Flashcards in OB caring for pt w labor epidural Deck (66)
An epidural is important for blunting the HD effects from contractions in what sub populations?
mitral stenosis, spinal cord injury, intracranial neuro vascular lesions, preeclampsia
Absolute contraindications for laboring epidural?
refusal, uncooperative, increased ICP, infection at site of needle placement, frank coagulopathy, severe hypovolemia, anticoag therapy, decreased FHR variability or late decels, known allergy to med given
Relative contraindications to laboring epidural?
systemic maternal infection, preexisting neuro deficiency, mild or isolated coagulation abnormalities, relative hypovolemia, poor staffing
Moving towards the spinal cord from the epidural space, what are the 4 membranes that cover the spinal cord going from outermost to innermost?
dura, arachnoid, subarachnoid, pia mater
This is the outermost layer covering the nerve roots
This layer is thin, spider like and forms the middle layer
This layer beneath the arachnoid matter and filled w CSF?
This is the innermost layer and adheres tightly to the spinal cord and brain
When opioids and LA are used for epidurals, they collect in?
Epidural space contains?
fat, epidural veins, lymphatics, segmental arteries, nerve roots
Medications used in epidurals act on receptors in the?
dorsal horn by diffusing across meninges and CSF
T 4 dermatome?
T 10 dermatome?
S2, S3, S4 dermatome?
Poss situations causing inadequate pain coverage w epidural placement?
BMI >30, short or tall, previous spinal surgeries, variety of musckuloskeletal disorders, hx of previous epidural, radicular pain during placement, posterior presentation of the fetus, labor >6 hours
some troubleshooting suggestions for unsatisfactory labor epidural?
manipulate epidural catheter, add more LA, reposition, replace epidural, single shot spinal, continuous spinal, combined spinal epidural, place additional epidural, IV meds
Some causes of an adequate level but insufficient density of block?
not enough time, loss of LA (volume), inadequate % of LA, pt overexpectations
Some causes of satisfactory density but inadequate segmental level?
small vol of LA, insufficient time, loss of LA, anatomical features such as previous surgery, allow more time, additional epidural
Causes of not working epidural that had been working?
migration in to subarachnoid space (total spinal), intravascular, laterally (unilat block), completely out, labor progression, dysfunctional labor, pt perception changed
If pt has a lateral/one side block, what is something you can try?
have patient lie painful side down and bolus while lying
What can you do to troubleshoot an epidural that was working and is currently not?
catheter exam, redose, give more volume, add opioids, % LA, replace
Epidurals are typically placed at what level?
T10-L1 innervates what organs?
uterus, cervix, upper portion of vag
S2-S4 innervates what part of body?
First stage labor pain is visceral or somatic?
Second stage labor pain is visceral or somatic?