Class 1 Complications Flashcards
(46 cards)
What is the most common cause of Intrinsic obstetric paralysis?
-Cephalopelvic disproportion (huge head / little pelvis) that leads to lumbosacral trunk compression (nerve compression)
What two things contribute to prego backache?
- ↑ lumbar lordosis (counterbalance)
- ↑ laxity of pelvic joints
3 complications of neuraxial blocks.
- Nerve injury
- PDPH
- High, total spinal
How are nerves damaged during neuraxial block?
- Hematoma
- Abcess
- Chemical nerve injury
- Needle trauma
- Positioning injury
Hematomas occur w/ what type of patients and when?
- Hemostatic abnormality or coagulopathy
- Upon insertion or removal of catheter
Preggos w/ PIH platelets should be over _______ and not dropping while ____ _____ should be normal before block is placed
- 100k
- PT, PTT
When can a block safely be given with a patient on theraputic heparin? prophylatic heparin?
- Theraputic - 24 hours after last dose
- Prophylatic - 12 hours after last dose
If a patient is given heparin with a catheter in place, when can it safely be removed?
-12 hours after last dose
When can you safely give heparin w/ a catheter in place? and what should be avoided if you do give heparin?
- 2-4 hours after placement
- Concurrent NSAIDS
Signs of epidural hematoma?
- Bilat leg weakness
- Loss of bowel / bladder
- Back pain
When must a hematoma be surgically decompressed for full neurological recovery?
-within 6 hours
25% of lumbar epidural catheters colonize w/ bacteria after _______ days w/o signs of _______ _______.
- 1-5 days
- Local infection
After a infection is present, how long before symptoms occurs, and what are they
- 4-10 days
- Pain and loss of function
What is the treatment for abscess and when should it be done before permanent damage occurs?
- ABX and Laminectomy
- 6-12 hours
Signs of epidural abcess
- Back pain
- Exquisite local tenderness
- Fever
- Malaise
- ↑ WBC
Progression of abcess can lead to what?
- Neuro deficit
- Osteomyelitis
Why is the epidural space resistant to toxicity?
- Very vascular
- Intact membrane between subarachnoid space
What is Transient neurological symptoms (TNS)? What causes it? and in what position?
-Pain and dysesthesia in butt, legs or calves after a block, resolves in 72 hours.
What causes (TNS) and in what position?
- Lidocaine spinals
- Lithotomy position
Where is the conus? and where does the chord end?
- Conus T12-L3
- Chord ends @ L1/L2
If you hit the spinal chord with a needle what should you do? and not do?
- Immediately withdraw
- Do not inject
What nerve injury is common with lithotomy stirrups? What injury is common?
- common peroneal nerve
- Foot drop
What nerve injuries are common with the lithotomy position? What problems arise
- Femoral (difficult climbing stairs)
- Obturator (↓ sensation upper thigh, weak hip abduction)
What is the onset and duration of a PDPH?
- 12-48 hours after dura puncture
- Duration days to weeks
