Scenario in a Nutshell
Postpartum woman develops Group A streptococcal septic shock.
Stage 1: Initial assessment with initiation of management for sepsis.
Stage 2: Deteriorating hypotensive patient not responding to fluid boluses – septic shock.
Stage 3: Commence vasopressors and plan for invasive monitoring and transfer to critical care.
Target Learner Groups
All members of the multidisciplinary obstetric team: anaesthetists, midwives, obstetricians, operating department practitioners/anaesthetic nurses.
| Specific learning opportunities |
|---|
| Early recognition of a deteriorating septic patient |
| Knowledge of the management of sepsis with appropriate escalation of treatment |
| Effective team management of an acutely unwell obstetric patient with appropriate senior and multidisciplinary involvement |
| Suggested learners (to represent their normal roles) | In the room from the start | Available when requested |
|---|---|---|
| Anaesthetic ST3+ | √ | |
| Obstetric ST3+ | √ | |
| Midwife coordinator | √ | |
| Midwife in room | √ | |
| Operating Department Practitioner (ODP)/anaesthetic nurse | √ | |
| Suggested facilitators | ||
| Faculty to play role of ward midwife giving SBAR handover to midwife and obstetric ST3+ at start of scenario | √ |
Details for Facilitators
Patient Demographics
Name: Eva Age: 32 Gestation: 1 day post partum Booking weight: 80 kg Parity: P1 |
Scenario Summary for Facilitators
32-year-old, now P1 woman, had a normal vaginal delivery at 40+5 weeks, then had repair of a third-degree tear in theatre.
She is now 18 hours post-delivery with swinging temperatures, lower abdominal pain and foul smelling lochia.
She develops a tachycardia then hypotension.
Unresponsive to intravenous crystalloid infusion.
Diagnosis of septic shock.
Resuscitation with antibiotics, intravenous crystalloid and vasopressors.
Safe planning of transfer to critical care.
Set-up Overview for Facilitators
| Clinical setting | On a postnatal ward bed |
| Patient position | Semi-recumbent |
| Initial monitoring in place | None |
| Other equipment | None |
Medical Equipment
For core equipment checklist, see Chapter 9.
| Additional equipment specific to scenario | ||
|---|---|---|
| Local microbiology antibiotic guidelines | Arterial line |
| CVP line | |
Information Given to the Learners
| Information given to obstetric trainee and midwife who are taking over care of patient from the current ward midwife (facilitator) |
|
Scenario Schedule
Figure 28.1 ECG.
Suggested Topics for Debrief Discussion
Were the ‘sepsis 6’ completed in a timely manner?
Was there early escalation of management to involve anaesthetics and intensive care and senior obstetricians and anaesthetists?
Was there any problem locating any drugs/equipment needed: e.g. broad-spectrum IV antibiotics, clindamycin, noradrenaline?
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