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Flashcards in 29 - preg. in ED Deck (28)
1

normal test changes in preg

- WBC higher
- increased coag
- CO up 30-40%
- systolic murmur
- ST changes
- increased GFR
- cholestasis

2

2 main safe imaging studes

US and MRI

3

DVT and PE risk

- PE 15x higher
- physio changes can mimic PE
- D-dimer present in preg and therefor limited use

4

main test to Dx PE in preg**

**-for acute - portable ECHO is choice
-all others - CXR
-doppler US
- if both neg - can do half dose VQ scan

5

3 Tx info for preg

1. heparin - LMW
2. warfarin is teratogenci
3. life threatening should get thrombolytic

6

risk factors for abuse in preg

1. prior abuse
2. low income
3. unmarried
4. alcohol in partner
5. unplanned preg

7

3 major IVF emergencies

1. ectopic preg
2. heterotopic preg - 2 in 2 different sites
3. ovarian hyperstim. syndrome
- increase cap permeability and depletion of intravascular volume

8

Sx and signs of ovarian hyperstim

mild - distension, N/v, diarr, ovaries enlarge
mod - ascites on US
sever - clinical ascites, hydrothorax, hemoconc., low perfusion of kidney

9

Tx of ovarian hyperstim

- self resolving
- correct and maintain volume
- support renal
- prevent throbosis - LMWH

10

admit criteria for hyperstim

1. no intake
2. hemo unstable
3. resp compromise
4. peritoneal signs
5. tense ascites
6. hemoconc.
7. decreased O2 sats

11

outpatient mgmt of hyperstim

1. limit activity
2. weigh daily
3. monitor fluid intake
4. daily follow up
5. orna anal

12

6 hypertensive emergs

1. gest. hypertension
2. pre-eclampsia
3. eclampsia
4. chronic HTN
5. superimposed
6 HELLP

13

def. gest. HTN

- 140/90
- no proteinuria
- BP returns withint 12 weeks

14

2 main crit. for preeclampsia

1. 140/90
2. protenuria

15

def. of eclampsia

- grand mal seizures
- unrelenting severe HA or visual dist.
- 10% of seizures before onset of HA
-

16

def. superimposed

new onset proteinuria in those with chronic HT

17

def. HELLP

Hemolysis
Elevated Liver enzymes
Low platelets
- decreased organ perfusion
-

18

mgmt of preeclampsia

- admit if new or worsening
- decrease activity
- delivery is cure
- antihypertensive meds

19

mgmt of severe pre and eclampsia

- deliver if over 32 weeks
- IV Mg sulfate to prevent seizures
- if toxi reverse effects with Ca gluconate
- hydralazine and labetalol for HTN

20

outcomes in blunt abdo trauma

- abruption, rupture, death or distress, preterm labor

21

outcome in penetrating trauma

high rate of fetal demise

22

mgmt in trauma

mom is first
1. ABCs
2. place in LL decubitus
3. check for signs of perfusion
4. displace gravid uteruse for CPR
5. IV fluids and possible pressors
6. tocolytics?
7. secondary survey

23

Tx of cystitis and pyelo

asx baceruria - 3 days aBx
cystitis - 7-10days Abx - ceph or amox
pyelo - admit and IV aBx

24

how does asthma change in preg

1/3, better, worse, same
- oral steroids- check with OB
otherwise the same

25

what is hyperemesis gravidarium

more than usual: wieght loss>5%, ketonuria, dehydration, hypokalemia

26

Tx of hyperemesis

- hydrate
- IV meds
- lyte balance

27

what is postpartum endometritits

polymicrobial infection
- Csection is greatest risk

28

Tx of postpartum endometritits

- outpatient amox-clav
- broad spectrum for more severe