A Perplexing CODE: Amniotic Fluid Embolism
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- Опубликовано: 24 июл 2024
- Roger Seheult, MD of MedCram explains amniotic fluid embolism. See all Dr. Seheult's videos at: www.medcram.com/
(This video was recorded on August 11th, 2023)
Roger Seheult, MD is the co-founder and lead professor at www.medcram.com/
He is Board Certified in Internal Medicine, Pulmonary Disease, Critical Care, and Sleep Medicine and an Associate Professor at the University of California, Riverside School of Medicine.
LINKS / REFERENCES:
Incidence and risk factors for amniotic-fluid embolism (Obstetrics and gynecology) | pubmed.ncbi.nlm.nih.gov/20410...
Amniotic Fluid Embolism (Cleveland Clinic) | my.clevelandclinic.org/health...
Atypical Amniotic Fluid Embolism Managed with a Novel Therapeutic Regimen (Hindawi) | www.hindawi.com/journals/crio...
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#embolism #pregnancy #childbirth
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Hi Roger, Can you look at a possible link between RSP3E and long covid? I have two friends over 70 with sudden onset of RSP3E and both with serious covid infections.
I suffered and AFE /DIC almost 21 years ago. First pregnancy, 32 years old, healthy. On Sunday we celebrate my son’s 21st birthday. My husband is now a pulmonary/ critical physician in Dallas. He was in his residency at UTSW when we went through this. I’m thankful for physicians like you and my husband, who study this to help save the lives of women like me who experience these complications.
That’s an amazing story. Honored to have you in our audience.
Great case, outstanding care and superb educational explanation.
My wife had AFE 1 month ago. She had the same features you mentioned. She is 35 YO and the 1st baby for us. She was admitted for induction of labor and suddenly she collapsed and ventouse was apply for my daughter. Alhamdullah I’m very thankful for Allah then the doctors to recover her after 3 cycles of CPR and adrenaline injection. She had a massive bleeding and got 18 units of PRBC & 25 units of FFP. At that moment my life turned black in my eyes. At the moment Alhamdullah she’s doing well and getting better now. I’m so sorry for people who lost their families in AFE and I wish to find more info and studies in this situation. Hopefully find this video translated to Arabic.
So happy your wife is doing well. You will both have a story to tell your daughter!
Thanks for uncovering one of my past nightmares. These days the anesthesia provider is the one who is the first critical care provider to care for these patients as I was back in the early 90's. My case was fortunately mild-ish without severe CV collapse. These were the days before echo, TXA and AOK. We probably gave steroids. We did start an art line and were ready to float a SWAN if things got worse. Multiple aggressive transfusions with frequent labs kept her stable enough. It all is something that is outside of what an OB has ever experienced so it is in your hands until you have an ICU doc to help out.
Glad it turned out well!
Amazing video with clear information on what to look for and what to do. Thank you for your quick response to save this patient.
This is critical care at its finest, thank you so much for sharing this case and expanding knowledge to serve mankind.
Great review... thanks for presentation.
Thank you for this wonderful resource!
Great case study. What a complicated scenario. So many things happening at the same time. Thank you, Dr. Seheult!
Glad it was helpful!
Fantastic job!! another life saved…….⭐️⭐️⭐️⭐️⭐️⭐️
She was lucky to give birth in a hospital with blood bank …or she would not have lived . Having delivered a couple thousand babies over my career , I am happy that my number NEVER came up for this catastrophic event …have treated pts with massive hemorrhage, shoulder dystocia, DIC , uterine rupture , eclampsia,
etc but thankfully not AFE …. this is often SUDDEN , if UNdelivered , CPR very difficult , if not impossible with gravid uterus !!! Now you have TWO patients in trouble …….
Yes, it’s our worst nightmare in critical care. Hearing your comment from a obstetrician has a lot of meaning for me. Thank you.
thanks for the info God bless & family🙏🥰♥️🌷
That was wonderful.
Very helpful video!
For me as an OB&GYN
I have seen one case during my residency and it was very similar scenario like your case
Thanks to Allah ( GOD) she survived ❤
How can I be sure that if anything happens to me…that YOU ARE MY DOC?! You are brilliant.❤❤❤❤❤
Very well explain even a pharma can follow. Thank you
The baby in the drawing is a footling breech!!!
😅
Wow this patient is very unfortunate-fortunate. Unfortunate cuz of AFE, fortunate cuz of the UAE plus massive blood products infusion. I came across the case back then we couldn’t get her back even by “resuscitative” hysterectomy and high quality of CPR on the table.
Damn! Nice work.
Impressive
This is amazing that some people are so smart to study this to help people....this seems like this would be a nightmare to happen....this goes to show hiw dangerous a pregnancy can be.
At what point in her care did you initiate the AOK protocol? Is it after getting labs back that confirmed the diagnosis? Or during initial resuscitation?
Love the case -based teaching , by the way.
It was at the beginning. Right after initial resuscitation.
Sorry for an off topic question Dr, but you have been my and others goto Covid update Dr!
I’ve heard that hospitalizations are on the rise, what are the current Covid variants characteristics, risk levels, etc.
We got Covid earlier this summer for the first time in Eastern Europe.
It’s broken out a couple times this summer in my wife’s workplace here in SoCal.
Thanks for any updates on this as usual 🙏✨🙏
Video coming shortly
@@rogerseheult1312 thank you so much Dr Seheult!
Blessings ✨🙏✨
It should be out by the end of the week. Basically we’re having another summer surge like we have in the past. But I don’t think it’s going to be as large this time. It could be related to people going indoors and air conditioning spreading it around. There’s no evidence that this new variant is worse or that it’s more infectious so far. Vaccination and boosters still afford protection for cases, hospitalizations and deaths.
Hi Dr. Seheult, this is an excellent video as always, thank you! I have a question if you're still checking comments: If this is mechanistically similar to anaphylaxis, is there a world where it makes sense to perform something like a skin prick test with amniotic fluid prior to birth to see if the patient is more likely to have a response? Or is it a different type of reaction? Have seen some research on biomarkers but it looks like the jury is mostly still out. Thank you!
It’s very rare, so I don’t think they would do that. However, amniotic fluid in the bloodstream is always going to be unpredictable.
I had one august 2022. Very tramatic situation. Not sure how i survived. AND i chose to not except blood because of my beliefs.
Hi, thanks for making these it's been helpful. Im curious if calcium was given?
Yes. I often do when massive transfusions are given because of the dilution and citrate preservative in the pRBCs.
Great case!! What are the doses of atropine, Ondansetron and ketolorac used? And did you need to repeat doses? Pulm/CC here. Thank you
Atropine 1mg
Ondansetron 8mg
Ketorolac 30mg IV
We did not repeat the dose.
@@Medcram thank you
This is a complex process. I'm not sure I understand why the emboli initially triggers the body to form all these clots (that use up fibrinogen).
Wife had AFE+DIC at age 24 when bring induced for our 4th child. They ended up removing her uterus... we had wanted a larger family 😢. I don't think Interventional Radiology was even considered.
Sounds like she’s lucky to be alive
I don’t think you realize how lucky you and your wife are that she survived and is still alive. I have seen a previously healthy woman with an uncomplicated pregnancy die from this leaving a newborn and her two other young children without a mother and a grieving husband without the love of his life.
Do you look at what the patients health was prior to this happening so that perhaps the next patient could be helped to avoid it?
The NIH has a good list: "cerebrovascular disorders and cardiac disease have 25 fold and 70 fold higher risk of AFE, respectively. There is also a strong association of AFE with cesarean delivery, placenta previa, eclampsia, placental abruption, polyhydramnios, dilatation and curettage, and renal disease." It doesn't sound like many opportunities for prevention.
@@flagmichael
You got 9 months to fix things.
Is the cesarean delivery after this happens?
Cesareans are also associated with low vitamin d levels.
Are vitamin d levels low in these patients?
Cardio vascular and brain issues are often related to high sugar intake, high insulin, even if prediabetic or diabetic, is this related here?
When we back track to the root cause what do we find?
Mildly elevated blood pressure was all. Not even in the preeclamptic range.
There was really nothing to fix. Pretty healthy.
@@Medcram
What is "pretty healthy"?
Something wasn't working well.
Was she on zero medications?
Hi, I would love to hear your advice on getting a booster this year. Thanks.
Meditech. Don’t Miss that EMR.
I am a survivor of A.F.E my Dr says he has ;not seen it in over 40 years So many young Dr's tell me oh I've seen it I say stop lying I still need help nO ONES UNDERSTAND omG please help me
In Vet Med DIC stands for Dead in Cage 😑
Oh wow
Mostly because we when we realize they have it usually they are found bled out in their cage 😢