You are working as a double paramedic crew with a Student Paramedic on an EA. You receive a call to 32-year-old female who is query in cardiac arrest. Further information is that the patient is 34 weeks pregnant. The address is 7 minutes away. Control informs you that a second ambulance and an RRV with an Advanced Paramedic Practitioner on board are also on route, but will be 15 minutes.
You arrive at scene and see the partner of the patient frantically shouting at you from the upstairs window. You quickly collect all necessary equipment, enter the house, and go upstairs. You walk into the bathroom where the partner is doing CPR on the patient. He explains that the patient was in the bath, she has been diagnosed with pre-eclampsia, he could hear some commotion and when he came to check on her, she was under the water. He’s pulled her out of the water and she wasn’t breathing, so called 999 and started chest compressions.
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The student takes over chest compressions as you place defibrillator pads on the patient. Your initial rhythm shows Asystole. Your colleague starts looking for IV access as you set up a BVM and ventilation kit. What considerations need to be in place for chest compressions
You explain the need for manual displacement and tilt. The patients’ partner is willing to apply the manual displacement, and you place a rolled-up towel underneath the patients’ lower right back to create a tilt. In an ideal circumstance, what degree of angle should the tilt be
You attempt ventilations with the BVM, and give 5 initial ventilations to cover the drowning aspect. You are getting rise and fall of the chest, but there is some resistance due to the pregnancy and pressure on the diaphragm. Early consideration for what airway adjunct is recommended within this scenario
Which of the following are complications that can be associated with airway support and pregnancy
You manage to intubate the patient with little difficulty using a video laryngoscope device. You utilise an automatic ventilator and adjust the settings to accommodate and effectively ventilate the patient. Your colleague has gained IV access and started ALS drugs. You come to the end of your first cycle and check the rhythm, which is still Asystole. You advise you will take over the chest compressions from the student while they assist your colleague.
As you are doing chest compressions you note it is difficult to maintain a central chest compression position with your hands due to the position of the fundus. What is acceptable to do in this circumstance
Your colleague goes through the elements of the 4 H’s and T’s whilst managing drug administrations. What dose of Adrenaline 1:10000 IV is recommended for a pregnancy cardiac arrest
You have completed your second cycle and the patient is still in Asystole. Your colleague takes over compressions. What should you now be considering in this scenario
In a pregnancy arrest, it is recommended that a time critical transfer to an ED (ideally with an obstetrics unit) should be undertaken if there is no response to CPR after
You can hear the additional resources arriving outside and you instruct your student to handover the situation, and ask them to bring up extrication devices. With the additional support, you quickly extricate the patient into the back of the Ambulance and pre-alert into hospital. At the ED, you handover the resuscitation to the awaiting team. You all decontaminate from the job, and an Ambulance Support Officer arrives to debrief you and discuss the scenario. Support is important following difficult cases. Who else must you consider could be affected by the scenario
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