do I become an ACLS-OB Instructor
Become an ACLS instructor in your area Take the on-line Core Instructors course from AHA- (manual purchased from AHA) Attend a one day ACLS instructor class Attend two day ACLS-OB provider class  Do teachback class in your area Set up program with your Organizational Development department- CEU’s etc Offer first class for managers, charge staff

52 Implementing ACLS-OB program at your facility

53 Implementing ACLS-OB program at your facility
Two day provider course- initially Followed by one day renewal Train ACLS instructors Anesthesia, ED, other educators Mock simulations on the units

54 Implementing ACLS-OB program at your facility
Limit class size to 6 participants per 2 instructors Read scenario/run simulator Grade and debrief Organize paperwork into a file box Laminate practice and megacode scenarios ECG simulator- $ x 2 Mannequin, Sample meds, Ambu bag, ETT, Stethescope, IV bag/tubing, O2 mask, Monitor belts, Internal Monitors, Airway, CO2 detector, bathing suit with low transverse incision, baby, placenta.

55 Considerations Unit specific criteria for instructors Hospital Budget
Target audience Administrative /Management challenges Supplies, Equipment- Funding??? Startup investment/regulatory issues

56 Hope you don’t feel like this

Download ppt "ACLS-OB A Maternal Code Are You Ready?"

Similar presentations

Ads by Google