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43 Cards in this Set
- Front
- Back
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What are the 4 T's?
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-Tone
-Trauma -Tissue -Thrombin |
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How much bloodloss can occur in pregnancy before symptoms may be unmasked?
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1500 ml
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What is important to remember about the PaCO2 in pregnant women?
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They are often in Resp Alkalosis dt increased RR so a PaCO2 of 35-40 may mean respiratory failure
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How many minutes do you have to restore circulation to a fetus of an apneic and asystolic mother?
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FOUR MINUTES
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What should you do after 4 minutes?
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Consider perimortem cesarean
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What are the 2 requirements for Perimortem Cesarean?
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-Fetal viability - at least 23-24 weeks gestational age
-Adequete staff/equipment |
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How much does seatbelt use decrease severe injury and death in pregnancy in car accidents?
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By 50%
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What is the main thing you can do to PREVENT postpartem hemorrhage?
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Active management of third stage labor (AMTSL)
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What are the 3 steps of third stage labor managing?
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-Oxytocin with delivery of shoulder
-Cord traction -Uterine massage after placenta delivers |
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What are the 4 meds you can use to treat PPH that doesn't stop?
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1. Oxytocin
2. Hemabate 3. Methergine 4. cytotec |
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What is the dose of Oxytocin?
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20 Units per liter NS IV
run at 500ml in 10min then 250ml per hour |
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How much oxytocin is in an intramuscular dose?
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10 Units
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What is the max dose of Oxytocin for IV vs IM?
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IV 40 U
IM 20 U |
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What are the contraindications for oxytocin?
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none
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What can overdose or prolonged use of oxytocin cause?
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Water intoxication
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What is the dose for Hemabate?
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0.25 mg IM every 15-90 min
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What is the total max dose of Hemabate?
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2 mg
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What are the contraindications to Hemabate?
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Any chronic disease - pulm, renal, hepatic, or cardiac
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What are the side effects of hemabate?
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Diarrhea/vomiting
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What is the dose of Methergine?
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0.2 mg IM
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How often can you repeat Methergine?
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Every 2-4 hours
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What are the contraindications for Methergine?
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-Hypertension
-Pre-eclampsia |
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What is the dose of Cytotec?
cytotec=misoprostol |
800 mg rectally
o 600 mg orally |
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What are the contraindications of cytotec?
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none
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What is the first step in managing a massive PPH?
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-Call for help
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Where does helper 1 stand?
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At the head
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Where are helpers 2/3?
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Arms
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What should you do next after calling for help?
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Check to see if the bladder is drained
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What should you do if atony persists after giving oxytocin, delivering placenta, and uterine massage?
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Bimanual uterine massage and compression
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What is the cause of 70% of cases of pph?
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Uterine atony
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what is the first step in treating uterine atony?
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Bimanual massage and compression
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What do you do if bimanual massage doesn't work?
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Oxtocin 20U/1000ml IVF at 250cc/hr
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What can you use if oxytocin doesnt work?
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Methergine
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What does of Methergine?
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.2mg IntraMuscular
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When should you use Methergine with caution?
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Hypertension
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What can you use if methergine doesn't work?
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Hemabate .25 mg IM or Intramyometrial
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How often can you repeat Hemabate?
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every 15 min up to 8 doses but no more than 2 mg
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Why would you probably not get up to 8 doses of hemabate?
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You should consider surgery after 2 doses of hemabate
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What causes 20% of PPH cases?
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Trauma
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How do you treat trauma?
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Repair
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What causes 10% of PPH?
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Tissue retained
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What causes 1% of PPH?
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Thrombin
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How do you treat thrombin causes?
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Replace blood products
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