Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
56 Cards in this Set
- Front
- Back
|
Define the HELLP syndrome
|
1. Hemolysis-due to RBC’s being forced thru the fibrin network @ high pressures (DIC not far off)
Bilirubin> 1.2mg/dl LDH> 600u/l 2. Elevated Liver Enzymes-pre portal lesions/hemorrhage/capsular hemmorrhage SGOT>70u/l 3.Low Plts < 100k |
|
|
What is the tx when the HELLP criteria is met?
|
Delivery of the baby-however may still develop postpartum
|
|
|
What are the manifestations of DIC?
|
Prolonged PT, & aPTT,
DEC Fibrinogen, INC fibrin degradation products |
|
|
What is the tx for the CNS involvement of seizures, in Pregnancy?
|
MgSO4-will cause generalized CNS depression
Load 4-6gm iv over 20 minutes Infusion: 1-2gm/hr Breakthru-2-4gm iv |
|
|
What are the S/E of MgSO4?
|
Potentiate/prolong MR
Regional- HOTN Fetal involvement-hypotonia/HR variability /Resp depression Uterine Atony |
|
|
What is an ideal anesthetic for PIH pts about to deliver?
|
Epidural-BP, placental BF, No respiratory depression
|
|
|
How is BP tx’d with PIH?
|
Labetalol 1 mg/kg-has both beta and alpha blockade
Hydralzine-5-10mg but has slower onset Nifedipine-will cause uterine muscle relaxation- has a synergistic effect with MgSo4 = HOTN NTG-0.25-0.5mcg/kg/min SNP-safe but may cause VQ mismatching |
|
|
Why do you not use Esmolol in pregnancy?
|
Because it will cross the placenta and DEC FHR
|
|
|
The tx for fluid overload, in pregnancy, which is the primary reason for pulm edema consists of?
|
O2/Diuretics/MSO4
|
|
|
How is Pulm Edema from LV dysfunction tx’d?
|
Afterload reduction-Hydralzine, Nifedipine, SNP
|
|
|
Why does Creatinine INC in PIH?
|
Because of the DEC IV volume and subsequent DEC GFR
|
|
|
How is the Renal preservation tx’d?
|
Judicious fluid challenges
Dopamine NTG SNP |
|
|
The INC uterine arterial resistance and viscosity will result in what uterine problems?
|
Fibrin deposits-infarcts
Abruptio DIC IUGR-lack of flow Premature delivery |
|
|
What does the RUQ Epigastric pain evolve from?
|
Liver involvement-hemorrhage or edema
Requires CT/US and possible immediate delivery |
|
|
What are the potential complications of placing/removing an epidural in a Preeclamptic pt?
|
The thrombocytopenia-hematoma/cord compression
HOTN- DEC. UBF/Fetal distress LA -risk of seizures (already @ risk of seizures), FHR variability DEC, distress/hypoxia |
|
|
How does a standard General Anesthetic induction proceed FOR DELIVERY?
|
STP-4mg/kg Sch-1 mg/kg
O2/N2O 50/50 until delivery After delivery-standard maintenance- INC. N2O use agent-remember MgSO4 will enhance all MR |
|
|
Major considerations post partum include?
|
Fluid shifts-pulm edema (diuretics/dopa)
Coagulopathies-platelets reach nadir 1-2 days Seizures- DEC. risk in 2 days continue MgSO4 HTN-may continue for 6 wks |
|
|
What two parameters does Cardiotocography monitor?
|
FHR & Contractions
|
|
|
What is the FHR mostly controlled by?
|
PNS (Vagus) > SNS the closer to birth
|
|
|
Name the causes of fetal asphyxia?
|
--Maternal hypoxia
--DEC. UBF --Cord compression --Fetal pathology ***Follow the flow |
|
|
What is the response in the fetus to hypoxia?
|
1. DEC. Resp movements to decrease consumption
2. Shunt blood to vital organs including adrenals 3.Lactic acid buildup from non-perfused areas = met acidosis --Continued hypoxia impairs myocardial function = continued vasoconstriction = cell death = fetal death |
|
|
What indicates good fetal progression on the Cardiotocography?
|
-- FHR beat-to-beat variability,
-- Normal HR -- Appropriate timing of decelerations in HR with quick return |
|
|
What are poor indicators of fetal progression re: Cardiotocography?
|
-- Tachycardia>150-160 for longer than 10 min or 30BPM INC. from baseline for > 10min
-- Late decelerations may or may not have quick rebound --Bradycardia- with or w/o quick rebound |
|
|
What is normal pH of a fetus/newborn?
|
7.25-high metabolic state
|
|
|
When is one suspicious of stress IN THE FETUS?
|
<7.25 suspicious <7.2 is significant
|
|
|
What interventions are needed for poor progressing fetuses?
|
O2 for mom,
Vag exam with scalp stimulation, ∆ positions, Fluids- evaluate for stat c-s |
|
|
What is the interval for the recording IN CARDIOTOCOGRAPHY?
|
Small blocks are 10 secs
|
|
|
Define causes of FETAL Tachycardia?
|
Hypoxia
Prematurity (nml response) Maternal fever Chorioamniontitis Fetal acidosis Fetal infection Parasympatholytic-atropine Sympathamomimetic-Terbutaline |
|
|
DEFINE FETAL Bradycardia-
|
<110 or 30BPM for > 10 minutes
|
|
|
Causes of FETAL bradycardia?
|
Asphyxia
Acidemia-cord/Paracervical block/HOTN/Seizures Post date Hypothermia |
|
|
FHR variability is affected by what factors?
|
Maternal meds-sedatives/opioids/MgSO4
Sleeping Preterm< 28wks Fetal anemia Hypoxia |
|
|
WHAT CAUSES FHR Accelerations-
|
Transient INC - due to fetal movement (normal)
|
|
|
SIGNIFICANCE OF Early decelerations-
|
Benign- mirror contractions-stimulation of head
|
|
|
WAT CAUSES FHR Variable decelerations-
|
Cord compression- occur at any time in relation to contractions
“V” shaped with shoulders |
|
|
WHAT CAUSES Late decelerations-
|
Uteroplacental insufficiency- GET BABY OUT
Occur after contractions |
|
|
Uteroplacental insufficiency may be caused by?
|
HOTN/HTN
Pre/Eclamptic Abruption of placenta Post maturity DM |
|
|
Tx for uteroplacental insufficiency?
|
LUD
O2 Fluids DEC Oxytocin if on-causes contractions |
|
|
What are Sinusoidal wave patterns?
|
Regular, smooth undulating rhythm with little variability within a normal HR range
Indicates severe fetal anemia (Rh disease)/Hypoxia Is ominous and has INC rate of M/M |
|
|
How high does CO peak during pregnancy?
|
As high as 150% after 28weeks
|
|
|
When in gestation should LUD be implemented on pregnant patients?
|
12-14 weeks
|
|
|
Define the NY functional classification system?
|
I-No physical limitations
II-Ordinary activity will precipitate CV problems III-< ordinary activity precipitates symptoms IV-CV s/s present at rest |
|
|
What stage of delivery is a Paracervical block initiated?
|
Stage I
|
|
|
What stage of delivery is a Pudendal block initiated?
|
Stage II
|
|
|
What are the 5 evaluations of Cardiac function that should be evaluated in diseased states?
|
HR Rhythm Preload Afterload Contractility
|
|
|
What arrhythmia is common in Mitral Stenosis?
|
Afib-due to the Left Atria Hypertrophy
|
|
|
What is a normal Mitral Valve size?
|
4-6cm- s/s <1cm
|
|
|
What will be noted on the PA waveform indicating MVR?
|
A large v wave
|
|
|
S/S of MVP?
|
Anxiety, TIA, Sudden Death, Arrhythmias, Palpitations, SBE
|
|
|
S/S of Aortic Stenosis?
|
Syncope & Angina-due to decreased coronary-systemic perfusion, DOE, CHF
|
|
|
List the common R to L shunts:
|
(5 T’s and a P),
TOF, Tricuspid Atresia, Transposition of the Great Arteries, Total Anomalous Pulmonary Venous Return, Truncus Arteriosis, Pulmonary Atresia Eisenmenger’s Syndrome, |
|
|
List the common L to R shunts:
|
ASD, VSD, PDA
|
|
|
What is Eisenmenger’s Syndrome?
|
Pulm HTN, (PDA, VSD, ASD shunt sites)
R to L (reversal of end stage) |
|
|
What things will inc. PVR?
|
Hypercarbia, Hypoxia, Hypothermia, Acidosis, PIP, ephedrine
|
|
|
What are the anesthetic goals of Eisenmenger’s Syndrome?
|
Avoiding:
Inc. Pulm HTN (PVR) Dec. SVR-which already occurs in the disease Dec in Preload Desire: Elevated HR-may compromise RV function Narcs-IT/IV |
|
|
Anesthetic considerations for VSD and ASD?
|
Want R to L somewhat
Avoid Pulm HTN that would promote total R to L and avoid Lto R shunting |
|
|
What are the 4 components of TOF?
|
Pulm Stenosis
VSD RVH Overriding Aorta |
