Managing Medical and Obstetric Emergencies and Trauma. Группа авторов

Чтение книги онлайн.

СКАЧАТЬ to pain, unconsciousAEDautomated external defibrillatorAFEamniotic fluid embolismAIPabnormally invasive placentaALSGAdvanced Life Support GroupALSOAdvanced Life Support in ObstetricsALTalanine aminotransferaseARDSacute respiratory distress syndromeASTaspartate aminotransferaseATLSAdvanced Trauma Life SupportBMIbody mass indexBPblood pressureBSOTSBirmingham Symptom‐specific Obstetric Triage SystemCEMACHConfidential Enquiry into Maternal and Child HealthCEMDConfidential Enquiry into Maternal DeathsCESDIConfidential Enquiry into Stillbirths and Deaths in InfancyCGMcontinuous glucose monitoringCJDCreutzfeldt–Jakob diseaseCMACECentre for Maternal and Child EnquiriesCMDhCoordination Group for Mutual and Decentralised Procedures – humanCNScentral nervous systemCO2 carbon dioxideCPAPcontinuous positive airway pressureCPDcephalopelvic disproportionCPRcardiopulmonary resuscitationCRPC‐reactive proteinCRTcapillary refill timeCScaesarean sectionCSEcombined spinal and epiduralCSFcerebrospinal fluidCTcomputed tomographyCTGcardiotocographyCTPAcomputed tomography pulmonary angiographyCVPcentral venous pressureCVTcerebral venous thrombosisCXRchest x‐rayDASDifficult Airway SocietyDKAdiabetic ketoacidosisDVTdeep vein thrombosisEASexternal anal sphincterECGelectrocardiogramECMOextracorporeal membrane oxygenationECVexternal cephalic versionEDemergency departmenteFASTextended focused assessment with sonography for traumaERCPendoscopic retrograde cholangiopancreatographyFASTfocused assessment with sonography for traumaFFPfresh frozen plasmaFRCfunctional residual capacityGCSGlasgow Coma ScaleGICGeneric Instructor CourseGMCGeneral Medical CouncilGPgeneral practionerGTNglyceryl trinitratehCGhuman chorionic gonadotrophinHDUhigh dependency unitHELLPhaemolysis, elevated liver enzymes, low platelet count (syndrome)HIEhypoxic ischaemic encephalopathyIASinternal anal sphincterICPintracranial cerebrospinal pressureIgEimmunoglobulin EILCORInternational Liaison Committee on ResuscitationIOintraosseousITUintensive treatment unitIVintravenousLDFleucocyte depletion filterLMAlaryngeal mask airwayLMWHlow molecular weight heparinMBRRACE‐UKMothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UKMEOWSmodified early obstetric warning scoreMEWSmaternity early warning scoring systemsMHRAMedicines and Healthcare products Regulatory AgencyMIMMSMajor Incident Medical Management and SupportmMOETManaging Medical and Obstetric Emergencies and TraumaMMRmaternal mortality rateMOHmajor obstetric haemorrhageMRImagnetic resonance imagingmRNAmessenger RNAMRVmagnetic resonance venographyMSVMauriceau–Smellie–VeitMTSManchester Triage SystemMUDmanual uterine displacementNACCSNeuro Anaesthesia and Critical Care SocietyNAPNational Audit ProjectNAPSTaRNeonatal, Adult and Paediatric Safe Transfer and RetrievalNICENational Institute for Health and Care ExcellenceNICUneonatal intensive care unitNLSnewborn life supportNNTnumber needed to treatOAAObstetric Anaesthetists’ AssociationOASIobstetric anal sphincter injuryONSOffice for National StatisticsORodds ratioOVDoperative vaginal deliveryPASTposterior axillary sling tractionPCIpercutaneous coronary interventionPDPHpostdural puncture headachePDSpolydioxanonePEApulseless electrical activityPEEPpositive end‐expiratory pressurePEFRpeak expiratory flow ratePETpre‐eclampsia toxaemiaPMCSperimortem caesarean sectionPNDpostnatal depressionPOCUSpoint of care ultrasoundPPHpostpartum haemorrhagePRESposterior reversible encephalopathy syndromeqSOFAquick sequential organ failure assessmentRCoARoyal College of AnaesthetistsRCOGRoyal College of Obstetricians and GynaecologistsRCTrandomised controlled trialRCVSreversible cerebral vasoconstriction syndromeRhrhesusROSCreturn of spontaneous circulationROTEM®rotational thromboelastometryRRrespiratory rateRRrisk ratioSADsupraglottic airway deviceSAG‐Msaline‐adenine‐glucose‐mannitolSALVOCell Salvage in Obstetrics (trial)SAPsystolic arterial pressureSBARsituation, background, assessment and recommendationSCADspontaneous coronary artery dissectionSHOsenior house officerSSRIselective serotonin reuptake inhibitorSTEMIST segment elevation myocardial infarctionSUDEPsudden unexpected death in epilepsySVTsupraventricular tachycardiatdster die sumendum (three times a day)TEG®thromboelastographyTFTthyroid function testTIVAtotal intravenous anaesthesiaU&Esurea and electrolytesUKUnited KingdomUKOSSUK Obstetric Surveillance SystemUSAUnited States of AmericaVADventricular assist deviceVFventricular fibrillationV/Qventilation/perfusionVTventricular tachycardiaVTEvenous thromboembolismWHOWorld Health Organization

PART 1 Introduction

CHAPTER 1 Introduction

      Throughout both the developed and the developing world, maternal mortality continues to present a serious challenge. Globally, there is estimated to be one maternal death every minute. This course will provide you with a system for managing the seriously ill and seriously injured pregnant woman. The system is designed to be simple and easy to remember when life‐threatening emergencies arise and is known as the structured approach.

      The structured approach is based on the ABC of resuscitation and is practised throughout all areas of medicine and the emergency services. The concept is familiar to the lay person and known even to school children. This structured approach has led to the development of courses that attend to the resuscitation needs of all patients, from neonates to children, adults and women with the altered physiology and anatomy of pregnancy.

      This manual, Managing Medical and Obstetric Emergencies and Trauma (mMOET), online material and the practical course are divided into sections that provide a structured revision in recognition, resuscitation and treatment of emergencies in pregnancy. This includes trauma, medical and surgical emergencies and obstetric emergencies and is aimed at obstetricians, anaesthetists, emergency and other physicians, and midwives. The structured approach is applied to resuscitation and is taught didactically as a drill. Subsequently, what has been learned is applied to both the recognition and management of the seriously ill and injured pregnant patient.

      The physiological adjustments of pregnancy affect the response of the mother to illness and injury. These changes mean that resuscitation should be tailored to the pregnant patient and this manual, and the mMOET course, teaches how this is achieved.

      The Managing Obstetric Emergencies and Trauma (MOET) course began in 2001 and runs under the auspices of the Advanced Life Support Group (ALSG). Its aim is to provide the knowledge, practical skills and procedures necessary to save the mother and fetus in life‐threatening circumstances. The course runs in six countries and, since its inception, over 8380 providers and 720 instructors have been trained. Course information and links for candidates and faculty are available from the ALSG website (www.alsg.org).

      Recent catastrophic traumatic events including terrorist attacks and major fires have heightened awareness of the need for expanding trauma education amongst the obstetric community. To date trauma management has not been widely taught to obstetricians, but when trauma does occur to pregnant women those in other specialties will consider the obstetrician the expert when managing them.

The importance of serious medical co‐morbidities within the pregnant population contributing to maternal death and the need for early recognition of the seriously ill pregnant woman has been emphasised in confidential mortality reports, and this has resulted in a particular new focus for MOET teaching: we now call the course mMOET – managing Medical and Obstetric Emergencies and Trauma to reflect this.

      This text is essential pre‐course reading for the mMOET course and also provides a valuable reference for all healthcare workers involved in caring for pregnant women.

In more recent years, and in acknowledgement of the challenging study leave climate in the UK, a pre‐course online learning component (Box 1.1) was devised, piloted and widely introduced to supplement the manual and the face‐to‐face material (www.alsg.org/vle). This continues to be updated and aims to reinforce the current text and provides an interactive method of delivering the knowledge components of the course. It prepares participants for the practical application of knowledge during the face‐to‐face course.

Box 1.1 Content of the mMOET online learning package

      Structured approach

СКАЧАТЬ