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test ob > Module 8: Part 2 > Flashcards

Module 8: Part 2 Flashcards

24-46 (81 cards)

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1
Q

30-40% pregnant women have a fasting gastric volume of ___ ml and ___ acidity

A

volume > 25 ml
gastric fluid acidity < 2.5

Hi, Mendelson Syndrome, how are ya?

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2
Q

Bicitra
when to give?
how much to give?
why?

A

give 30 ml at least 20 min prior to induction

Non-particulate antacid; buffers gastric fluid and raise pH

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3
Q

H2 antagonist (Pepcid)
when to give?
moA?

A

within 30 minutes of induction
(max effect in 60-90 min)

prevents histamines potentiation of acid production

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4
Q

T/F
Pepcid (20 mg) inhibits gastric acid pH

A

False
inhibits gastric acid secretion

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5
Q

Reglan
dose
moA

A

10 mg
increases LES & reduces gastric volume by increasing peristalsis

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6
Q

Aspiration Prophylaxis
medication options

A
  • Non-particulate antacid (Bicitra 30 ml)
  • H-2 antagonist (Pepcid 20 mg)
  • Reglan (10 mg)
  • Proton-Pump inhibitors
  • Zofran
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7
Q

Decreases in Maternal mortality from pulmonary aspiration are due to:
(5)

A
  • Increased use of NA (most important factor in decline)
  • Reglan, Pepcid and Bicitra, PPI’s
  • RSI and general anesthesia
  • Training, Communication
  • NPO policies
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8
Q

Nerve Lesions can be located…

A

Central
&
Peripheral

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9
Q

Nerve Lesions
Central vs. Peripheral

A

Central:
* Mostly bilateral
* weakness or paralysis from the site of the lesion distally
* autonomic dysfunction
* possible upper motor neuron signs (spasticity, bowel/bladder dysfxn)

Peripheral:
* Usually unilateral
* Weakness or paralysis limited to a single muscle or muscle group that the peripheral nerve innervates

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10
Q

(Central/Peripheral) Nerve Lesions are often a/w as spasticity and bowel/bladder dysfunction.

A

Central

Central:
* Mostly bilateral
* weakness or paralysis from the site of the lesion distally
* autonomic dysfunction
* possible upper motor neuron signs (spasticity, bowel/bladder dysfxn)

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11
Q

Obstetric injuries include compression & palsies of….

A

compression: lumbosacral trunk

palsies: obturator, femoral, lateral femoral cutaneous, sciatic and peroneal nerves

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12
Q

Peripheral Nerve Palsies
ocurrence

A

0.6 to 92 per 10,000 reported incidence

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13
Q

(Central/Peripheral) Nerve Palsies usually have obstetric causes instead of neuraxial

A

peripheral

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14
Q

Peripheral Nerve Palsies often occur from …

A

compression in the pelvis by the fetal head

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15
Q

Distal compression (positioning) is a/w (Central/Peripheral) Nerve Palsies

A

peripheral

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16
Q

Signs of Peripheral Nerve Palsies are often overlooked if…

A

using neuraxial

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17
Q

Peripheral Nerve Palsies
Risk factors

A
  • prolonged second stage of labor
  • difficult instrumental delivery
  • nulliparity
  • prolonged lithotomy position
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18
Q

Neurologic Complications in OB
Anesthesia vs. Childbirth

A
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19
Q

Neurologic injuries of childbirth
Risk factors

A
  • Prolonged 2nd stage
  • Nulliparity
  • Epidural (stretch and compression injuries masked)
  • Positioning/ time in lithotomy
  • Operative delivery
  • Malpresentation, occiput posterior, fetal macrosomia
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20
Q

About 1% of neurlogical injuries is d/t

A

childbirth

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21
Q

Neurologic injuries of childbirth
how long do they last?
does it resolve?

A
  • Median duration 6-8 weeks
  • Symptoms resolve or improve in most
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22
Q

Intrinsic Birth Nerve Injuries
(2)

A

Lateral femoral cutaneous
(MOST common)

Femoral
(second)

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23
Q

T/F
Femoral nerve injuries are the most common nerve injury d/t intrinsic birth.

A

False
Lateral femoral cutaneous

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24
Q

(Intrinsic birth injuries)
Lateral femoral cutaneous
vs
Femoral

A

Lateral femoral cutaneous
* compression under inguinal ligament
* prolonged hip flexion or pressure at waist
* sensory deficit on anterolateral aspect of thigh
* purely sensory

Femoral
* C/S: retractor compression against pelvic wall
* partial hip flexion
* weak knee extension
* diminished patellar reflex
* hyperesthesia: anterior thigh and medial calf

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25
Which nerve injury is purely sensory?
Lateral femoral cutaneous
26
All are true of Lateral femoral cutaneous nerve injury EXCEPT: A) most common intrinsic birth nerve injury B) purely sensory C) can be caused by retractor compression against pelvic wall D) caused by compression under inguinal ligament E) prolonged hip flexion or pressure at waist
C) can be caused by retractor compression against pelvic wall this applies to femoral nerve injury
27
T/F Bicitra only works if you take all 30 ml.
True suck it up, buttercup
28
Peripheral nerve injuries other than Lateral femoral cutaneous and Femoral are more r/t...
* fetal head * forceps * retractors
29
Lumbosacral plexus injury
75% unilateral 25% bilateral * large fetus * malpresentation * small pelvis
30
Mom has a small pelvis. Wha nerve injury is she at risk for?
Lumbosacral plexus injury
31
Peripheral nerve injuries other than Lateral femoral cutaneous and Femoral
* Lumbosacral plexus * Sciatic * Peroneal * Obturator
32
Mechanisms by which bladder function may be disturbed
33
SATA Which can contribute to urinary incontinence and retention? A) subarachnoid neurotoxicity B) damage to lateral pelvis C) uterine hypertrophy D) cauda quina syndrome E) trauma to conus
A) subarachnoid neurotoxicity D) cauda quina syndrome E) trauma to conus damage to pelvic FLOOR postpartum ATONY
34
Neurologic Sequelae of Dural Puncture (2)
* Cranial nerve palsy (major CSF loss d/t dural puncture with a large needle) * Cranial subdural hematoma (↓ CSF pressure can rupture bridge meningeal veins)
35
Cranial nerve palsy
major CSF loss if dural puncture with a large needle * Cranial nerve VI, VII and VIII most common * Abducens (VI) most vulnerable * prompt epidural patch * possible delayed recovery * If cranial nerve VIII, tinnitus may become permanent
36
Cranial subdural hematoma
Decreased CSF pressure can rupture bridge meningeal veins * use blood patch * if headache persists + altered consciousness, seizures or focal issues…. Immediate MRI and possible surgery
37
T/F Blood patch is used for Cranial subdural hematoma but not Cranial nerve palsy.
False must use for both!
38
Mechanism by which lesions of the central nervous system may arise in parturients
39
Epidural Hematoma must be taken to surgery within..
6 hours
40
If paresthesia with insertion of the needle for SAB/Epidural ....
Stop advancing and redirect the needle once paresthesia goes away
41
Epidural cath can injure a nerve root if..
too rigid or inserted too far
42
Spina bifida occulta
Imaging is preferred (practitioner dependent) insert needle remote from site of malformation seen on imaging 
43
Patients with _____ are at higher risk of post dural puncture headache 
Spina bifida occulta
44
T/F Neuraxial anesthesia is contraindicated in Spina bifida occulta
False not if its occulta
45
You're doing a SAB. When injecting the local anesthetic, the patient complaints of pain. What can happen?
SAB Insertion Trauma
46
T/F CSF leak can cause arachnoiditis.
False wrong injection or formulation
47
Epidural Hematoma
-Blood collects in epidural space -Rare in OB Signs/symptoms: * Acute back pain and radicular pain * LE numbness and weakness * Urinary and bowel dysfunction
48
Epidural Hematoma Risk factors
* Difficult epidural * coagulopathy * spinal deformity * spinal tumor
49
Epidural Hematoma what do to if suspected
* Immediate MRI & neuro consult * Minimize time to decompression * If >6 hours since s/s & diagnosis, often don’t recover
50
Epidural abscess
* 4-10 days postpartum * Severe Backache & local tenderness * Fever, headache, neck stiffness * Staph (most common) * WBC and ESR increased * Often mistaken for PDPH
51
In contrast to epidural hematoma, symptoms of epidural abscess are more ___
insidious ## Footnote develops slowly without noticing
52
Often mistaken for PDPH
Epidural abscess
53
Epidural abscess intervention
* Prompt MRI * Antibiotics, needle drainage * Surgical decompression
54
Epidural Abcess vs Meningitis usual causative organism
Epidural Abcess: Staphylococcus aureus Meningitis: Streptococcus salivarius
55
Procedures to Decrease the Risk for Infection after Neuraxial Anesthesia
56
Not wearing a mask during NA can cause
meningitis
57
T/F Cauda Equina Syndrome and transient neurlogical syndrome are examples of a chemical injury.
True
58
Cauda Equina Syndrome what is it? S/S?
* Pressure or swelling of the lumbar nerves * Hematoma * Severe low back pain, motor weakness, sensory loss, bowel and bladder dysfunction * Needs immediate treatment
59
Cauda Equina Syndrome caused by...
Intrathecal injection of hyperbaric 5% lidocaine and sometimes other locals
60
Transient neurologic syndrome what is it? S/S?
Pain: buttocks, back, thighs Lithotomy position Transient presentation
61
Transient neurologic syndrome
* Follows spinal and usually the use of lidocaine * Concentration, additives, and preservatives of LA * More with Lidocaine and mepivaine vs prilocaine and bupi
62
Which LA is a/w a higher rate of Transient neurologic syndrome? A) Prilocaine B) Bupivicaine C) Chloroprocaine D) Tetracaine E) Lidocaine
E) Lidocaine * Follows spinal and usually the use of lidocaine * More with Lidocaine and mepivaine vs prilocaine and bupi
63
Arachnoiditis
Neurologic condition -pain, stinging or burning in the back, perineum, legs, arms and feet -worse case: paraplegia
64
Arachnoiditis -causes -treatment
Injection of dyes, iodine Exposure to chemicals that do damage to the arachnoid and meninges Treatment: MRI, Pain meds, Steroids?
65
Adhesive arachnoiditis
chemical origin from intrathecal injection of medications with preservatives, iodine
66
We must deliver, If CPR is unsuccessful after this long
4 minutes
67
Direct trauma and injury
* Single root neuropathy * Radicular injuries often with pain or paresthesia * Damage to conus medullaris from SAB/CSE * Neurotoxicity from wrong drug or high concentration * Lidocaine 5%
68
T/F 0.75% Bupivicaine is the LA most often a/w direct nerve trauma and injury.
False Lidocaine 5%
69
pinching of nerve
Radiculopathy
70
Nerve injury prevention
* Stop advancing needle if pain * Inject or place catheter if pain resolves * Remove & start again if it doesn’t resolve * use low lumbar site for SAB * Double check drugs & dose (EPI ?) * Aseptic technique
71
Assessment of neurologic injury
* Full details of labor & delivery course * Assess neurologic deficits & pain * Onset, progression * Sensory or motor? * Consider neuro consult * PT consult * Differential diagnosis (birth injury or neuraxial)
72
When assessing neurologic injury, what's the differential diagnosis?
birth injury or neuraxial
73
Horner’s Syndrome can be seen after...
epidural insertion, brachial plexus block usually due to the spread of local anesthesia Stellate blocks; converting labor→c/s epi-d bc high dose lido
74
T/F Horner’s Syndrome is benign and short-lived.
True Usually self-limiting
75
Horner’s Syndrome most common presentation
Unilateral ptosis with miosis
76
Horner’s Syndrome s/s
* Unilateral ptosis w/ miosis (most common) * Anhidrosis * enophthalmos * High sympathetic block but pt is breathing
77
Differential Diagnosis of Postpartum Headache Review table 30-1 ## Footnote its huge
* Tension headache * Migraine * Musculoskeletal * Preeclampsia/eclampsia * Posterior reversible (leuko)encephalopathy syndrome (PRES) * Stroke * Subdural hematoma * Carotid artery dissection * Cerebral venous and sinus thrombosis * Brain tumor * Idiopathic intracranial HTN (pseudotumor cerebri/benign) * Spontaneous intracranial hypoTN * Pneumocephalus * Meningitis * Sinusitis * Caffeine withdrawal * Lactation headache * Ondansetron headache * Post–dural puncture headache
78
Postpartum headaches occur during the first __ weeks after delivery and manifest as ...
6 cephalic, neck or shoulder pain
79
Differential Diagnosis of Postpartum Headache ## Footnote just what the ppt mentioned
* Migraine * tension * musculoskeletal * pre-E * subarachnoid hemorrhage * brain tumor * subdural hemorrhage * meningitis * caffeine withdrawal * PDPH
80
Postpartum Headache primary vs. secondary
Primary headaches are 20 times more common than secondary in the first week postpartum
81
most common postpartum complication of neuraxial anesthesia
Post-Dural puncture headaches (PDPH)

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