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56 Cards in this Set
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Why w should give cryo. early In obstatric hemorrhage ? |
B.c Dec. in fibrinogen led to strongly Inc. In severity of PPH |
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What is PPH? |
Bl loss more than 500ml in VD or 1000 in CS |
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Causes of PPH? |
Uterine Atony |
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How u ll tt PPH ? |
Agresive uterotonic therapy D&C with uterine relaxation eather by volatile under GA or NTG IV under RA |
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What is sever preclampsia? |
Occur in more than 20 wGA with 1- protin urea more than 5g in 24hurin 2- evidence of EOD 3- hypertension sys 160 dis. 110 |
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W I. eclempsia |
Preclempsia + sizure |
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What is pathology in preclampsia? |
Un blanc in prostaglandin relase Led to more Thrombxane then prostacycline |
Thrombxane response to Increase vasoconstriction, platelet aggregation & urine activity while decrease Utroplacental blood flow |
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What is treatment of preclampsia and eclampsia? |
- Mg sulfate anticonvulsions - Hydralazin antihypertension
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Hydralazin inc the utrine and renal blood flow |
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W u know about Mg sulfate |
- give a warm feeling and sid tion in IV - Anti convulsions - neuroprtective for fetus (Dec risk of cerebral palsy ) - Metabolise by kidney - Inc effect of MR by Dec ACH - cross BBB - Therapeutic concentration is 4 to 8 mg /dl - in serum concentration of me than 12 Patellar reflex lost - antagonis the effect of adrnargic agonist so ephedrine preferred over phenylephrine when need - CCB and Mg led to more hypotension
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What is dose of Mg sulfate? |
4G Iv bolus follow by 2g /h |
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What is Mg toxicity & w I the sign? |
- Serum mg 》12 mg/dl - led to lose patellar reflex - sign Hypotension Bradycardia Respiratory compression at 18mg/dL Confusion or sizure that is tonic clonic Cardiac arrest at 30 mg/dl - Antidote is calcium |
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W i ttt of Mg toxicity? |
Calcium gluconate 1g IV Ttt the respiratory compression |
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WU Know about MH in pregnancy ? |
- It's Autosomal dominant - trigerd by volatile or sux - Nuroaxial Anesthesia should carry on - All local Anaesthetic is safe |
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W is Dentrolene |
- Ttt of MH with manitol 300mg /20mg of DTL - cross BBB and cause hypotonia for fetus - manitol led to utrine Atony if giving to pt for CS or VD |
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H. U can Dx MH? |
By caffeine test |
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W is APGAR score |
Score for fetus evaluation of wellbeing at 1m and 5m after delivery By HR , RS effort, MS tone, Reflex irritability, & Color |
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What make resuscitation of pregnancy different? |
- Pt must have let utrine displacement - chest compression performed above the center of sternum - no risk of Cardioverion on fetus - vasopressin may Dec bl flow to fetus but not contrindiction |
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What you can do if resuscitation effort in pregnancy not effective? |
Primortem CS ( remove the aortocaval pressure and could help the mother as well as baby depend on his GA)
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W is GI system change in pregnancy ? |
- upward displacement of stomch and relaxent of muscle by progestine led to lowering esophgeal sphincter tone - gastric emptying daily in labor - Inc secretion of bile and it's complications - opioid drug Iv or neuroaxial delay gastric emptying |
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What is cardiac Change at term ? |
Increase - COP - LVEDV - SV -EF -HR Decrease -SVR |
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What is RS Change in pregnancy? |
Inc - O2 consumption 20 -60% - MV 50 % =TV 45% ×RR (slightly) - Pao2 - IRV Dec - Paco2 30 to 32 wich cause alkalis - Bicarbonate fall to Dec the ph - FRC due to = ERV+ RV - TLC |
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What change occur in Enndocine during pregnancy ? |
- thyroid gland enlargement - estrogen led to Inc in thyroid binding globulin led to inc total T3 & T4 - unbound T3 & 4 unchanged so it euthyroid - Inc. Cortisol level - lactogen production from placenta led to Insulin resistant |
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How u can detect Lower utrine rupture? |
By Fetal heart rate monitor P.s LUR not cause bleeding as LU is avascular |
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What factors affecting transfer of drug In BBB? |
Drug size less than 1000 daltons Pka Ph Blood flow Protein binding e.g ionised protin bind Lipid solubility or lipophilic And unbounded drug cross easly |
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What are the criteria of drug that cross BBB? |
- low Molecular Wight 《500 Da - lipophilic - Low degree of ionisation - large concentration gradient a cross the membranes |
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What dermatom should be cover in 1st and 2nd stage of lapore |
1st stage T10 to L1 2nd stage S2 to S4 I.e. pedendal nerve |
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What is +ve oxytocin contraction test ? |
Is 3 aducute contractions in 10m period with repetitive late deceleration. |
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What is meaning of early deselection? |
Slowing FHR with onset of utrine contraction |
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What is meaning of late deceleration? |
Slowing of FHR after the utrine contraction 10-30sec Cuse by Fetal distrase Ttt is left utrine displacement, Iv fluide If mother hypotensive give ephedrine |
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What is renal change in pregnancy? |
- Increase Kidny size - dilation of ureters - increase renal blood flow - increase clearance of urea and creatinine and uric acid ( Dec. Level) - glucose urea |
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Physiological change in utroplacental blood flow? |
- 12% of COP is account for uterus at term - it has letal or no autoregulation - UPBF depend on maternal circulation |
the main supply is utrine artery from internal iliac artery ( hypogastric) - GA minimal effect the utrine Bl flow |
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What is hemodynamic gole for MS ? |
Avoid pulmmonary hyerention by Sinus rythm Dec HR Maintain SVR AND VENUE RETURN Agresive ttt acute AF. Avoid aortocaval compression Prevent pain, hypoxia, Acidosis and hypercarbia
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What is hemodynamic gole for MR? |
SR Mild Inc HR Avoid Inc SVR and venous returne |
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What is hemodynamic gole for AS? |
SR Maintain HR and venues return Avoid Dec SVR |
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What is hemodynamic gole for AR? |
Mild Inc HR Avoid Inc SVR |
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What is lab cheng in pregnancy ? |
- Dec hg and Htc - plt unchanged or Dec - Inc cogulation factor - Dec BUN and creatinine by inc GFR and renal bl flow - bicarbonate and pco2 by 10 Dec led to Unchanged ph - inc po2 by 10 |
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What is lab cheng in pregnancy ? |
- Dec hg and Htc - plt unchanged or Dec - Inc cogulation factor - Dec BUN and creatinine by inc GFR and renal bl flow - bicarbonate and pco2 by 10 Dec led to Unchanged ph - inc po2 by 10 |
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What is tried of amniotic fluid embolism? |
1- hypoxemia 2- sever systemic collapse 3- cogulopathy |
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What is the Nor. Fetal scalp ph ?? |
Is 7.25
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7.2 to 7.24 is intermediate required close monitoring Less than 7.2 reflect hypoxemia and need immediate delivery |
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What is Neurophysiology change in pregnancy ? |
Decrease the requirements of anesthesia with 25% LA. Atomic change decrease CSF led to increase the speed of LA - increase secretion of endorphins led to inc threshold |
The change Happen from 1st trimester |
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What is placenta Acreta nd what is her risk factor ? |
It is abnormal implantion of placenta RF is placenta previa Previous CS
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What is Dx criteria of spinal cord compression? |
- sever back pain - leg weakness greater than expected -recurrent of weakness after recovery |
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When dose Epidural hematoma or Abbess occur? |
-Hematoma take 12 h -Abbess take a day |
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How do you Dx Hematoma or Abscess in Nuroaxial and what is best time for recovery ? |
- Need Neuro surgical consultation - MRI - Dx befor 8h from hematoma is better than after 8h |
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What is terbutaline ? |
B2 adrnargic agonist Tt Asthma and tocoilytic agent SE. Hypotension Hypoxemia Hypokalemia Hyperglycaemia Pulmonary edema Anxiety Nervesnes MI Tycardiac MA. |
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What happened to COP in pregnancy ? |
Increase Return to Normal 2w. after delivery |
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What is the normal utrine blood flow at term ? |
700 to 900 ml / min |
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What are the anesthetic goals for prgnancy in nonobstatric surgery? |
1- Maternal safety 2- prevention of - Tertogenic drug - Nenatal asphyxia - preterm labor |
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What are the anesthetic complications in obstatric? |
1- matrnal nerve damage 2- neonatal brain damage 3- matrnal death 4- Headch 5- back pain 6- neonatal death 7- emotional distress 8- matrnal brain damage 9- pain during anesthesia 10- aspiration pneumonitis |
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What you do in cases of sever emergency bleeding in ob? |
- Do RSI with Ketamine or Etomidat + Sux - If pt in shock do RSI with sux just - If pt is difficult intubation just do local infltration |
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Why we mix epinephrine with local anesthetic in Nuroaxial Anesthesia ? |
- To decrease vascular uptake by Vasoconstriction - Increase the intensity and duration of LA block |
The more lipid soul able is the LA the less effect of epinephrine |
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What is complications of intra spinal narcotic? |
1- pruritus 2- N/V 3- urinary retention 4- Drawsiness 5- Respiratory depression or headch |
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What is O2 saturation in newborn ? |
- 60-65% at 1min - 65-70% at 2min - 70-75% at 3min - 75-80%at 4min - 80-85% at 5min - slowly inc after 5 min up to 95% at 10 min |
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Placenta previa |
1st episode has - pain less bleeding - in 2nd or 3rd trimester - no distress or colapse |
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What are the normal values for arterial umbilical cord blood ? |
Ph 7.25 Pco2 50 Po2 20 Bicarbonate 22 |
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How you can improve the saturation in one lung ventilation ? |
- Increase the Hg - Increase the COP - inflating the pulmonary artery catheter - less likely is to increase fio2 |
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