A&A practice
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This survey study evaluates the user experience of an electronic maternal early warning system that generates automated pages. Survey domains included the system's effect on patient care, alarm fatigue, and continued use of the system. ⋯ A majority, 83%, felt that the system should remain in use, and 64.5% felt it improved patient safety. Of those who believed that they had received a page, 51.4% felt that they received pages "too frequently." Although alarm fatigue was not fully evaluated, providers on our unit support the continued use of this automated maternal electronic surveillance system.
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This case describes an anticoagulation strategy in a postpartum patient on venoarterial extracorporeal membrane oxygenation (VA ECMO) for a pulmonary embolism (PE) with a concurrent ischemic stroke. After receiving systemic lysis, the patient had impending cardiovascular collapse, right heart strain, worsening clinical picture, prompting VA ECMO cannulation and subsequent cautious management of the patient's anticoagulation. There have been no similar cases published describing an ECMO anticoagulation strategy and management for this complex clinical situation. By withholding a heparin bolus and delaying initiation of a heparin drip for 24 hours, thromboelastogram (TEG) R-time and partial thromboplastin time (PTT) could be closely monitored while the patient began to recover.
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Aromatic L-amino acid decarboxylase deficiency (AADCD) is a rare autosomal recessive disorder of neurotransmitter synthesis with lack of sympathetic autoregulation. Owing to hemodynamic regulatory dysfunction and impairment of sympathetic regulation of heart rate, anesthesia is challenging. ⋯ Neuraxial anesthesia was administered, as she had not developed complications previously. Thus, neuraxial anesthesia can also be used safely for a cesarean delivery with appropriate anticipation of potential autonomic disturbances and lack of adrenergic neurotransmission.