Module 19 Obstetric & Pediatric Flashcards by Megan Manasco

What lung volume decreases during pregnancy? By how much

FRC decreases 20%

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Is MAC increased or decreased during pregnancy

Decreased by 1/3

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Does pregnancy mimic an obstructive or restrictive defect

Restrictive FEV1/FVC is normal

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When is cardiac output greatest with pregnancy

After delivery for next few weeks

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What hematologic changes are seen in pregnant patient

Plasma volume increases 25-40% leading to dilutional anemia

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Pregnancy effects on coagulation

Accelerated but compensated coagulation
Increased platelet turnover
Increased clotting
Increased fibrinolysis

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At term uterine blood flow is how much of cardiac output

10%

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Painless vaginal bleeding during second or third trimester associated with

Placenta prevails

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Painful vaginal bleeding is associated with

Placental abruption

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Placenta invades and is confined to the myometrium

Placenta increta

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Placenta adheres to myometrium without invasion or passage through uterine muscle

Placenta accreta

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Placenta invades and may penetrate the myometrium, uterine serous, or other pelvic structure

Placenta percreta

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AFE treatment

Atropine
Ondansetron
Ketorolac

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PIH combined with new onset proteinuria after 20 weeks gestation

Pre-eclampsia

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Hallmark of preeclampsia

Abnormal placental implantation

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Definitive treatment for preeclampsia

Delivery of fetus

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Drug of choice for preeclampsia and eclampsia

Magnesium sulfate

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Preeclampsia in presence of seizures

Eclampsia

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HELLP stands for

Hemolysis
Elevated Liver Enzymes
Low Platelets

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Drug shown to improve maternal outcome in HELLP

Dexamethasone 10mg every 2 hours increases number of platelets

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Magnesium sulfate dosing for preeclampsia/eclampsia

4-6g over 30 minutes followed by infusion 1-2g/hr

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Normal magnesium level

1.8-2.5mg/dL

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Loss of DTR at what magnesium level

7-12 mg/dL

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Deceleration indicated head compression

Early deceleration

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Deceleration indicated cord compression

Variable deceleration

What is the rule of 60s

Variable deceleration associated with fetal asphyxia if fetal HR decreases by 60bpm, greater than 60 seconds, persists for more than 60 seconds

Deceleration indicating uteroplacental insufficiency and fetal compromise. Occurs at peak of contraction

Late deceleration BAD

How does maternal blood circulate through the placenta

``` Uterine arteries (2) in Spurted into intervillous space Passes fetal villi Drains back into urethane vein ```

Uterine blood flow formula

UBF = (Uterine MAP - Uterine vein pressure) / uterine vascular resistance

Predominant adrenergic receptor in Uterine vasculature

Alpha adrenergic receptors

3 factors that decrease uterine blood flow

Maternal hypotension Uterine vasculature vasoconstriction (Neo) Uterine contraction

Fetal bradycardia is defined as

HR < 120

2 signs of fetal hypoxia

Fetal bradycardia Late deceleration

The amniotic sac has ruptured and is accompanied by bleeding and fetal heart rate deceleration. What should you suspect?

Vasa previa Fetal vessels implanted over cervical os and not protected by placenta or umbilical cord CAN LEAD TO EXSANGUINATION OF FETUS

Classic presentation of AFE

Dramatic and abrupt onset of dyspnea and hypotension Coagulopathy near delivery Cardiovascular collapse

Oxytocin should be avoided in what 3 groups of patients

Preeclampsia HTN Cardiac disease

Oxytocin MOA Side effects

Acts on uterine smooth muscle to stimulate frequency and force of contraction Increase in BP and HR antidiuretic effect leads to water intoxication, cerebral edema, and convulsions

Tocolytic MOA Name 2

Suppress uterine contractile activity Ritodrine Terbutaline

Formula for ETT size in children over 2

(16 + age)/4

Formula for ETT depth

ETT internal diameter x 3

Normal SBP formula children >1yo

(Age x2) + 70

EBV premie

90-100ml/kg

EBV term newborn

80-90ml/kg

EBV 3mo to 3yo

75-80ml/kg

EBV 3-6yo

70-75ml/kg

EBV >6

65-70ml/kg

EBV obese

50-55ml/kg

Congenital diaphragmatic hernia most common at what site

Left foramen of Bochdalek

Goal in treatment of congenital diaphragmatic hernia

Preductal sat >85% with PIP <25cmH20 Avoid N20

Most common variation of TEF

Ends in a blind pouch and lower esophagus that connects to trachea

Intubation technique for TEF

Intentionally mainstem then withdraw until bilateral breath sounds. Tip distal to TEF (between TEF and carina)

Nonbilious projectile vomiting at 2-5 weeks of age associated with

Pyloric stenosis

Classic metabolic disturbance with pyloric stenosis

Hypokalemic, hypochloremic metabolic alkalosis with compensatory respiratory acidosis

Bilious vomiting is classic sign of

Intestinal malrotation and volvulus

How to mix racemic epi new

2.25% solution. 0.5-1ml in 2-3 ml NS Repeat in 20 minutes and every 2-4 hours PRN

APGAR score 0-2 action

Intubate and CPR

APGAR 3-4 action

Temporary ventilation assistance

APGAR 5-7 action

Stimulation and oxygen across face

Normal HR and RR for newborn

RR 30-60 HR 120-160

Hallmark of intravascular fluid depletion in neonates is

Hypotension without tachycardia

Two limitations of kidney function in newborn

Obligate sodium excreters Diminished ability to concentrate urine

When is cytochrome P450 enzyme system fully functional

1 month old

Hemoglobin concentration drops after birth when/to what

9-12 weeks reaching 10-11g/dL

When does hemoglobin stabilize

12 weeks until 2 years 11.5-12g/dL

What is the caloric need in relation to BSA for full term infant

30kcal/m2 per hour By 2 yo 50kcal/m2 per hour

Resting 02 consumption for infant

6-8ml/kg/min

Where are pulse oximetry placed to monitor preductal and postductal saturation

Preductal right hand Post ductal left foot

Preductal pulse ox used to monitor

Cerebral oxygenation

Postductal sat monitor monitors what

Quantitative severity of left to right shunt

What causes foramen ovale to close

Decrease in PVR and increased pulmonary flow Increased pressure in LA shuts the flap

What closes the ductus arteriosus

Increased arterial oxygen tension and decreased circulating prostaglandins

4 factors that may cause infant to return to fetal circulation

Hypothermia Hypercarbia Acidosis Hypoxemia Increased PVR and R-L shunting

Congenital defects in which there is a simple right to left shunt

TOF Pulmonary atresia Epstein’s anomaly Eisenmenger’s syndrome

Congenital defects in which there is a simple left to right shunt

``` ASD VSD AV canal defect PDA Aortopulmonary window ```

Conditions that increase PVR

``` Hypoxia Hypercarbia Acidosis Hypothermia High mean airway pressures Catecholamine release Medications (neo, ketamine, N20) Decreased SVR B2 agonists Neuraxial Deep general anethesia ```

Congenital defects seen with tetralogy of fallot

VST RVOT RV hypertrophy Overriding aorta

Mandibular hypoplasia is associated with what congenital diseases

Pierre Robin Treacher Collins Goldenhar

What are the causes of retinopathy of prematurity

Oxygen toxicity | Prematurity (PCA <32 weeks)