At 4:30 pm, on a Tuesday afternoon, L&D received a phone call from Dr. Lopez, regarding a 38.1 weeks pregnant patient being triaged in the emergency department for tachycardia and palpitations. An echocardiogram revealed increased pressure and fluid collecting in the sac surrounding the heart, commonly referred to as cardiac tamponade. The decision for a pericardial window, the procedure used to relieve the pressure and fluid from around the heart, and a primary Cesarean section was made by Dr. Lopez, Dr. Neal, and Dr. Squillaro.
Coordination and collaboration of services began in earnest to perform both surgeries and deliver a healthy baby ASAP. This involved teams from the OR, Anesthesia, L&D, Nursery, and Respiratory. All worked together simultaneously and seamlessly to prepare the OR for this critically ill mother and unborn baby. The pericardial window was performed first by Dr. Squillaro, assisted by Dr. Lopez. After the pericardial fluid was drained and two chest tubes were inserted, the chest was packed and the primary C-section began. At 7:30 pm, Dr. Neal delivered a healthy baby, who entered the world with a loud cry and 9 & 9 Apgar scores even after 30 minutes of general anesthesia.
The Nursery staff prepared for a full resuscitation due to maternal cardiac complications and prolonged general anesthesia. Luckily, none was needed. After the C-section, Dr. Squillaro completed the pericardial window with Dr. Neal and the patient was transferred in stable condition to the PACU. The infant was taken to the regular nursery after visiting with the father and family in the OR waiting room. As a part of the nursing team that cared for this patient, I was humbled by the efforts of all involved to provide seamless care of this critically ill mother and baby.