Starting at toxoplasmosis Flashcards Preview

Obs and gobs > Starting at toxoplasmosis > Flashcards

Flashcards in Starting at toxoplasmosis Deck (38):
1

Toxoplasmosis

Can cross BBB. Mother infected handling cat litter, or ingesting contaminated meat.
Causes rodents to be attracted to feline urine (turns it into an aphrodisiac) instead of fear it

2

Toxoplasmosis defects

CNS damage, severity varies with gestational age, growth impairment, hydrocephalus as it blocks ducts between ventricles

3

Rubella Fetal/infant effects

Cardiac anomalies, deafness, microcephaly, cataracts, heart disorders, intrauterine growth impairment, psychomotor impairment (in first 4 weeks of gestation)

4

Cytomegalovirus

Preterm delivery, intrauterine growth impairment, mental impairment, deafness or blindness

5

Lymphocytic choriomeningitis virus (LCMV)

CDC says 2-10% effected, carried by rodents and shed through poo
Causes mild fever, fatigue, anorexia, muscle aches, headaches, N/V (meningitis and encephalitis in small numbers)
Pregnant females in 1st trimester increase miscarriage risk
Fetal abnormalities (hydrocephalus and choriotinitis leads to vision loss)

6

Chorioretinitis

is an inflammation of the choroid (thin pigmented vascular coat of the eye) and retina of the eye. It is a form of posterior uveitis.

7

Zika Virus

Transmitted by mosquitos
Microcephaly, abnormal growth and development causing cognitive and functional disorders

8

Rh incompatibility

Mother Rh-, baby + no problem first pregnancy, but when placenta separates the mom gets exposed to Rh + blood and then she makes Rh positive antibodies IgG is only one that can cross placenta barrier.

9

Rh incompatibility

Mother Rh-, baby + no problem first pregnancy, but when placenta separates the mom gets exposed to Rh + blood and then she makes Rh positive antibodies IgG is only one that can cross placenta barrier.
If second baby is Rh+ hemolysis results causing anemia, heart failure, death or erythroblastosis fetalis.
More pregnancies for mom creates greater risk

10

Erythroblastosis fetalis

Hemolysis of fetal RBC, increased RBC production but immature
After birth, hemolysis of increased RBC, hyperbilirubinemia.
TX is sunlight and transfusions

11

Kernicterus

Brain damage from high levels of bilirubin in a baby's blood. Can cause athetoid cerebral palsy and hearing loss

12

Athetoid cerebral palsy

is a type of cerebral palsy primarily associated with damage, like other forms of CP, to the basal ganglia in the form of lesions that occur during brain development due to bilirubin encephalopathy and hypoxic-ischemic brain injury.

13

Testing for Rh positive antibodies

Coombs test - direct - measures presence of antibody Rh+ antibodies in baby's blood
-Indirect measures amount of Rh+ antibodies in mom's blood

14

Rh incompatibility TX

Formation of anti-Rh antibodies can be prevented by giving Rh immune globulin (WinRho, RhoGAM) at 28 weeks gestation and within 72 hours after birth.
Need sunlight and if really bad complete blood transfusion

15

Sunlight for bilirubin

Directly degrades bilirubin in blood

16

PIH

7% of all pregnancies, directly responsible for a significant number of maternal deaths and fetal death.
More common in primigravida, 20-35 years old, lower socioeconomic groups, poor nutritional status, the beeties, multiple pregnancies (especially with multiple placenta) and fmaily hx of PIH

17

PIH clinical subsets

Related to end organ perfusion also sequence of progression
1. Kidney
2. CNS
3. Hematologic and hepatic
Not individual disorder, but instead a spectrum. Preecalmpsia --> Eclampsia--> HELLP

18

Pathology of PIH

Inappropriate vasospasm

19

Kidneys in PIH

First hits kidney with decreased flow, less reabsorption of protein results in PIH.

20

Preeclampsia BP

140 or up 30 mmHg systolic
Diastolic BP >90 or up 15 from baseline
Edema face and hands
Weight gain over 0.5kg/week
Common in last 10 weeks

21

CNS PIH

Severe pre eclampsia
Headaches, visual disturbances, hyperactive reflexes, BP 160/100 or greater
Generalized edema to face, hands, sacral area, lower ext and abdomen
Gain of 1kg in a few days or week

22

Eclampsia

Tonic clonic seizures or coma

23

Hematologic and hepatic clinical manifestations HELLP syndrome

H - Hemolysis
EL - elevated liver enzymes
LP - lo platelet count
resulting in ischemia and tissue damage

24

Pathology of PIH

Thought to start at implantation, possibly from abnormal implantation of placenta, causing placental ischemia, which activate proinflammatory mediators
Or immunologic response where placenta is perceived as foreign
Vasoconstriction or vasospasm

25

Vasoconstrictrion and vasospasms in PIH

Increased BP, decreased blood flow to placenta and fetus, intrauterine growth impairment, fetal distress and hypoxia
Lowering of renal blood flow, decreased filtration and reabsorption, increase in proteinuria and peripheral edema

26

CNS effects of PIH

Cell damage and cerebral edema causing headaches and visual disturbances

27

Hepatic effects of PIH

Enlargement and tension of the liver capillaries, epigastric pain which often precedes seizures.
Increased prevalence to abnormalities in bleeding and clotting and abruptio placenta

28

Severe S&S of PIH

BP of 160/100
Headaches and visual problems
epigastric or RUQ abd pain
Dyspnea from pulmonary edema
Generalized edema to face and ext w/ excessive weight gain
Cyanosis
Liver dysfunction

29

Assessment of PIH

HELLP syndrome
Hyperactive reflexes, nausea, renal failure, oliguria, confusion
Eclampsia is S&S of above plus seizures

30

TX

Avoid excessive stimulus, can induce seizures. ABCs, intubate prn, High flow O2 (baby ischemic) V/S monitoring, pulse ox, control HTN, ecg

31

HTN PIH tx

Labetalol or mag sulfate or hydralazine

32

Control ceasers with

Mag sulfate or midaz

33

Mag does

Anticonvulsant, decrease platelet aggregation, increases uterine flow and has antihypertensive properties

34

EMS contras for mag

Any degree of heart block, renal failure

35

Mag PIH doses

Loading dose 4g IV/IO over 20 minutes, do not infuse at faster rate OR
10G IM (5 per cheek) not in EMS guidlines
Maintenance 2g/hr

36

Mag toxicity

Assessment of deep tendon reflexes prior to loading
Depressed respiration
Hypotension
Patellar reflex absent
Urine output less than 100mL in preceding 4 hours
TX for mag CaCL 1g IV/IO over 2-minutes

37

More TX of PIH

Labetolol 10-20mg IV/IO q 10 PRN or
Hydralanzine 5-10mg IV/IO over 2 minues q 20 PRN

38

TX of PIH midaz

5mg SIVP/IO or 10mg IM prn q 5 to max of 20mg