Amniotic Fluid Embolism is a devastating and rare complication of pregnancy. The A-OK protocol is commonly advocated for as a life saving therapy in this scenario. Dr Stephanie Martin reviews the case reports and discusses her opinions on the role of A-OK in AFE management. Go to www.amnioticfluidembolism.org for access to a free educational program on AFE. Case reports referenced: Wothe JK, Elfstrand E, Mooney MR, Wothe DD. Rotational Thromboelastometry-Guided Venoarterial Extracorporeal Membrane Oxygenation in the Treatment of Amniotic Fluid Embolism. Case Rep Obstet Gynecol. 2022 May 18;2022:9658708. doi: 10.1155/2022/9658708. PMID: 35646404; PMCID: PMC9132692. Long M, Martin J, Biggio J. Atropine, Ondansetron, and Ketorolac: Supplemental Management of Amniotic Fluid Embolism. Ochsner J. 2022 Fall;22(3):253-257. doi: 10.31486/toj.21.0107. PMID: 36189093; PMCID: PMC9477128. Berry A, Salcedo A, Riba C. Atypical amniotic fluid embolism successfully treated with a novel protocol: A case report. J Case Rep Images Obstet Gynecol 2022;8:100109Z08AB2022. Rezai S, Hughes AC, Larsen TB, Fuller PN, Henderson CE. Atypical Amniotic Fluid Embolism Managed with a Novel Therapeutic Regimen. Case Rep Obstet Gynecol. 2017;2017:8458375. doi: 10.1155/2017/8458375. Epub 2017 Dec 21. PMID: 29430313; PMCID: PMC5753013.

Family presence during resuscitation is becoming more accepted in ICUs and Emergency Departments. What about obstetric resuscitations? Dr Suzanne Baird and Julie Arafeh discuss family presence during maternal cardiac arrest and other obstetric emergencies.

Adequate volume replacement is a key patient management goal of many severe illnesses during pregnancy particularly hemorrhage. Often patients are not adequately volume resuscitated with disastrous outcomes. Listen to Julie Arafeh talk with Dr Alan Frankfurt, OB Anesthesiologist on volume replacement during pregnancy.

In this episode, Stephanie and Suzanne discuss DKA pathophysiology, causes, signs and symptoms, diagnosis, and management. The critical care management aspects outlined include: 1. Replace fluids 2. Supply insulin 3. Replace potassium 4. Supply glucose

Suzanne and Stephanie discuss the clinical presentation and diagnosis of pulmonary edema, including how to differentiate between cardiogenic and noncardiogenic pulmonary edema. They also address assessment of the pregnant patient with hypoxemia and management of both types of pulmonary edema.

In this podcast Julie Arafeh discusses rethinking the response to maternal early warning criteria to be better prepared for obstetric emergencies.

Dr. Stephanie Martin and Julie Arafeh discuss another hemorrhage case and how the outcome could have been prevented. Communication plays such a huge part in this case.

Dr. Stephanie Martin and Julie Arafeh discuss when and how to use the chain of command to ensure patient safety and maintain trust between members of the healthcare team.

Dr Lou Halamek joins Julie Arafeh in a discussion on the use of debriefing to improve team performance, including strategies and tactics for more effective and efficient debriefings. Here are some useful references to review: Halamek LP, Cady R, Sterling MR. Using briefing, simulation and debriefing to improve human and system performance. Semin Perinatol 2019;43(8):151178. Epub 2019 Aug 10. PMID 31500845 Chitkara R, Bennett M, Bohnert J, Yamada N, Fuerch J, Halamek LP, Quinn J, Padua K, Gould J, Profit J, Xu X, Lee HC. In situ simulation and clinical outcomes in infants born preterm. J Pediatr. 2023 Aug 31:113715. doi: 10.1016/j.jpeds.2023.113715. Epub ahead of print. PMID: 37659586 Sawyer T, Loren D, Halamek LP. Post-event debriefings during neonatal care: Why aren’t we doing them, and how can we start? J Perinatol 2016;36(6):415-419. PMID: 27031321 https://cape.stanford.edu/programs/BannerPage.html

In this podcast episode, Dr. Stephanie Martin and Dr. Suzanne McMurtry Baird will discuss the 2nd portion of an unusual postpartum hemorrhage case study. As you follow along, ask yourself if you are confident in how your hospital would respond to this patient presentation. Where would this patient be managed? Who would manage this patient?

To prevent maternal morbidity and mortality, it is essential that postpartum hemorrhage is recognized and managed according to the etiology. In this podcast episode, Dr. Stephanie Martin and Dr. Suzanne McMurtry Baird will present part 1 of a postpartum hemorrhage case study. During the case presentation, think about these questions: - In the absence of external bleeding, how is hemorrhage recognized? - How would your team respond to this clinical situation? - What are the opportunities in your clinical practice to improve care with postpartum hemorrhage?

Julie Arafeh has a conversation with Dr Nicole Yamada, neonatologist, and human factors enthusiast. They discuss human factors in healthcare, what it is and how it can impact clinical practice.

Not all obstetric patients who have complications during pregnancy, labor, birth, or postpartum have known risk factors. This case study will follow a patient who enters the hospital for an induction of labor at term gestation with no identified risk factors. During labor, she becomes critically ill. Ask yourself several questions as you listen: 1. What signs and symptoms would concern you? 2. What other assessments would you like to perform? 3. What tests you would want to order? 4. What would be your diagnosis?

Thoughts on Preparing OB Units for a Disaster: A Discussion with Dr Kay Daniels Dr Kay Daniels, OB/GYN physician and simulation expert joins Julie Arafeh to talk about disaster preparedness for OB units. They discuss what prompted Dr Daniels interest in disaster planning, who was involved in the planning and tips for OB units on disaster planning. www.clinicalconceptsinob.com Twitter: @OBCriticalCare Instagram: @criticalcareOB LinkedIn: Clinical Concepts in Obstetrics Facebook: Clinical Concepts in Obstetrics

Dr. Stephanie Martin discusses everything you need to know about recognizing and diagnosing iron deficiency anemia in pregnancy, in this part two of a two part series. Dr Stephanie Martin is the Medical Director for Clinical Concepts in Obstetrics and a Maternal Fetal Medicine specialist with expertise in critical care obstetrics. www.clinicalconceptsinob.com Twitter: @OBCriticalCare Instagram: @criticalcareOB LinkedIn: Clinical Concepts in Obstetrics Facebook: Clinical Concepts in Obstetrics

Dr. Stephanie Martin discusses everything you need to know about recognizing and diagnosing iron deficiency anemia in pregnancy, in this first episode of a two part series. Dr Stephanie Martin is the Medical Director for Clinical Concepts in Obstetrics and a Maternal Fetal Medicine specialist with expertise in critical care obstetrics. www.clinicalconceptsinob.com Twitter: @OBCriticalCare Instagram: @criticalcareOB LinkedIn: Clinical Concepts in Obstetrics Facebook: Clinical Concepts in Obstetrics

Julie Arafeh has a conversation with Dr. Andrea Shields, co-creator of the Obstetric Life Support (OBLS) Program. Julie and Dr. Shields discuss what OBLS is, how OBLS is different from other life support courses in preparing for and responding to maternal cardiac arrest, and how you can get more information about this new program. Julie Arafeh, RN, MSN is the Simulation Director for Clinical Concepts in Obstetrics and a leading expert in simulation. Andrea D. Shields, M.D., M.S. is an Associate Professor of Obstetrics & Gynecology in the Division of Maternal Fetal Medicine and Program Director of the Maternal Fetal Medicine Fellowship at the University of Connecticut School of Medicine. www.clinicalconceptsinob.com Twitter: @OBCriticalCare Instagram: @criticalcareOB LinkedIn: Clinical Concepts in Obstetrics Facebook: Clinical Concepts in Obstetrics

Suzanne and Stephanie review hot topics with the use of magnesium sulfate in pregnancy. The experts at Clinical Concepts in Obstetrics pool their decades of experience caring for critically ill pregnant women to discuss the challenges encountered in caring for these vulnerable women. Dr Stephanie Martin is the Medical Director for Clinical Concepts in Obstetrics and a Maternal Fetal Medicine specialist with expertise in critical care obstetrics. Suzanne McMurtry Baird, DNP, RN is the Nursing Director for Clinical Concepts in Obstetrics with many years of experience caring for critically ill pregnant women. Julie Arafeh, RN, MS is the Simulation Director for Clinical Concepts in Obstetrics and a leading expert in simulation. www.clinicalconceptsinob.com Twitter: @OBCriticalCare Instagram: @criticalcareOB LinkedIn: Clinical Concepts in Obstetrics Facebook: Clinical Concepts in Obstetrics

Hemorrhagic stroke accounts for approximately half of strokes during pregnancy and is a leading cause of disability which underscores the need for quick intervention if suspected. Julie Arafeh shares SCANME, a cognitive aid for perinatal stroke recently discussed in the first Annual Virtual Conference on Obstetric Life Support (OBLS) by Dr. Eliza Miller and found in the OBLS Manual. The experts at Clinical Concepts in Obstetrics pool their decades of experience caring for critically ill pregnant women to discuss the challenges encountered in caring for these vulnerable women. Dr Stephanie Martin is the Medical Director for Clinical Concepts in Obstetrics and a Maternal Fetal Medicine specialist with expertise in critical care obstetrics. Suzanne McMurtry Baird, DNP, RN is the Nursing Director for Clinical Concepts in Obstetrics with many years of experience caring for critically ill pregnant women. Julie Arafeh, RN, MS is the Simulation Director for Clinical Concepts in Obstetrics and a leading expert in simulation. www.clinicalconceptsinob.com Twitter: @OBCriticalCare Instagram: @criticalcareOB LinkedIn: Clinical Concepts in Obstetrics Facebook: Clinical Concepts in Obstetrics

Dr Stephanie Martin interviews a survivor of a stroke after the birth of her child. All of us can learn from listening to this patient's story. The experts at Clinical Concepts in Obstetrics pool their decades of experience caring for critically ill pregnant women to discuss the challenges encountered in caring for these vulnerable women. Dr Stephanie Martin is the Medical Director for Clinical Concepts in Obstetrics and a Maternal Fetal Medicine specialist with expertise in critical care obstetrics. Suzanne McMurtry Baird, DNP, RN is the Nursing Director for Clinical Concepts in Obstetrics with many years of experience caring for critically ill pregnant women. Julie Arafeh, RN, MS is the Simulation Director for Clinical Concepts in Obstetrics and a leading expert in simulation. www.clinicalconceptsinob.com Twitter: @OBCriticalCare Instagram: @criticalcareOB LinkedIn: Clinical Concepts in Obstetrics Facebook: Clinical Concepts in Obstetrics