Dr Anna Nunokawa presents case of Amniotic Fluid Embolism (#AFE) at @DalAnesthesia grand rounds #OBAnes
(get her on #Medtwitter @garrettsbarry @axe1314 @Ropivacaine @jon_bailey_anes @AnaSjaus @bmacaulay2000 @Dolores_McKeen?)
The case: #AFE #OBAnes
Any questions at this point?
(Written consent for case presentation from patient)
A brief discussion of epidemiology and pathophysiology. #AFE is rare, but some retrospective literature suggests up to 45% mortality even in developed world - much higher in developing world #OBAnes
Considerations for diagnosis of #AFE: up to 25% will be atypical (not meeting all 4 Clark’s Criteria). A quick refresher on diagnosis of DIC. Other signs include aura in awake patients and seizures/stroke
#OBAnes
The differential diagnosis of #AFE is necessarily broad. @stanfordanes emergency manual has a list to rule out, although latest version puts AFE under embolism, losing the specific section. Investigations help - including echo
#OBAnes
On echo in #AFE - what was found in the case (less movement of RV wall, TR, elevated RVSP - all resolved postoperatively
#OBAnes
What does literature say about echo in #AFE? @CJA_Journal case series and review in 2021 - will add reference. LV failure in Acute phase suggests an alternative diagnosis.
#OBAnes
Our outcome was great for this #AFE, able to mobilize a great team (@Dolores_McKeen @OBsleepmerchant @AnaSjaus), but recognize limitations of no POC ABG (@IWKHealth lab against POC), no ROTEM, pumps not set for significant resus. #OBAnes
Some discussion points:
* reluctance to use cell salvage in setting of #AFE despite major transfusion (UK/IE/EU experience?) @noolslucas
* REBOA is becoming more useful in #OBAnes setting - definitely consider if surgeons applying aortic compression buys time to stabilize
MOST important take home point: we were able to mobilize a team of 3 #OBAnes fellowship trained specialists, and despite a few POC limitations had capacity to access vascular surgery and interventional radiology during the case.
This is NOT the norm in the community hospital.
How do we improve outcomes in #AFE more widely?
@SOAPHQ @ruthi_landau @Ron_George @emilysharpe @OAAinfo @noolslucas @Eltonchris @girardDev @DrNickB_ObAnaes @LoughreyJPR @MarcVandeVelde6 @runa123 @yusuke_mazda
#OBAnes
@threadreaderapp unroll please
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