Atropine 0.9mg, Ondansetron 4mg, Ketorolac 30mg at minute 5.Intubated, chest compression, epinephrine 1mg, vasopressin 40 units with brief weak pulse, no BP.28 yo G2P1 39 wks, elective c/s, uterine incision, tachypnea, restlessness, gasp, decerebrate posturing, apnea, PEA. ![]() Ketorolac 30mg to block throboxane production.Ondansetron to block serotonin receptors and for vagolysis.Vagal stimulation caused severe SBP decrease and death.Vagotomy prevented SBP decrease, few death, no effect on PAP.injected rabbit with marrow compared platelet depletion, vagotomy, 5-HT3 blocker, vagal stimulation About half of the vagal afferent terminals in the lung and the heart are serotonergic, not cholinergic.Systemic hypotension and bradycardia due to reflex vagal stimulation and PTH.Pulmonary hypertension due to serontonin and thromboxane.Peripheral vasodilation, bradycardia are the final lethal events.Thromboxane, serotonin cause intense pulmonary vascoconstriction, stimulate vagal reflex.Just barely lethal amount of material embolized into pulmonary arteries (blood clot, marrow, fat, microsphere).It is known as AOK treatment, atropine, ondansetran and ketorolac. If you encounter AFE in your clinical practice, you may want to try something innocuous that may get you out of trouble. Evidence is based on the case report and animal studies. There are no RCA, retrospective studies due to the rarity of the AFE. There are some new insights on the proposed MOA of AFE. Recombinant factor VIIa is not recommended as it may lead to increased mortality. Treatment for coagulopathy if occurred should initiate early with fresh frozen plasma, cryoprecipitate/fibrinogen concentrate, and antifibrinolytics. ![]() We all know there is really no cure for AFE but supportive management of ABC directing at treating cardiovascular, pulmonary, and coagulation derangements. Severe symptoms include hypotension, cardiac arrest, dyspnea, cyanosis, respiratory arrest and coagulopathy. ![]() It mostly occurs during labor but could happen before labor or after delivery. The new mortality rate is actually a lot lower than what we learned in textbook which is roughly 20-30%. For those of you who provide obstetric care to patients, it is crucial that we need to know what to do and how to optimize the patient when it happens. We all wish we don’t have to experience this during our career. AFE is a rare but serious obstetric emergency.
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