PRIMARY AND SECONDARY ABCD SURVEYS
2005 ECC Guidelines
Airway - no modifications
Breathing - no modifications
Place patient on her left side with her
neck angled back approximately 15 to 30 degrees back from the left lateral
position. Then start chest compressions.
Place a wedge under her right side to tilt her to her left side
Have one rescuer kneel next to the woman’s left side and pull her
gravid uterus laterally. This maneuver is designed to relieve pressure on her inferior vena cava .
No modifications to dose or pad placement
Defibrillation shocks transfer no significant current to the fetus.
Be sure to remove any fetal or uterine monitors before shock delivery.
Assure that all team members are clear of patient before delivering
Insert advanced airway early in the resuscitation attempt to reduce the
risk of aspiration and regurgitation.
Airway edema and swelling may reduce the diameter of the trachea. Be prepared
to use a tracheal tube that is slightly smaller than the one you would normally use on a non-pregnant woman of similar size.
Monitor for excessive bleeding following insertion of any tube into the
oropharanx or nasopharanx.
No modifications to intubation techniques. A provider experienced in intubation
should insert the tracheal tube.
Effective pre-oxygenation is critical because hypoxia can develop quickly.
Rapid Sequence intubation (RSI) with continous cricoid pressure is the preferred
Anesthesia or deep sedation medications should by selected to minimize hypotension
No modifications of confirmation of tube placement. Note that the
esophageal detector may suggest esophageal placement despite correct placement .
The gravid uterus elevates the diaphragm:
Patients can develop
hypoxemia if either oxygen demand or pulmonary function is compromised. They have
less reserve because residual capacity and functional residual volume are decreased. Minute ventilation and tidal volume are
Tailor ventilatory support
to produce effective oxygenation and ventilation.
Follow standard ACLS recommendations
for administration of all resuscitation medications.
DO NOT use the
femoral vein or other lower extremity sites for venous access. Drugs administered through these sites may not reach the maternal
heart unless or until the fetus is delivered.
Differential Diagnosis and Decisions
1. Decide whether to perform emergency hysterectomy.
and treat reversible causes of the arrest. Consider pregnancy related causes and those considered for all ACLS patients, e.g.
6 H’s & 6 T’s.