defib and the pregnant patient

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Specializes in MICU.

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....:eek: ... 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.

lifelongstudent

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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....:eek: ... 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.

lifelongstudent

would go with anterior-posterior. if you have a dead mother, someone that needs to be defibrillated, then you go for it. if her heart isn't eworking, then the baby's heart will soon be having trouble too. you are trying to save the mother's life at this point.

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Just a question - but if the pregnant mother were in the hospital (which im assuming she is) - wouldn't the concentration be more set on delivering the baby??...rather then shocking the mother?? im probably wrong - but just curious

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Just a question - but if the pregnant mother were in the hospital (which im assuming she is) - wouldn't the concentration be more set on delivering the baby??...rather then shocking the mother?? im probably wrong - but just curious

Even if the mother is in the hospital, what if she comes in thru the ER? You usually aren't going to do a stat C-Section there, or are you? You are going to try first to save the mother...............it will still take time to transfer her to to the OR or to get a team down there. If the heart doesn't start, you are going to have problems with the baby also.

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Just a question - but if the pregnant mother were in the hospital (which im assuming she is) - wouldn't the concentration be more set on delivering the baby??...rather then shocking the mother?? im probably wrong - but just curious

This is not an either/or situation. While the code progresses, an emergency c/section would be set up (there would be preparations to receive a poorly perfused preemie, as well).

This is a very high drama situation, as you can well imagine!

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Specializes in MICU.

"would go with anterior-posterior."

that is the answer i got from the acls class also. they mentioned also using a biphasic defibrillator (when you have the choice) because they achieve better results with a lower shock. if you only had a monophasic defibrillator, they said they might try to start the first shock with a higher voltage (300j in stead of 200j) in the hopes that you get a desired result in one shock (verses the 3 stacked.... you would hopefully only have to shock once).

basically, the bottom line was "a dead mom is a dead baby" in the field/er where stat section is not immediately available as an option.

it was just a hypothetical scenerio i thought of as i was studying. thanks to everyone for their replies.

lifelongstudent

and btw... i passed

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Out of Hospital.....You should treat a pregnant mother like any other during resuscitation. But in hospital treatement should be geard towards emergency C-section as well as resusctiation of the mother.

But, to answer your question, you do defib pregnant mothers........But studies show if you get the baby out fast, the mother as well as child have a better prognosis of recovery.

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