Scenario in a Nutshell
Severe life-threatening anaphylaxis following benzypenicillin IV for intrapartum antibiotic prophylaxis for group B streptococcal colonisation.
Stage 1: Recognition of anaphylaxis and initial management.
Stage 2: Patient continues to deteriorate, with airway, respiratory and cardiovascular compromise.
Stage 3: Continuing severe life-threatening anaphylaxis.
Stage 4: Patient continues to deteriorate, requiring intubation, ventilation and referral to critical care.
Target Learner Groups
All members of the multidisciplinary obstetric team: midwives, obstetricians, anaesthetists.
| Specific learning opportunities |
|---|
| Knowledge of common causes of anaphylaxis |
| Recognition of anaphylaxis |
| Knowledge of algorithm for treatment of severe life-threatening anaphylaxis |
| Orientation – knowledge of emergency equipment to treat anaphylaxis in local environment |
| Suggested learners (to represent their normal roles) | In the room from the start | Available when requested |
|---|---|---|
| Anaesthetic CT2 | √ | |
| Anaesthetic ST3+ | √ | |
| Obstetric ST3+ | √ | |
| Midwife Coordinator | √ | |
| Suggested facilitators | ||
| Midwife | √ (first to respond) | |
| Faculty to play role of partner | √ |
Details for Facilitators
Patient Demographics
Name: Kira Age: 38 Gestation: 37 Booking weight: 87 kg Parity: P3 (Prev NVD) |
Scenario Summary for Facilitators
38-year-old para 3, 37 weeks pregnant, admitted to delivery suite in active labour. Spontaneous rupture of membranes (SROM) 2 hours ago, examined 1 hour ago, cervix 4 cm dilated. Receiving first dose of antibiotics for group B Streptococcus.
Previous baby with group B streptococcal infection as neonate. Baby spent prolonged period on NICU and parents very anxious.
Shortly after receiving first dose of IV benzylpenicillin (3 g in 100 ml normal saline running over 1 h as per guidelines) patient complains of feeling unwell – hot, light-headed and difficulty breathing.
Partner (facilitator) alerts staff to the problem. He notices that she appears rather red and flushed.
Treatment of severe life-threatening anaphylaxis ensues, requiring repeated IM/IV adrenaline boluses, bronchodilators and intubation/ventilation and delivery.
Set-up Overview for Facilitators
| Clinical setting |
|
| Patient position |
|
| Initial monitoring in place |
|
| Other equipment |
|
| Useful manikin features |
|
Medical Equipment
For core equipment checklist see Chapter 9.
| Additional equipment specific to scenario | ||
|---|---|---|
|
| |
|
|
|
Information Given to the Learners
| Patient’s relative approaches passing midwife alerting her to his concerns |
|
Scenario Schedule
Suggested Topics for Debrief Discussion
How confident were you managing anaphylaxis in the ward environment?
Would you intubate and ventilate this deteriorating patient on the ward or transfer to a safer location?
When would you check the tryptase levels?
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
