Ob Rotation Administrative Information

Front 1

What is the ASCOM of the OB1 attending?

Back 1

24602

Front 2

What is the code for the Anesthesia Workroom?

Back 2

5&3, then 2, then 1

Front 3

What is the code for the resident call room in CHONYT10?

Back 3

3 - 5 - 1

Front 4

What is the code for the resident call room on BH11N

Back 4

2 - 1 - 4 - 5

Front 5

What time does morning sign-out start?

Back 5

7AM

Front 6

Following the lecture the residents on daytime duty are required to get in touch with______

Back 6

The OB1 attending to confirm availability and assignments for the day.

Front 7

What drugs should be drawn up at all times in the ORs?

Back 7

Ephedrine, Phenylephrine, Atropine, Nitroglycerine, Succinylcholine

Front 8

Calls for labor analgesia from the nursing staff are placed to which phone number?

Back 8

24605

Front 9

List of conditions which need coagulation (PT, PTT, INR) and platelet studies prior to a neuraxial analgesia procedure

Back 9

Preeclampsia/eclampsia/HELLP syndrome
Chronic abruption
IUFD >24 hours
Patients on anticoagulation (except prophylactic heparin)
Patients with known or suspected coagulation disorder
Acute fatty liver of pregnancy
Acute or chronic hepatic or renal disease

Front 10

What level needs to be blocked for adequate epidural anesthesia?

Back 10

T10

Front 11

Test dose for epidural labor analgesia

Back 11

3 ml 1.5% lidocaine with 1:200 K epinephrine or 100 mcg fentanyl or
3 ml 0.25% bupivacaine

Front 12

Loading dose of epidural anesthesia

Back 12

- 5 ml 0.25% bupivacaine or
- 5 ml 0.25% bupivacaine and 50-100 mcg fentanyl or
- 5 ml 0.25% bupivacaine and 50-100 mcg fentanyl diluted with N saline to 10 ml

Front 13

Combined test dose and loading dose of epidural anesthesia

Back 13

6 ml 1.5% lidocaine with 1:200 K epinephrine, 2 ml 0.25% bupivacaine, and 100 mcg fentanyl diluted to 12 ml; this is given in divided doses of 4+8 ml

Front 14

Spinal dose for combined spinal epidural for labor analgesia

Back 14

1 ml 0.25% bupivacaine and 15-20 mcg fentanyl

Front 15

The routine top up is

Back 15

5 ml 0.25% bupivacaine or

10 ml 0.125% bupivacaine or

4 ml 0.25% bupivacaine 50-100 mcg fentanyl diluted to 8 ml

Front 16

Regarding top-ups: Segmental sparing (most commonly L1) often needs more ___________

Back 16

concentrated local anesthetic

Front 17

Regarding top-ups: Sacral sparing often needs ___________

Back 17

more or a different adjuvant (fentanyl, clonidine)

Front 18

Regarding top-ups: Pain related to direct plexus (lumbar or sacral) stimulation by the fetal head often needs

Back 18

2% lidocaine

Front 19

Regarding top-ups: Unilateral blocks often need _______

Back 19

the same amount of drug in a larger volume (0.125% bupivacaine rather than 0.25%)

Front 20

What percent of epidurals will need replacing during labor?

Back 20

10%

Front 21

Maintenance infusion for epidurals

Back 21

0.0625% bupivacaine with 2 mcg/ml fentanyl at a rate of 10-12 ml/h

Front 22

Setting for PCEA on OB anesthesia

Back 22

5 ml bolus at 6-10 minute intervals with a maximum of four boluses an hour

Front 23

For continuous spinal what infusion should be used?

Back 23

0.0625% bupivacaine with 2 mcg/ml fentanyl solution at 2 ml/h rate with no bolus option on the pump

Front 24

Intravenous analgesia for labor and delivery

Back 24

Remifentanil 4 mg in 250 ml solution; start at a rate of 0.05 mcg/kg/min (this is ~ 13-18 ml/h for most parturients) and increase in increments of 0.02 mcg/kg/min every 5-10 minutes as needed, no PCA bolus

Front 25

What level block is needed for a c-section for adequate anesthesia?

Back 25

T6

Front 26

Emergent loading and epidural for a Cesarean section

Back 26

15-20 ml 3% chloroprocaine single push (this dose may be toxic if given IV and will result in a total spinal if given intrathecally)

Front 27

Urgent / Non-emergent Loading and epidural for a c-section

Back 27

15-20 ml 2% lidocaine with 100 mcg fentanyl

2 ml sodium bicarbonate and 5 mcg/ml epinephrine is commonly added (that is 0.1 ml epinephrine of the 1mg/ml stock solution)

Front 28

What level block is needed for post partum bilateral tubal ligation

Back 28

T8 or higher block needed for adequate anesthesia

Front 29

For post partum bilateral tubal ligation, what are the doses for a spinal?

Back 29

1.6 ml 0.75% hyperbaric bupivacaine and 25 mcg fentanyl or

1.6 ml 5% hyperbaric lidocaine and 25 mcg fentanyl

No need for Duramorph in these cases, it does not improve postoperative analgesia significantly

Front 30

For post partum bilateral tubal ligation, what are the doses for an epidural?

Back 30

15-20 ml 2% lidocaine with 100 mcg fentanyl

2 ml sodium bicarbonate and 5 mcg/ml epinephrine is commonly added (that is 0.1 ml epinephrine of the 1mg/ml stock solution)

Front 31

For post partum bilateral tubal ligation, what are the doses for a cerclage?

Back 31

T12 block needed for adequate anesthesia

1-1.2 ml 0.75% hyperbaric bupivacaine and 20-25 mcg fentanyl

It is a saddle block; keep the patient in the sitting position for 5-7 minutes after the block

Front 32

Ecbolic (uterotonic) drugs used during Cesarean sections and for postpartum hemorrhage

Back 32

oxytocin
methylergonovine
carboprost (hemabate)
misoprostol (cytotec)

Front 33

Tocolytic drugs

Back 33

nitroglycerine
terbutaline

Front 34

Oxytocin dosing

Back 34

30 U in 500 ml N saline at a rate of 500-1000 ml/hour followed by 20 U in 1000 ml LR at a rate of 250 ml/hour

Front 35

Methylergonovine (Methergen) dosing

Back 35

200 mcg IM or 200 mcg diluted into 20 ml and given in 20-40 mcg increments
Methylergonovine can be repeated every 5 minutes up to five doses

Front 36

Carbaprost dosing

Back 36

250 mcg IM; can be repeated every 15 minutes up to eight doses

Front 37

Misoprostol (Cytotec) dosing

Back 37

1 mg PR or buccal