At the EMCrit 2013 Conference we had a Blast Competition. The BLAST rules are easy:
The winner this year was Salil Bhandari with an incredible presentation on peri-mortem caesarean section.
Here is an article:
Eur J Emerg Med. 2011 Aug;18(4):241-2. doi: 10.1097/MEJ.0b013e328344f2c5. Prehospital resuscitative hysterotomy.
Want to know more about peri-mortem c-section? Check out this insanely good post:
The post Perimortem C-section at St.Emlyn’s appeared first on St Emlyns.
And here is a simulator video:
Now on to the Wee…
Podcast: Play in new window | Download (27.3MB) | Embed
insanely brilliant presentation! Love the BLAST format!
Great teaser performance at start with the sleight of hand magic tricks!
One suggestion from me.
Dont worry about cutting baby. It happens not too uncommonly doing C sections , even elective ones.
Cuts heal well. hypoxic brain injury not so well.
Interesting choice of midline vertical classic incision both to open abdo and uterus. Makes me think about choice of cut in surgical cric. horizontal vs vertical.
I think for complete novices to abdo surgery then the vertical cut makes a lot of sense for perimortem CS and surgical cric.
The slide images and pace of delivery was perfect.
really enjoyed and I agree that this type of delivery for conference presentations is here to stay! Love it!
Wow! Love the BLAST. Great pearls, memorable and sticky! Look forward to seeing more and trying BLAST and hearing more from emcrit conf
Fantastic presentation Salil! Certainly one of those topics that makes any sane doctor sweat.
Perfect pace and amount of content.
Love the blast idea Scott. There’s a lot of mileage in these and the Pecha Kucha format, can’t wait to see more!
Oli
Great presentation Salil! Great topic pick also. Thanks for putting it up there Scott. Great job once again!
JH
Fantastic Presentation…Thanks Dr. Bhandari
I was just wondering about the insert regarding the midline incision with avoidance of the umbilicus. In the image shown, there appears to be a small hernia, so there would be concern for bowel injury. Is this what you were going for? Otherwise with no hernia, just stay midline?
I also saw on Resus another article listed. My university does not provide access to the journals, so it would be helpful if you could provide a direct link. Thanks again.
1.Prehospital resuscitative hysterotomy
Eur J Emerg Med. 2011 Aug;18(4):241-2
2.Out-of-hospital perimortem cesarean section
Prehosp Emerg Care. 1998 Jul-Sep;2(3):206-8
Yep, it is usually safer to avoid the umbilicus in any midline incision though that may just be dogma.
FEAR!
It’s what holds us back from doing these very rare procedures where the stakes are so high.
But when the S__T hits the fan, most of these procedures are easy. And overcoming the fear of making a mistake is the biggest obstacle we face.
In my career, I’ve done two surgical airways, a few lateral canthotomies, a thoracotomy and each one went well.
Get rid of the fear folks. We Can Do This!
Curious about the timeline — I was always taught the 4-minute rule as well, however I assume that this is based around no-flow time. If CPR (especially bomber, fast, deep, professional compressions) is ongoing, is there a longer window?
Cliff Reid has an article on his site stating the window is longer and we should give it a shot even later in the course.
Running through this procedure in my head, I came to a step where I didn’t know what to do…
After baby is out, hopefully mom gets ROSC, what now?
Do you close her up? If so, does the placenta stay in or come out?
Thanks,
Matt Barden
Loma Linda University EM2
Deliver the placenta. Cover Abd with sterile towels. Let OB do the closure.