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AP III > OB (7/10) > Flashcards

OB (7/10) Flashcards

1
Q

an epidural test dose consists of __________ lidocaine and ___________ epi

A

1.5%; 1:200000

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2
Q

if your epidural catheter is in the epidural vein, after test dose your HR would raise by _____________

A

20-40 bpm

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3
Q

if your epidural catheter is in the subarachnoid space, when you administer your test dose, what would happen

A

rapid spinal block in 3-5 min

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4
Q

T/F: loading doses into epidural should be given as bolus

A

false; should be incremental

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5
Q

what are your options for loading dose epidural after you get a negative test dose

A
  1. 0.25% bupivicaine
  2. infusion solution (0.125% bupiv/2 mcg/mL fentanyl)
  3. 100 mcg of fentanyl (gives fast onset while waiting on LA)
  4. lidocaine 1-2%
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6
Q

which is more accurate in assessing the level of a regional block - etoh swab or pin prick?

A

pin prick

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7
Q

if your epidural block seems adequate except in the sacral area, how should you intervene?

A

consider large volume of local (1% lido in 15 cc)

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8
Q

if your pt is having breakthrough pain with epidural, but the sensory block seems adequate ________________ of the block may be inadequate; therefore you should use a ________________ of local

A

density; more concentrated

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9
Q

pt with epidural is having decreased efficacy of pain control with repeated doses of LA. how should you intervene?

A

pt is experiencing tachyphylaxis - switch to different LA

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10
Q

which organ system is more susceptible to LAST ?

A

CNS

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11
Q

tx for LAST

A
  1. stop LA
  2. maintain ABGs
  3. iv infusion of 20% lipid emulsion
  4. tx arrhythmias
  5. Bz for seizures
  6. IV fluids/vasopressors (epi preferred)
  7. avoid: CCB, LA, BB, vasopressin
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12
Q

progression of sx you may see with LAST

A
  1. numbness of tongue (1st sxs)
  2. lightheadedness
  3. muscular twitch
  4. loss of consciousness
  5. convulsions
  6. coma
  7. respiratory arrest
  8. CVS depression (last sx)
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13
Q

________________ is the most common anesthetic used for C-section

A

spinal anesthesia

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14
Q

indications for spinal anesthesia in OB

A
  1. cerclage (incompetent cervix - has to be sutured to prevent early opening)
  2. non-OB surgery during pregnancy
  3. instrumental vaginal delivery
  4. C-section
  5. removal of retained placenta
  6. postpartum tubal ligation or salpingectomy
  7. labor analgesia
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15
Q

how long does a laboring spinal typically last

A

70-120 minutes

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16
Q

laboring spinal

A
  1. single shot LA into SA space during labor
  2. smaller doses to avoid motor block
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17
Q

laboring spinal is ideal for which patient

A

spontaneous labor in multiparous pt with advanced dilation

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18
Q

what are the different htn d/o that can be experienced during pregnancy

A
  1. preeclampsia
  2. eclampsia
  3. gestational Htn
  4. chronic htn
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19
Q

________________ is a pt who did not have htn prior to pregnancy, but because htn during pregnancy but do not have any features of preeclampsia

A

gestational HTN

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20
Q

_________________ is new onset of hypertension after 20 weeks gestation

A

preeclampsia

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21
Q

preeclampsia affects _______% of pregnancies

A

4

22
Q

what is the only effective and definitive tx of preeclampsia

A

delivery of infant and placenta

23
Q

what is the leading cause of pre-term deliveries

A

preeclampsia

24
Q

______________ can present as maternal syndrome with or without fetal syndrome

A

preeclampsia

25
Q

what is the maternal syndrome experienced with preeclampsia

A

htn and proteinuria

26
Q

what are the fetal syndromes that can exist due to preeclampsia

A
  1. fetal growth restriction
  2. oligohydraminos
  3. abnormal oxygenation
27
Q

pregnant woman > 20 wks gestation with htn + proteinuria = definitive diagnosis of __________________

A

preeclampsia

28
Q

htn without proteinuria must present with what to be diagnosed as pre-eclampsia

A
  1. persistant epigastric pain or RUQ pain
  2. peristent cerebral sx - HA, visual disturbances, confusion
  3. fetal growth restriction
  4. thrombocytopenia
  5. elevated liver enzymes
29
Q

what is the leading risk factor for preeclampsia

A

nulliparity (first pregnancy)

30
Q

risk factors for preeclampsia

A
  1. 1st pregnancy (nulliparity)
  2. women with preeclampsia with previous pregnancy
  3. women of advanced maternal age
  4. maternal or paternal family hx
  5. women with hx of previous placental abruption, IUGR, or fetal death
  6. non-hispanic blacks
31
Q

what are some maternal comorbidities that increase the risk of preeclampsia

A
  1. obesity
  2. chronic HTN
  3. DM
  4. metabolic syndrome (obesity, hyperglycemia/insulin resistance, htn)
32
Q

for every _________ pt increase in BMI, risk of preeclampsia increases ___________ fold

A

5-7; 2

33
Q

T/F: smokers are at increased risk for preeclampsia

A

false; non smokers at higher risk

34
Q

preeclampsia is known to be a 2 stage disorder that is _________________ at the first stage and ______________ at the 2nd stage

A

asymptomatic; symptomatic

35
Q

T/F: the exact pathogenic mechanism of preeclampsia is not known

A

true - do know there is some failure of trophoblastic invasion though

36
Q

urine protein: urine Creatinine > ___________ = preeclampsia

A

0.3

37
Q

urine protein > __________ in 24 hour sample = preeclampsia

A

0.3 gm

38
Q

what defines mild preeclampsia

A
  1. BP >/= 140/90 after 20 wks gestation
  2. proteinuria > 0.3 gm on 24 hour urine
39
Q

what defines severe preeclampsia

A
  1. BP >/= 160/110
  2. proteinuria > 5 g/24 hour

and at least one of the following:
3. increased serum Cr
4. pulmonary edema
5. oliguria
6. IUGR
7. HA
8. visual disturbances
9. epigastric pain or RUQ pain
10. signs of HELLP

40
Q

trophoblastic invasion of the spiral arteries causes the loss of _____________ ability of vessels to ___________ which explains the __________ resistance nature of the uteroplacental circulation

A

smooth muscle; constrict; low

41
Q

pre-eclampsia prophylaxis

A
  1. ASA
  2. Calcium
  3. antioxidant supplements
42
Q

how does pre-eclampsia affect the airway

A
  1. increased edema which could lead to obstruction
  2. pulmonary edema (3%)
  3. decreased tracheal size
43
Q

how does preeclampsia affect the CV system

A
  1. hyperdynamic
  2. BP and SVR increased
  3. increased vascular tone
  4. vasospasm of vessels
  5. exaggerated response to catecholamines
  6. edema everywhere
  7. plasma volume decreased by 40% (so do not even get benefits of increased plasma volume with preg)
44
Q

how does preeclampsia affect the hepatic system

A

increased risk of liver rupture –> hemorrhage and death

45
Q

how does preeclampsia affect the kidneys

A
  1. decreases GFR
  2. proteinuria
46
Q

T/F: decreased UOP is an early sign of pre-eclampsia

A

false; it is a late sign

47
Q

how is the hematologic system affected by pre-eclampsia

A
  1. hypocoagulable (increased bleeding risk)
  2. risk of DIC
48
Q

how do you manage pre-eclampsia

A
  1. fetal monitoring
  2. tx of htn (typically hydralazine and/or labatelol + mg + epidural)
  3. seizure prophylaxis (magnesium gtt)
  4. delivery decisions
  5. betamethasone
49
Q

what sx should you be assessing for when pt comes in with pre-eclampsia

A
  1. HA
  2. visual disturbances
  3. AMS
  4. SOB
  5. abdominal pain
  6. N/V
  7. decreased UOP
  8. seizures
50
Q

what is the plasma magnesium level goal for the pt with pre-eclampsia

A

5-9 (remember normal is 1.7-2.7)

AP III (20 decks)

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