Obstetric Patient Hot Case

GENERAL APPROACH

  • Illness requiring ICU admission
  • Pregnancy + Baby
  • Delivery – when or already done

INTRODUCTION

CUBICLE

  • CTG
  • presence of midwives

INFUSIONS

  • PET: MgSO4, phenytoin, hydralazine, GTN
  • pre-term labour: tocolytics, steroids
  • thromboembolism: heparin
  • bleeding: blood products, fluid boluses, TXA
  • cardiogenic shock: inotropes

VENTILATOR

  • mode
  • level of oxygenation: high FiO2, PEEP (pulmonary oedema)
  • bronchospastic ventilation: asthma
  • remember normal PaCO2 = 27-32mmHg and pH 7.47
  • if spontaneously breathing: expect increased TV, RR, MV and reduced ETCO2
  • increased A-a gradient with normal compliance: PE

MONITOR

  • PET: hypertension
  • PE: high CVP
  • fever: sepsis, SIRS, drug fever

EQUIPMENT

  • bleeding: large bore IV access
  • PET: invasive monitoring
  • CTG: fetal well being
  • uterine bleeding: angiocatheter sheath in femoral artery

QUESTION SPECIFIC EXAMINATION

  • hands/arms -> head -> chest -> abdo -> legs/feet -> back

-> general:
-> cardiovascular:
-> respiratory:
-> abdominal: fundal height, presenting part, lie, liquor volume, Caesarian scar

  • neurological: unconscious or conscious
  • HELLP: bruising/ecchymoses/petechiae:
  • fatty liver of pregnancy: jaundice
  • lower limb DVT
  • ovarian hyperstimulation syndrome: oedema, pleural effusions, ascites
  • PET: reflex for Mg toxicity, ask whether patient had a seizure
  • pregnancy: gestational age and progress, results of vaginal examination
  • steroids given pre-delivery
  • if mother already delivered, ask about health status of child

RELEVANT INVESTIGATIONS

  • CTG: heart rate, decelerations
  • fetal U/S

OPENING STATEMENT

=

  • Global statement
  • Mother
  • Pregnancy + Baby
  • Complications
  • How to progress from here

CCC 700 6

Critical Care

Compendium

Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also the Innovation Lead for the Australian Centre for Health Innovation at Alfred Health, a Clinical Adjunct Associate Professor at Monash University, and the Chair of the Australian and New Zealand Intensive Care Society (ANZICS) Education Committee. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE.  He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.

His one great achievement is being the father of two amazing children.

On Twitter, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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