Acute Respiratory Failure and Obstetrics
4/10/10
OH
PY Mindmaps
- causes: asthma, pulmonary oedema and infection
Asthma
- can use B2 agonists and corticosteroids without adverse fetal outcome
APO
-
determine cause -> can be from tocolysis with beta-agonists
NIV, diuresis, O2
ETT if required
can be due to tocolytics
ARDS
- low TV and permissive hypercapnia -> fetal acidosis which reduces oxygen binding to fetal
Hb -> try and keep PaCO2 < 45, PaO2 > 70mmHg (no human trials on this to confirm this
management)
- few case reports using NO
- delivery of fetus doesn’t appear to result in marked improving in respiratory failure
Acid Aspiration
- high risk: decreased gastric emptying, increased gastric acidity and volume, increased
abdominal pressure
- bronchoscopy for large pieces
- no role for steroids or BAL
- only use antibiotics in proven infection
Venous Air Embolism
- can occur at any time but more common @ C/S
- air enters subplacental venous sinuses
- sudden SOB, CP, tachycardia, hypoxia -> cardiac arrest
- mill wheel murmur, ST depression
- FiO2 1.0, left lateral and head down, aspirate CVL if in RV, hyperbaric O2 in those with
paradoxical cerebral embolism
Respiratory Distress in Labour + Cardinal Signs
Peripartum cardiomyopathy: cardiomegaly, S3
Jeremy Fernando (2011)
Venous thromboembolism with PE: swollen, painful calf, R heart failure, ECG - S1Q3T3, ST, R
strain, CTPA - filling defect
AFE: Haemodynamic collapse, DIC, seizure, bleeding
Air embolism: hypotension, cardiac mill wheel murmur
Pre-eclampsia: HTN, proteinuria
Tocolytic pulmonary oedema: Tocolytic administration, rapid improvement
Aspiration penumonitis: Hx od vomiting or silent aspiration, CXR findings
Pneumomediastinum: occurs during delivery
Other causes as in non-pregnant patient
Jeremy Fernando (2011)