hypothetical ? about defib a pregnant patient

  1. i am studying for acls and have a hypothetical question about defibrillation:

    let's say you have an 8 month pregnant patient who is in v-fib. in my study book, it says that only about 4% to 20% of the total current of the shock actually reaches the heart due to factors affecting transthoracic resistance. my question is.... what is the net effect to the baby? ... especially if the mom were to receive 3 progressive (high voltage) shocks?

    and -- do you use the standard paddle positioning of apex-anterior ... or, try other positioning to minimize exposure to the baby? ... eg.. would you position paddles in the apex-posterior position?

    i just pray that i never have to be in on this type of code.... ... but what do you guys do???

    and, just fyi - i will start nursing school in may. i work in the blood bank (and have for 12 years). the acls instructor where i work said that if i take the class and pass the test, then she will let me get my certification, but she warned me that it will be hard for me (without the nursing background yet). i am up for the challenge! and i appreciate all of your input. (i posted this in the cardiac critical care forum also)


    lifelongstudent
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  2. 9 Comments

  3. by   lifeLONGstudent
    hmmmm... 22 people have looked at this, but not 1 reply.

    So, either
    (a) you don't know
    (b) you don't care

    Come on... it is just a hypothetical question ... I am not asking to get the answer for some test (I think some students use this board as a search engine for answers to their homework ). I just wondered about the situation as I was reading over the material. I'll ask the ACLS instructor the day of the class, but that is over a week away. I am anxious to know now... how is it handled in real life? What would you do?
  4. by   ageless
    http://rnweb.com/rnweb/article/artic....jsp?id=107349


    easily found with google...............
  5. by   UM Review RN
    Quote from lifeLONGstudent
    My question is.... what is the net effect to the baby? ... especially if the mom were to receive 3 progressive (high voltage) shocks?
    I have never seen this situation, but I think it's safe to say that if the mom gets no shocks, they will both die. I'm thinking of a scenario where mom is shopping at the mall, for instance, and the choices for treatment would be extremely limited.

    After that, there are too many variables to even make a good guess.

    Maybe that's why nobody took a stab at it.
  6. by   zambezi
    I too am unaware of what the effect of electricity will have on the baby...however, it is safe to say (as Angie did) that if the shocks are not delivered, neither will live (or the mother may pass on and the baby can be c-sectioned out quickly)...I would say the only choice is to defibrillate...and hope that the defib works and you don't have to do rounds of drugs too...As for patch placement, I would go with the normal configuration (but have not looked for any information otherwise)...Hopefully, I will never encounter this situation...

    Edited to add: Just read the site that another poster directed you to...lots of good information!! Defibrillate is still first line...
    Last edit by zambezi on Feb 13, '05
  7. by   lifeLONGstudent
    google - there is a good idea. I will look up more this week. My instructors had no experience with the pregnant VF/pulseless VT patients... and it was not specifically covered in class.

    thanks for the replies

    lifeLONGstudent

    BTW - I passed:hatparty:
  8. by   Liddle Noodnik
    Quote from lifeLONGstudent
    google - there is a good idea. I will look up more this week. My instructors had no experience with the pregnant VF/pulseless VT patients... and it was not specifically covered in class.

    thanks for the replies

    lifeLONGstudent

    BTW - I passed:hatparty:
    Congratulations! Not an easy task; I took it when I worked ICU in 84 and it was really tough for me!
  9. by   lifeLONGstudent
    Quote from zoeboboey
    Congratulations! Not an easy task; I took it when I worked ICU in 84 and it was really tough for me!

    It was not easy, but I studied a LOT. I will have to learn it sooner or later and I cannot WAIT for school to start. I have had some rhythm classes in the past, so that was a blessing and I used all the little sayings to help me remember (example: ALMS for the Poor = Amioderone, Lidocaine, Mag, Procainamide, NAVEL - nerve, artery, vein, empty space, ligament; LEAN = lidocain, epi, atropine, and narcan can go down the ETT... yada, yada, yada).

    One of the instructors asked people to raise their hands if they had ever had the class before. I always sit in the front (because I need GLASSES ) she looked at me and said, "now I know you have had the class...who else"... I said, "try again... I start nursing school in MAY". She was a little suprised.

    Thanks for the kind words,
    lifeLONGstudent
  10. by   medic1488
    Per ACLS, no change in current or pad position. Also state that no signifigant energy gets transferred to the fetus.
  11. by   Gompers
    I was always taught that you save the mother first, worry about the baby later. Neither is going to survive without CPR/defib. So do what you can to save the mother and worry about the baby later. The child is going to die anyways if you don't do anything, so why even worry about potential side effects of defibbing the mother? It just seems like common sense to me, am I the only one?

    I've only personally heard of one case where they let mom die without extensive CPR/defib efforts and just did a crash c-section to get the baby out. Our NICU was called to a delivery and found out that the mother had arrived DOA from multiple GSWs. The high risk delivery nurse was freaked for weeks because the dead mother's eyes were open, "staring" at her as they tried to resuscitate the baby. They got the baby back, but by then it was too late and there was significant asphyxia.

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