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98 Cards in this Set
- Front
- Back
Reasons not to get spinal anesthesia |
1. Patient refusal 2. Infection at the site 3. Sepsis 4. severe coagulothapy 5. severe aortic or mitral stenosis 6. increased intracranial pressure 7. indeterminate neurologic dz |
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C sections usually done under |
spinal anesthesia |
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What is the effect of baricity on a spinal |
baricity refers to the ratio of an anesthetic solution's density to CSF. 1 = isobaric. Less than 1 = hypobaric, it will travel against gravity. Hyperbaric solutions ( baricity > 1) travel in the direction of gravity. |
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what is duramorph |
duramorph is a preservative free form of morphine, it is isobaric |
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difficult airway algorithm for parturients |
awake fiberoptic/awake glidescope, intubate, bmv, gum elastic bougie, external laryngeal manipulation to right, LMA/Combitube |
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typical dose of local for an epidural for c section
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1. 20 ml of Lidocaine with epi 1:200,000
2. 100 mcg fentanyl 3. 2 ml of 8.4% NaHCO3 |
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why is NaHCO3 added to epidurals? |
increases pH and percent of lidocaine that is unionized. This results in a more profound block of sensory and motor nature. It also makes the onset of the block much faster. |
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how is a Combined Spinal Epidural performed? |
place the epidural, pass the spinal needle thru till you get CSF leakage, inject spinal dose, remove spinal needle, pass epidural catheter like normal, remove toughy needle. Then you're done. |
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CSE stands for |
Combined Spinal Epidural |
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Primary anesthetic solution for epidural infusion during labor is |
0.2% ropivicaine with 2 mcg/ml fentanyl |
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what is a test dose, what do you look for? |
a test dose of local anesthetic with epi. Look for signs of epinephrine infiltration. Or signs of a spinal |
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a parturient with multiple babies in her can only deliver vaginally if |
both fetuses are in vertex position |
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anesthetic for cerclage |
spinal anesthesia |
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What is breech presentation?
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butt first
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What does ECV stand for |
external cephalic version |
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what is an external cephalic version? |
process of trying to externally turn a breech presentation to a vertex presentation before a child is born. Usually done under ultra sound and FHR monitoring. |
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breech presentation requires |
c-section |
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how long must you wait for spinal anesthesia after taking:
1. warfarin 2. NSAIDs or ASA 3. Lovenox 4. minidose hep 5. ticlid 6. plavix 7. abciximab or integrilin |
1. 4 days or need normal pt and inr
2. not a threat to increased hematoma 3. 24 hrs 4. mini dose heparin (subq hep) is not a contraindication to neuraxial anesthesia. 5. 14 days 6. 7 days 7. 48 hours |
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Normal Fetal Heart Rate is
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110-160 bpm |
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what is an amnioinfusion? |
a method of thinning thick meconium in amniotic fluid. Sometimes used with oligohydroamnios to prevent umbilical cord compression. |
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what is oligohydroamnios? |
having inadequate levels of amniotic fluid. |
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What is Magnesium Sulfate used for? |
* Prevention and treatment of seizures in women with preeclampsia or eclampsia. * Fetal neuroprotection before anticipated early preterm (less than 32 weeks of gestation) delivery. * Short-term prolongation of pregnancy (up to 48 hours) to allow for the administration of antenatal corticosteroids in pregnant women between 24 weeks of gestation and 34 weeks of gestation who are at risk of preterm delivery within 7 days |
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What are the therapeutic levels of Magnesium Sulfate? |
4.3-8.4 meq/dL |
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macrosomia |
having a big baby. Usually marked as 8 lbs 13 oz (4kg) or 9 lbs 15 oz (4.5kg) |
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what percent of cardiac output is shunted to the pregnant uterus? |
10% |
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Placenta previa |
Placenta Previa is a condition where the placenta lies low in the uterus and partially or completely covers the cervix. The placenta may separate from the uterine wall as the cervix begins to dilate (open) during labor. |
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placenta accreta |
occurs when the placenta attaches too deep in the uterine wall but it does not penetrate the uterine muscle. Placenta accreta is the most common accounting for approximately 75% of all cases. |
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placenta increta |
occurs when the placenta attaches even deeper into the uterine wall and does penetrate into the uterine muscle. Placenta increta accounts for approximately 15% of all cases. |
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placenta percreta |
the rarest and most severe form of placenta accreta, occurs when the placenta penetrates through the entire uterine wall and attaches to another organ such as the bladder. Placenta percreta is the least common of the three conditions accounting for approximately 5% of all cases. |
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placental abruption |
Placental abruption (abruptio placentae) is an uncommon yet serious complication of pregnancy. The placenta is a structure that develops in the uterus during pregnancy to nourish the growing baby. If the placenta peels away from the inner wall of the uterus before delivery — either partially or completely — it's known as placental abruption. Placental abruption can deprive the baby of oxygen and nutrients and cause heavy bleeding in the mother. |
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uterine rupture
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A uterine rupture is a tear in the wall of the uterus, most often at the site of a previous c-section incision.
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premature rupture of membranes |
Premature rupture of membranes (PROM) refers to a patient who is beyond 37 weeks' gestation and has presented with rupture of membranes (ROM) prior to the onset of labor. |
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chorioamnionitis |
bacterial infection of the chorion and amnion (fetal membranes). often caused by prolonged labor. |
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umbilical chord prolapse |
when the umbilical chord passes thru the cervix ahead of the baby, can cause hypoxia and death. Detected by FHR showing brady (<120 bpm) |
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neuraxial anesthesia effects pulmonary function... |
unless the phrenic nerve is blocked, Vt remains constant and VC decreases only slightly. |
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if pt is on warfarin, these must be normal before applying spinal anesthesia |
Prothrombin time and INR |
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spinal catheters |
no longer approved bc they cause cauda equina syndrome. |
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the ph of lidocaine with epinephrine is relatively to regular lidocaine |
more acidic |
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Fetal bradycardia defined as |
fhr < 120 bpm |
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how much does MAC decrease in pregnancy |
40% |
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which has oxygenated blood, the umbilical artery or vein? |
the umbilical vein
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before any neuraxial technique is performed on an obstetric patient, what should be done |
large fluid bolus to combat hypotension |
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hetastarch in what dose causes increased allergy risk? |
>20 ml/kg |
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spinal or epidural: tends to err by producing a one sided block? |
epidural |
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types of placenta previa |
* Complete previa: the cervical opening is completely covered
* Partial previa: a portion of the cervix is covered by the placenta * Marginal previa: extends just to the edge of the cervix |
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Dural Puncture epidural |
a CSE without injection of medxn thru the spinal needle. |
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for a Dural Puncture Epidural or a CSE, how far does the spinal needle usually extend beyond the epidural needle? |
10-15 mm |
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which is more effective and why?
IV or neuraxial opioids? |
Neuraxial opioids are more effective at providing analgesia than IV opioids because they target both supraspinal and spinal opioid receptors. |
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At Memorial University Medical Center, how much narcotic is usually placed in a spinal? |
0.2 mg of Duramorph and 20 mcg of Fentanyl |
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which local anesthetic is usually cited as the most teratogenic? |
cocaine |
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are muscle relaxants teratogenic? |
muscle relaxants are not |
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is ketamine teratogenic? |
ketamine is not |
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are benzodiazepines teratogenic? |
benzos are not |
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are opioids teratogenic? |
no, opioids are not |
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most common causes of anesthesia related death in obstetrics |
failed intubation, ventilation, oxygenation, or aspiration (AIRWAY MANAGEMENT) |
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the uterus receives how much blood flow per min when pregnant? |
600-700 ml/min |
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which type of uterine displacement can alleviate hypotension in the supine position? |
Left Uterine Displacement |
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amniotic fluid embolism happens most often during |
placental separation or uterine rupture |
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which has less failure as a technique, epidural or spinal? |
spinal has less |
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what is better for surgical pain treatment in the ob patient who is undergoing unrelated surgery? Opioid or NSAID |
opioids are better because they don't disrupt the 'prostaglandin milieu' of pregnancy |
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cervical cerclage |
performed for an incompetent cervical os, the procedure involves placement of sutures around the the cervical os to keep it closed |
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two techniques of performing a cervical cerclage and the recommended anesthetic |
laparascopic - GETA vaginally- hyperbaric spinal anesthesia |
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when are cerclages supposed to be performed |
between weeks 13-16 |
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what happens to the uterus at week 20? |
it becomes less of a pelvic organ and more of an abdominal one, which complicates the whole risk of aspiration thing |
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which is better, external cephalic version with or without anesthesia? |
ECV is better performed with spinal anesthesia, it allows the abdominal muscles to relax, the mother is not in pain, and the doc can use more effort |
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where should ECV be performed? |
in the OR, as induced labor, fetal compromise, uterine rupture and other complications can all ensue |
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in addition to tocolytics, what drug has been show to cause added uterine relaxation? |
nitroglycerin in 50 mcg boluses with 45 seconds in between |
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when can the fetus feel pain? |
20-30 weeks |
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why is an epidural preferred for vaginal delivery |
it has more motor preservation |
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how much blood is used in an epidural blood patch |
10-20 ml of autologous blood |
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greatest cause of post partum hemmhoragge |
uterine atony |
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if a patient with a spinal for C/section begins desatting, loses handgrip or the ability to vocalize... |
RSI should be performed |
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bicarbonate should be used with which local anesthetic, and avoided in which others |
use bicarb with lidocaine, but not with longer acting LAs like bupivicaine or ropivicaine as they can cause precipitation. |
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a good reason why we don't redose spinals |
more holes in dura is not good |
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good LA for use in emergent C/section with an epidural |
quick onset drug like chloroprocaine |
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nausea in the ob patient during a c/section correlates strongly with... |
hypotension! Tx with fluids, phenylephrine, and ephedrine |
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literature supports the use of how many vital capacity breaths to replace pre oxygenation in emergencies |
4 Vital capacity breaths.... whatever |
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how does epinephrine benefit spinal anesthesia |
prolongs the analgesia and indicates intravascular injection |
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peak effect of morphine in spine is |
60-90 minutes |
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morphine can provide analgesia for how long |
24 hours |
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how does chloroprocaine effect opioids? |
it greatly reduces the duration of analgesia that opioids can provide. |
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2 most common causes of late term hemmhorrage |
abruptio placenta and placenta previa |
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symptoms: painless vaginal bleeding, malpresentation of fetus, difficulty palpating the presenting part of the fetus |
placenta previa |
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symptoms: painful vaginal bleeding, uterine tetany, fetal distress/death, coagulothapy |
placenta abruption |
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up to this percent of blood loss shows no signs |
15-20% |
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hb level indicating PRBC are needed |
6 gm/dl |
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if the cardiac accelerator fibers are blocked, how do you treat bradycardia? |
epinephrine in 10 mcg boluses |
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fibrinogen level requiring blood products |
80-100 mg/dL |
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the suggested goal of antihypertensive therapies |
systolic of 140-155 and a diastolic of 90-105 |
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Transient Neurologic Syndrome caused by which LA |
all but mostly Lidocaine |
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onset of TNS usually occurs |
12-24 hours after surgery |
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TNS is the manifestation of |
pain or numbness in the lower back, buttocks, or LE |
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TNS lasts |
6 hours - 7 days |
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treatment for TNS |
nsaids, opioids, heat, leg elevation |
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Cauda Equina syndrome presentation |
pain in low back with motor and sensory defecits, also bowel and bladder loss of control. |
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cause of Cauda Equina syndrome |
ischemic compression from hematoma or abcess, or neurotoxicity. |
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onset, recovery, and duration of cauda equina syndrome |
variable |
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signs of epidural hematoma |
lower back/buttock pain with sensory and motor defecits, as well as bladder and bowel dysfunction. |