OB case, mother vs infant

[Worldtraveler]

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C-section @ 9pm. No sig med Hx.
Baby delivered with meconium, no cry mother stable. After 1min still no sound. Peds resident asks for help, unable to inubate and tries to call a code.
My attending stepped out for meds. Asked obstetrician to watch mother.
cords visualized, 3.5 Ett too big- Ambubag, HR increased good cries.
Do I leave the mother?

 

[timtye78]

Are you still in the same room? No big deal.

I wouldn't leave the room unless another anes provider with mom. The books say primary patient is mother.

The OB team should have anticipated baby problems based on U/S, fetal HR patterns, etc. They should have peds intensivist/neonatologist/or competent peds attending in room at delivery.

If not in the same room, pedi resident should be able to handle mask ventilation until more help can arrive.

My two cents.

 

[Worldtraveler]

In same room, NICU fellow on the way(just peds residents in available). Had to make quick decision

 

[Lefty]

Same scenario has been brought up multiple times in my training. Seems appropriate to ask peds to bring bassinette up to head of anesthesia bed so you're still close to mom in case anything happens.

 

[Noyac]

Same scenario has been brought up multiple times in my training. Seems appropriate to ask peds to bring bassinette up to head of anesthesia bed so you're still close to mom in case anything happens.

I understand the reasoning here but if mother is doing just fine and awake then I don't want to be coding her new baby right there next to her head while her belly is open and she can't move. I would keep her in my direct site but not right next to her. I would help with the baby. Now with that being said, our first and only responsibility is the mother. AND IF ANYTHING HAPPENS TO HER YOU WILL BE FRIED.

So I would have helped the peds resident by tubing the baby if needed and then back to the pt. But I won't watch a baby die if I can help and mom is stable.

 

[DropkickMurphy]

The last facility I worked at as an RT required an RT to be present for ALL c-sections, by order of the senior anesthesiologist for exactly this sort of situation (because there is no peds or neonatology attending in-house at night) and his thinking was we were the second most competent group when it came to airway in the hospital (although I would argue that a few of the ER docs are better than we are).

 

[markneil]

The last facility I worked at as an RT required an RT to be present for ALL c-sections, by order of the senior anesthesiologist for exactly this sort of situation (because there is no peds or neonatology attending in-house at night) and his thinking was we were the second most competent group when it came to airway in the hospital (although I would argue that a few of the ER docs are better than we are).

so you were an RT? i'm currently an RT starting med school and i want to go into anesthesiology. an RT is required for all c-sections where i work (small, 200 so bed facility). 1 out of 4 times the pediatrician is there and she/he takes over but an RT is still present. most times i see anesthesia solely focused on the mother.

 

[DropkickMurphy]

so you were an RT? i'm currently an RT starting med school and i want to go into anesthesiology. an RT is required for all c-sections where i work (small, 200 so bed facility). 1 out of 4 times the pediatrician is there and she/he takes over but an RT is still present. most times i see anesthesia solely focused on the mother.

Yeah, I'm currently a CRT about to take my RRT here in a few months.