Scenario in a Nutshell
Complete heart block in patient for TOP with known Mobitz type II requiring pacing.
Stage 1: Assessment of stable patient with known Mobitz type II heart block.
Stage 2: Bradycardia with adverse features necessitating medical management.
Stage 3: Bradycardia unresponsive to medical management, requires transcutaneous pacing.
Stage 4: Plan for temporary pacing wire insertion.
Target Learner Groups
All members of the multidisciplinary obstetric team: anaesthetists, midwives, obstetricians, HDU nurses (if part of the usual team), operating department practitioners and cardiologists.
|Specific learning opportunities|
|Knowledge of appropriate medical management of bradyarrhythmia|
|Knowledge of risk factors for complete heart block|
|Recognition of need for pacing|
|Knowledge of transcutaneous pacing set-up|
|Suggested learners (to represent their normal roles)||In the room from the start||Available when requested|
|Midwife in room||√|
|Operating Department Practitioner (ODP)/anaesthetic nurse||√|
|Faculty to play role of antenatal midwife handing over||√|
Details for Facilitators
Booking weight: 80 kg
Scenario Summary for Facilitators
Patient admitted to delivery suite for termination of pregnancy for severe fetal cardiac anomalies at 21 weeks pregnant.
She has a past history of Mobitz type II heart block.
She had mifepristone 24 hours ago and has received one dose of misoprostol PV on the delivery suite.
She complains of chest tightness, is bradycardic at 35 bpm and hypotensive.
She remains unresponsive to medical management (atropine/isoprenaline/adrenaline) and requires transcutaneous pacing and transfer for a temporary pacing wire.
Set-up Overview for Facilitators
For core equipment checklist, see Chapter 9.
|Additional equipment specific to scenario|
|Arterial line||Resuscitation trolley with defibrillator||Pads for pacing|
|Atropine||Drugs for sedation|
Information Given to the Learners
Figure 32.1 Letter from Cardiology Clinic.