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Anesthesia Management of an Amniotic Fluid Embolism

An Amniotic Fluid Embolism(AFE) is terrible situation for any nurse anesthetists. Have you experienced one in your practice? It’s a scary situation. Unfortunately, an AFE is an unpredictable, unpreventable complication of pregnancy that has an extremely high mortality rate.

blood transfusion during amniotic fluid embolism

The literature supports two types of AFE.

The first type is “typical” AFE which has three phases.

  • Phase 1 starts with respiratory and cardiovascular collapse
  • Phase 2 incudes coagulation disturbances.
  • Phase 3 is renal failure and ARDS.

The second type is “atypical” and starts with life-threatening hemorrhage

  • Which leads to cardiovascular collapse

Over the years, I have experienced several patients with  “atypical” AFEs. With aggressive treatment from a team of providers all of these patients have survived. Then I had a patient with a “typical” AFE. No signs of excessive bleeding, but the patient became unresponsive and was in PEA. This experience prompted me to do more research. One of the major problems with typical AFE is it causes right sided heart failure. Much of what we do when we suspect an AFE goes against treating right sided heart failure. With an AFE we want to administer lots of blood and blood products to control the hemorrhage associated with AFE, but that just makes the right sided heart failure worse. So, getting an ECHO as early as possible can help guide your treatment. Using a TEG to determine which blood products are indicated will also be useful. Here is a short video from our course on AFE. I hope you find it helpful.

If you would like to complete this course it is in our short course. It consists of 3 class A CEU.

Improving Anesthesia Outcomes Short Course I

 

Are you ready to have a magical time while earning your CEUs? Join us at The World's Most Magical Celebration for Nurse Anesthetists

January 19-22, 2023 | Walt Disney World