drduck
Forum Guru
Topics: 82
Posts: 529
|
female undergoing amniocentesis......develops amniotic fluid embolism.
what is your next best step,
-low molecular wt. heparin
-intravenous fluid
-induction of labour
-I/V diazepam
-intubation and mechanical ventilation.
|
| Aashi
Forum Moderator
Topics: 113
Posts: 1,060
|
Respiratory support is of gr8 value in pts that develop AF embolism, so I would go for intubation and MV
___________________
"Obstacles are those frightful things you see when you take your EYES off your goal."
|
| farnsworth
Forum Newbie
Topics: 0
Posts: 165
|
good one!
If the world was all black and white: ABCDE! -> airway/breathing (intubate and ventilate), cardiocirculatory support.
Considering different shades of gray (or the world in color vision!):
As long as the patient is alert and has only mild-moderate respiratory distress, but is cardiocirculatory-wise compromised: go for B, rationale: optimizing right ventricular preload. Pulmonary hypertension occurs, some reports exist, that cardiopulmonary bypass and inhaled pulmonary vasodilators are effective. Systemic vasopressors are likely needed.
If situation deteriorates (severe respiratory distress): intubate, ventilate
further considerations: some authorities suggest that amniotic fluid embolus is an anaphylactoid reaction. Keep application of epinephrine, corticosteroids, H1/H2-receptor blockers in mind!
Monitor right ventricular preload (central line), in severely compromised patients: TEE (or PAC, if TEE unavailable), coagulatory monitoring (hypercoagulatory status should be exspected, patient probably needs FFPs, sometimes PLTs, PRBCs). Invasive blood pressure monitoring.
|
| nany
Forum Guru
Topics: 14
Posts: 989
|
E
___________________
" You Are Limited Only By What You Think "
|
| drduck
Forum Guru
Topics: 82
Posts: 529
|
very nice,
everyone sticking to the basics,
except me, as i went for heparin in a hurry.
|
| Ivonne
Live your dreams
Topics: 57
Posts: 1,591
|
___________________
"The question isn't who is going to let me; it's who is going to stop me. " ~ Ayn Rand
|
| Ujk
Forum Guru
Topics: 42
Posts: 446
|
e
___________________
“When a person really desires something, all the universe conspires to help that person to realize his dream.”
|
|
| |
| | | | | | | |
