The collapsed parturient

2020 ◽  
pp. 535-568
Author(s):  
Rachel Collis

This chapter covers a wide spectrum of causes for collapse on the labour ward or in the emergency department, for the first steps in management. The latest guidance on the management of cardiac arrest which the obstetric anaesthetist will be required to immediately attend and initiate in a pregnant woman is described in detail, with the steps needed to progress to perimortem caesarean delivery if resuscitation is not immediately effective. The serious complications of regional anaesthesia; high blocks, total spinals, and local anaesthesia toxicity are emphasized. Anaphylaxis, magnesium toxicity, and management of trauma in the obstetric patient are also outlined.

2020 ◽  
pp. 455-468
Author(s):  
Lucy de Lloyd ◽  
Sarah Bell

Sepsis is a leading overall cause of direct and indirect maternal death in the UK. Successive recent confidential enquires have highlighted the importance of early recognition of sepsis markers, prompt initiation of treatment, and continuing monitoring to recognize further deterioration. The obstetric anaesthetist is key in leading the team in the management of any sick pregnant woman who presents to labour ward or the emergency department. This chapter includes sections on the assessment and identification of the septic mother, with a list of sepsis ‘red flag’ symptoms and signs, where immediate escalation in treatment is required. The sources and causes of sepsis are described. Management of sepsis on labour ward and transfer, if necessary, of the critically ill mother and management within critical care facilities are explained.


Author(s):  
Giorgio Cozzi ◽  
Marta Cognigni ◽  
Riccardo Busatto ◽  
Veronica Grigoletto ◽  
Manuela Giangreco ◽  
...  

AbstractThe objective of the study is to investigate pain and distress experienced by a group of adolescents and children during peripheral intravenous cannulation in a paediatric emergency department. This cross-sectional study was performed between November 2019 and June 2020 at the paediatric emergency department of the Institute for Maternal and Child Health of Trieste, Italy. Eligible subjects were patients between 4 and 17 years old undergoing intravenous cannulation, split into three groups based on their age: adolescents (13–17 years), older children (8–12 years), and younger children (4–7 years). Procedural distress and pain scores were recorded through validated scales. Data on the use of topical anaesthesia, distraction techniques, and physical or verbal comfort during procedures were also collected. We recruited 136 patients: 63 adolescents, 48 older children, and 25 younger children. There was no statistically significant difference in the median self-reported procedural pain found in adolescents (4; IQR = 2–6) versus older and younger children (5; IQR = 2–8 and 6; IQR = 2–8, respectively). Furthermore, no significant difference was observed in the rate of distress between adolescents (79.4%), older (89.6%), and younger (92.0%) children. Adolescents received significantly fewer pain relief techniques.Conclusion: This study shows that adolescents experience similar pain and pre-procedural distress as younger children during peripheral intravenous cannulation. What is Known:• Topical and local anaesthesia, physical and verbal comfort, and distraction are useful interventions for pain and anxiety management during intravenous cannulation in paediatric settings. • No data is available on pain and distress experienced by adolescents in the specific setting of the emergency department. What is New:• Adolescents experienced high levels of pre-procedural distress in most cases and similar levels of pain and distress when compared to younger patients• The number of pain relief techniques employed during procedures was inversely proportional to patient’s age, topical or local anaesthesia were rarely used


Author(s):  
Michael D. April ◽  
Allyson Arana ◽  
Joshua C. Reynolds ◽  
Jestin N. Carlson ◽  
William T. Davis ◽  
...  

2021 ◽  
Vol 43 ◽  
pp. 62-68
Author(s):  
Su Yeong Pyo ◽  
Gwan Jin Park ◽  
Sang Chul Kim ◽  
Hoon Kim ◽  
Suk Woo Lee ◽  
...  

2015 ◽  
Vol 78 (6) ◽  
pp. 360-363 ◽  
Author(s):  
Ching-Kuo Lin ◽  
Mei-Chin Huang ◽  
Yu-Tung Feng ◽  
Wei-Hsuan Jeng ◽  
Te-Cheng Chung ◽  
...  

2001 ◽  
Vol 8 (4) ◽  
pp. 207-211 ◽  
Author(s):  
CY Man

Dologesic is a commonly prescribed analgesic in accident and emergency department. Yet report of overdose with this drug is not common. We report a case in which the patient developed cardiac arrest within an hour of ingestion. Dextropropoxyphene, a component of the drug Dologesic, used to be a common cause of fatalities after drug overdose in the seventies. It is highly toxic in overdose and therefore caution should be exercised when prescribing this drug.


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