Hi Hugo - interesting scenario.
The prime indication for delivering the baby emergently would be to
facilitate resuscitation of the mother (MOET).
Assuming you opt for active management after involving Dad, I would consider
allowing Mum's core temperature to fall to around 32 degrees (exposure) and
rapidly transporting to tertiary cardiac centre for definitive cardiac care.
IABP might be useful if accessible as a 'bridge to transport' if in a low
cardiac output state. This would necessitate an unfractionated heparin
infusion.
I am sure you let us know the out come!
John Black
-----Original Message-----
From: Accident and Emergency Academic List
[mailto:[log in to unmask]] On Behalf Of Hugo Poncia
Sent: 14 November 2004 10:21
To: [log in to unmask]
Subject: Re: Case scenario
Craig, The approximate transfer time is about an hour.
Adrian, The CXR was normal, but risk factors included heavy smoking, mainly
marjuana. There is a strong family history of early coronary artery disease.
The baby is 'precious', mum has a stitch in place, 2 previous miscarriages
at 28 weeks.
Dad is fully informed, but obviously distressed having witnessed the arrest
and after giving BLS for 10-15 mins. But, when presented with the
therapeutic options just says 'do what you think is best doc'.
Hugo
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