Perimortem Hysterotomy

Case Summary

The patient is a 22-year-old primiparous (G1P0) woman at 38 weeks gestational age who has been endorsing pleuritic chest pain and progressive dyspnea for the last 24 hours. She presents to your community hospital with severe chest pain, 2-word dyspnea, and abnormal vitals. The team will be given 3 minutes to prepare as EMS patches in notification of the case. She will arrest soon after arrival to the resuscitation room. Perimortem hysterotomy will need to be performed. The diagnosis of massive PE can be made using history, physical exam, and using provided ultrasound findings. After the perimortem hysterotomy and thrombolysis is complete, the patient will see a pulse visible on ultrasound of her femoral artery, giving the group the opportunity to discuss pseudo PEA vs. PEA.

The team can use the C/S slides to walk through the steps involved in the perimortem hysterotomy, ending with a third slide that shows a video of the baby being delivered. This case could be used in sequence with the NRP case.

Video Demonstration of R3 EM Residents using the C/S slides
Thanks to Dr. Jeremy Gross, Dr. Moe El-Youssef, and Dr. Rajini Retnasothie
Links

The following slides are deliberately “view only” (since they are the master slides). To use them – you simply need to copy and paste the slides you would like to use into your own, new Google Slides Document.

How can you make your Virtual Resus Room using these slides?
  1. Click on link for Room
  2. This will open in a new tab as a “View Only” Google Slide document
  3. Google Slide -> File -> Make a copy -> Entire presentation
  4. Copy document pops up. Name case. Press Ok.
    • Name slide set something generic like “Room A” so it doesn’t contain spoilers when you share with your learners!
  5. This will open new tab as your editable Google Slide document
  6. File -> Version History -> Name Current Version -> “Unused Room”
    • This will save this untouched version of the room before the case starts (See “Resetting Room after Case” in “Running the Sim”:)
Case Written By:

Dr. Mike Saccone and Dr. Sarah Foohey

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