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13 Cards in this Set
- Front
- Back
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What is the sequence for Obtaining Epidural/ Spinal consent?
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1. Review H&P/ Allergies
2. Airway Assessment 3. Surgical history & complications 4. Anesthesia history 5. Explain Risks of Spinal/Epidural a. Inadequate block b. Infection /Bleeding c. Headache d. Allergic Reaction e. Neuro injury risk f. Backache |
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Sequence of Epidural Placement?
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1. Consent
2. Explain procedure 3. Set-up kit/ Sterile gloves, mask, hat 4. Call for nurse: Position pt. (sitting upright, cross legs, hump back) 5. Assess landmarks: a. iliac crests b. Palpate L3-4, L4-5, L2-3 c. ID midline of spine d. ID spine abnormalities 6. Clean skin and drape 7. Call attending 8. Inject local at inj site(warn pt) 9. Insert Tuouy Needle into back, advance until firm (lig Flav) 10. Advance using loss of resistance method 11. Thread catheter: length of needle into back + 5 cm 12. Test dose: Warn pt 13 tape and secure catheter while assessing test dose. |
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Dosages for Epidural:
"Manny's Crazy 8's" |
1. Premixed 240cc vag of 2mcg/ml Fentanyl + 0.08% Bupivicaine
2. Withdraw 8cc and add 2cc of Fentanyl (100mcg) into 10cc syringe.(this is your Bolus dose) 3. Program pump: 8cc/hr; 8min lockout; 8ml Bolus dose; 1hr lockout of 24ml |
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Procedure for C-Section?
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1. Spinal Anesthesia
2. Pt supine with LUD(wedge under R Hip) 3. Antibiotics: Ancef 1-2 gm if not allergic to PCN 4. Test level of anesthesia with needle (>T8) 5. Monitor BP closely-- may give ephedrine or phenylephrine to keep it up (note: BP ALWAYS falls= Hypoxic risk to baby) 6. Record Times of: a. incision b. uterine incision c. Delivery of baby d. Placental delivery 6. Open Pitocin wide with clamping of cord-- & Remove wedge from RHip. 7. NEVER give Methergine IV-- ONLY IM! if needed 8. If BP drops- She WILL throw-up, ..treat prophylactically w/ fluids and keep pressure up. |
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Manny's 7 B's for Breakthru Epidural pain:
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1. Rebolus Epidural
2. Manny's magic bullet 3. Increase Basal Rate of infusion 4. Encourage PCEA Button use 5. "Buck-up. you're having a Freaking Baby!" 6. "Be Quiet!" 7. "Bi---!" |
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Redosing Epidurals per Manny...
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1. 0- 3 Pain:
-0.08% Bup Bolus from pump and give Fentanyl Q4hr 2. 3-7 pain: - "MMB": 5cc of 0.125% Bup + 0.75%Lido (this is good for quick onset and good relief for a while) also-- increase Basal rate. 3. 7-10 pain : - give 5cc of 1.5 Lido + Epi (this is a good dense Block for a short period of time until able to push and deliver) |
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Definition of Mild Preeclampsia?
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HTN (140/90)
Edema +1- +2 Lipidemia Proteinuria (1-2+) |
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Definition of Severe Preeclampsia?
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HTN (160/90)
Edema +3 - +4 Lipidemia Proteinuria +3-4 Neuro symptoms: H/A , blurred vision Lungs: Pulm edema GI: Inc Liver enzymes Renal: Oliguria Heme: Low Plt Airway: Risk |
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Magnesium therapy for Preeclampsia?
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Loading dose: 4mg,.IV,...then 2mg/hr infusion.
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Therapeutic level of Magnesium for Preeclampsia?
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4-7 meQ/dl
>7 = Loss of Patellar Reflex and Toxic > 10 = Pulm Edema |
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What happens with Preeclampsia that causes all the problems during pregnancy?
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Increased levels of Thromboxane:
= vasoconstriction (inc BP) = Platelet Aggregation = Dec Uterine blood flow = Inc Uterine activity (premature labor) |
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What is the lowest amount of Platelets for a safe epidural?
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> 70,000
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Anesthesia Management of PUBS Procedre?
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1. this is done for fetal Transfusion and twin to twin transfusion.
2. Usually MAC sedation with Local per surgeon. 3. Abd needs to be still- May need to be converted to GA w/ muscle relaxant if large belly breather or movement. 4. Surgeon give Fetus Muscle relaxant: 0.1mg of Vecuronium to Dec fetal activity 5. May be asked to give Terbutiline SQ or IM to dec Tocolytic effect. |
