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263 Cards in this Set
- Front
- Back
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Where does the spinal cord end?
a) L1 - L2 b) L3- L4 c) L2 - L3 d) S2 |
L1 - L2
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Where does the dura end?
a) L1 - L2 b) L3- L4 c) L2 - L3 d) S2 |
S2
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The 1st stage of Labor involves
a) afferent nerve endings (T10-12) b) afferent nerve endings (L1-3) c) S2-4 d) both a & b |
afferent nerve endings (T10-12)
afferent nerve endings (L1-3) |
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For the first stage of labor what kind of block is needed
a) visceral b) somatic c) both visceral & somatic |
visceral
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The pain from uterine ischemia & force of contractions as well as dilation/distention/ischemia of cervix is
transmitted via a) afferent nerve endings from levels T-10 thru L1 b) afferent nerve endings from levels T-10 ONLY c) afferent nerve endings from levels S2-4 |
afferent nerve endings from levels T-10 thru L1
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In the 2nd stage of labor what kind of block is needed
a) visceral b) somatic c) both visceral & somatic |
both visceral & somatic
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Which areas need to be blocked for 2nd stage of labor?
a) T10-T12 b) L1-L3 c) S2 - S4 d) T10-S4 |
T10-S4
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Transitional stage of labor starts (choose all that apply)
a) when cervix is < 6cm dilated b) when cervix is dilated from 6-8cm c) after baby is delivered but before placenta is delivered d) Needs analgesia block from T10-S4 |
when cervix is dilated from 6-8cm
Needs analgesia block from T10-S4 |
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C-fibers (choose all that apply)
a) post ganglionic b) pre-ganglionic c) unmyelinated d) easiest to block e) would need to be blocked in early 1st stage of labor |
post ganglionic
unmyelinated would need to be blocked in early 1st stage of labor |
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A-delta fibers (choose all that apply)
a) somatic afferents b) visceral afferents c) myelinated d) unmyelinated e) would need to be blocked in late/transistional to 2nd & 3rd stages of labor |
somatic afferents
myelinated would need to be blocked in late/transistional to 2nd & 3rd stages of labor |
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B-fibers (choose all that apply)
a) unmyelinated b) myelinated c) easiest to block d) pre-ganglionic e) post ganglionic f) usually blocked 2-4 segements above sensory |
myelinated
easiest to block post-ganglionic usually blocked 2-4 segements above sensory |
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Paracervical block (choose all that apply)
a) used in 2nd stage of labor only b) used in 1st stage of labor only c) blocks T10-L1 d) blocks L2-L3 e) is a sensory/motor block |
used in 1st stage of labor only
blocks T10-L1 |
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Lumbar sympathetic block (choose all that apply)
a) used in 2nd stage of labor only b) used in 1st stage of labor only c) blocks T10-L1 d) blocks L2-L3 e) can convert abnormal labor to nml labor |
used in 1st stage of labor only
blocks L2-L3 can convert abnormal labor to nml labor |
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T/F In a paracervical block a common fetal side effect is bradycardia
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True
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Puedendal block (choose all that apply)
a) used in 2nd stage of labor only b) used in 1st stage of labor only c) could prolong labor if done too late d) is a sensory/motor block e) is good for spontaneous vaginal delivery |
used in 2nd stage of labor only
could prolong labor if done too late is a sensory/motor block is good for spontaneous vaginal delivery |
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Perineal Infiltration (choose all that apply)
a) injection into posterior fourchette b) useful for spontaneous vaginal delivery c) useful for episiotomy/anal tears d) blocks both small & large nerve fibers in the perineal area |
injection into posterior fourchette
useful for episiotomy/anal tears Blocks ONLY SMALL fibers! |
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The Local anesthetic of choice for a perineal infiltration is
a) lidocaine b) 2-Chloroprocaine c) bupivacaine |
2-Chloroprocaine
Results in less drug transfer to fetus LIDOCAINE will result in DELAYED respiratory depression! |
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T/F Latent & Early labor can be easily managed with injection of opioid alone into epidural/spinal space
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True but it is only short term lasting
1-2 hrs will need local anesthetic |
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In late active labor and delivery your patient starts complaining of severe pain even though during early stage she was comfortable this could mean
a) there is a unilateral block b) the catheter has migrated c) she obviously doesn't have any pain tolerance |
there is a unilateral block
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T/F a unilateral block may go undetected in the 1st stage of labor
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True
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Contraindications to a regional anesthesia include (choose all that apply)
a) pt refusal b) inc. ICP pressure c) coagulopathies d) uncorrected hypovolemia e) inadequately trained personnel |
a) pt refusal
b) inc. ICP pressure (hydrocephaly, d/t the amount of LA placed in dural space) c) coagulopathies d) uncorrected hypovolemia e) inadequately trained personnel |
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You are placing an epidural catheter how do you know that you have spinal placement after injecting?
a) slow onset sensory/motor block b) fast onset sensory/motor block, 5 minutes c) pt c/o tinnitus d) HR increases 10-15 bpm |
fast onset sensory/motor block 5 minutes
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Epidural anesthesia (choose all that apply)
a) requires more LA than spinal b) requires less LA than spinal c) is a dense motor block d) has higher risk for being "patchy" |
requires more LA than spinal
has higher risk for being "patchy" |
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An epidural catheter that previously was adequate for pain relief, now shows signs of being unilateral, how do you handle this problem
a) tell her to suck it up b) pull catheter back about 1cm and turn unblocked side up, & re-bolus c) pull catheter back about 1cm and turn unblocked side down, & re-bolus d) decide you must convert to a GA when the time comes for delivery |
pull catheter back about 1cm and turn UNBLOCKED SIDE DOWN, & re-bolus
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T/F There is a risk of high blocks with saddle blocks
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True, with hyperbaric solutions
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Advantages of a CSE include (choose all that apply)
a) rapid onset b) ability to re-bolus if needed c) has more motor block d) has less motor block e) fewer failed/patchy blocks |
rapid onset
ability to re-bolus if needed has less motor block fewer failed/patchy blocks |
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Hyperbaric LA (choose all that apply)
a) will rise b) will sink c) will stay put d) has a dextrose component e) has an H2O or CSF component |
will sink
has a dextrose component |
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Hypobaric solution (choose all that apply)
a) will rise b) will sink c) will stay put d) has a dextrose component e) has an H2O or CSF component |
will rise
has an H2O or CSF component |
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T/F Density is defined as the weight in grams of 1ml of LA solution at a specific temp
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True, Once LA enters body the temperature in the body changes the baricity of LA
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B-fibers (choose all that apply)
a) unmyelinated b) myelinated c) easiest to block d) pre-ganglionic e) post ganglionic f) usually blocked 2-4 segements above sensory |
myelinated
easiest to block pre-ganglionic usually blocked 2-4 segements above sensory |
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Paracervical block (choose all that apply)
a) used in 2nd stage of labor only b) used in 1st stage of labor only c) blocks T10-L1 d) blocks L2-L3 e) is a sensory/motor block |
used in 1st stage of labor only
blocks T10-L1 |
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Lumbar sympathetic block (choose all that apply)
a) used in 2nd stage of labor only b) used in 1st stage of labor only c) blocks T10-L1 d) blocks L2-L3 e) can convert abnormal labor to nml labor |
used in 1st stage of labor only
blocks L2-L3 can convert abnormal labor to nml labor |
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T/F In a paracervical block a common fetal side effect is bradycardia
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True
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Puedendal block (choose all that apply)
a) used in 2nd stage of labor only b) used in 1st stage of labor only c) could prolong labor if done too late d) is a sensory/motor block e) is good for spontaneous vaginal delivery |
used in 2nd stage of labor only
could prolong labor if done too late is a sensory/motor block is good for spontaneous vaginal delivery |
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Perineal Infiltration (choose all that apply)
a) injection into posterior fourchette b) useful for spontaneous vaginal delivery c) useful for episiotomy/anal tears d) blocks both small & large nerve fibers in the perineal area |
injection into posterior fourchette
useful for episiotomy/anal tears Blocks ONLY SMALL fibers! |
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The Local anesthetic of choice for a perineal infiltration is
a) lidocaine b) 2-Chloroprocaine c) bupivacaine |
2-Chloroprocaine
Results in less drug transfer to fetus LIDOCAINE will result in DELAYED respiratory depression! |
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T/F Latent & Early labor can be easily managed with injection of opioid alone into epidural/spinal space
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True but it is only short term lasting
1-2 hrs will need local anesthetic |
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In late active labor and delivery your patient starts complaining of severe pain even though during early stage she was comfortable this could mean
a) there is a unilateral block b) the catheter has migrated c) she obviously doesn't have any pain tolerance |
there is a unilateral block
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T/F a unilateral block may go undetected in the 1st stage of labor
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True
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Contraindications to a regional anesthesia include (choose all that apply)
a) pt refusal b) inc. ICP pressure c) coagulopathies d) uncorrected hypovolemia e) inadequately trained personnel |
a) pt refusal
b) inc. ICP pressure (hydrocephaly, d/t the amount of LA placed in dural space) c) coagulopathies d) uncorrected hypovolemia e) inadequately trained personnel |
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You are placing an epidural catheter how do you know that you have spinal placement after injecting?
a) slow onset sensory/motor block b) fast onset sensory/motor block, 5 minutes c) pt c/o tinnitus d) HR increases 10-15 bpm |
fast onset sensory/motor block 5 minutes
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Epidural anesthesia (choose all that apply)
a) requires more LA than spinal b) requires less LA than spinal c) is a dense motor block d) has higher risk for being "patchy" |
requires more LA than spinal
has higher risk for being "patchy" |
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An epidural catheter that previously was adequate for pain relief, now shows signs of being unilateral, how do you handle this problem
a) tell her to suck it up b) pull catheter back about 1cm and turn unblocked side up, & re-bolus c) pull catheter back about 1cm and turn unblocked side down, & re-bolus d) decide you must convert to a GA when the time comes for delivery |
pull catheter back about 1cm and turn UNBLOCKED SIDE DOWN, & re-bolus
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Saddle blocks
a) single shot spinal for imminent delivery b) requires a hypobaric solution c) requires a hyperbaric solution |
single shot spinal for imminent delivery
requires a hyperbaric solution |
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T/F There is a risk of high blocks with saddle blocks
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True, with hyperbaric solutions
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Advantages of a CSE include (choose all that apply)
a) rapid onset b) ability to re-bolus if needed c) has more motor block d) has less motor block e) fewer failed/patchy blocks |
rapid onset
ability to re-bolus if needed has less motor block fewer failed/patchy blocks |
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Hyperbaric LA (choose all that apply)
a) will rise b) will sink c) will stay put d) has a dextrose component e) has an H2O or CSF component |
will sink
has a dextrose component |
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Hypobaric solution (choose all that apply)
a) will rise b) will sink c) will stay put d) has a dextrose component e) has an H2O or CSF component |
will rise
has an H2O or CSF component |
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T/F Density is defined as the weight in grams of 1ml of LA solution at a specific temp
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True, Once LA enters body the temperature in the body changes the baricity of LA
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Plain bupivicaine 0.25% and/or opioid used in a CSE for labor are (choose all that apply)
a) hyperbaric b) hypobaric c) rise higher in CSF when pt is sitting up d) has a higher sensory block when pt is sitting up e) sinks when the pt is sitting up |
hypobaric
rise higher in CSF when pt is sitting up has a higher sensory block when pt is sitting up |
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Bupivicaine with dextrose used in a spinal or CSE (choose all that apply)
a) is hypobaric b) hyperbaric c) will roll up or down depending on pt position d) is not dependent on pt position since it is hypobaric |
hyperbaric
will roll up or down depending on pt position |
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Where is Tuffier's line located? (choose all that apply)
a) T10-T11 b) L4-L5 c) about even with iliac crest d) about level of last rib |
L4-L5
about even with iliac crest |
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Place the following anatomic areas in order from skin to area closest to spine
skin, ligamentum flavum, interspinous ligaments, supraspinous ligaments, epidural space, subarachnoid space, dura mater |
skin...supraspinous ligament, interspinous ligaments, ligamentum flavum, epidural space, dura mater, subarachnoid space
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What is the most important factor for determining successful placement of an epidural, spinal or CSE?
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POSITIONING, pt spine needs to be be midline for success!
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When using the loss of resistance technique to verify placement of an epidural catheter (choose all that apply)
a) air is placed in the syringe b) air will pass once in ligamentum flavum c) air will pass once in epidural space d) no air is placed in syringe it would be dangerous! |
air is placed in the syringe
air will pass once in epidural space |
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Factors that affect location of epidural space include (choose all that apply)
a) obesity b) pt geometric differences c) scoliosis d) prior back surgery |
a) obesity
b) pt geometric differences c) scoliosis d) prior back surgery |
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Lumbar spinal flexion (choose any or all that apply)
a) opens the spaces between bones of spine b) closes the spaces between bones of spine c) can cause aortocaval compression d) causes twisting of spine |
opens the spaces between bones of spine
can cause aortocaval compression |
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Once epidural space is verified what would your next step be
a) slowly inject test dose b) inject 5cc saline to check for midline status c) have pt lay down before injecting test dose |
inject 5cc saline to check for midline status (if pt says they feel pressure more on onside than other the catheter is NOT midline)
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When threading your epidural catheter you feel a "pop" and it threads like "butter" (choose any or all that apply)
a) you know you are in the epidural space b) you know you are either in spinal or Intravascular c) you suspect shearing of catheter tip |
you know you are either in spinal or Intravascular
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Pre-eclampsia is diagnosed on basis of (choose any or all that apply)
a) development of HTN b) proteinuria c) edema d) convulsions |
a) development of HTN
b) proteinuria c) edema |
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Eclampsia is diagnosed on basis of (choose any or all that apply)
a) development of HTN b) proteinuria c) edema d) convulsions |
a) development of HTN
b) proteinuria c) edema d) convulsions |
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You are threading your epidural catheter and meet resistance as you attempt to pull back catheter you meet resistance, what should your next step be? ___________ ____________________
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STOP! remove both needle & catheter
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When giving a test dose it is important to
a) inject 3ml of 1.5% Lidocaine w/ 1:200k epi rapidly b) inject 3ml of 1.5% Lidocaine w/ 1:200k epi slowly |
inject 3ml of 1.5% Lidocaine w/ 1:200k epi rapidly BECAUSE if too slow may only test the proximal hole and not get a true idea of where tip is (could be intravascular)
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3 minutes after your test dose of lido/epi via epidural catheter your pt states their legs feel warm & numb
a) you are satisfied that you are in the epidural space and give your bolus dose of medication b) suspect you are in subarachnoid space c) you suspect you are intravascular |
suspect you are in subarachnoid space
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5 minutes after your test dose of lido/epi via epidural catheter your pt states they are unable to move their legs
a) you are satisfied that you are in the epidural space and give your bolus dose of medication b) suspect you are in subarachnoid space c) you suspect you are intravascular |
suspect you are in subarachnoid space
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Pt. VS BP 136/70, HR 88 RR 22. You have just finished placing your test dose (lido/epi) via your pts epidural catheter, you recycle a BP and see 132/78, 106, 24. What do you suspect?
a) nothing, those VS are very normal for a woman about to give birth b) you are in the subarachnoid space c) you have just injected into a vessel |
you have just injected into a vessel The elevated HR 106 is subtle but it is 10% above the baseline HR
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The first sign that you have injected intravascularly is
a) HOTN b) elevated HR c) tinnitus/hearing changes d) muscle twitching |
tinnitus/hearing changes
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You have injected your pts epidural catheter with a bolus dose of medication (assume test dose OK). Testing for sensory block, your pt says they can still feel everything.
What is your next step? a) wait a few minutes longer, test again, if no block then inject with another small amt b) assume you are intravascular and remove catheter c) assume you are spinal, so you definitely have to inject more medication |
assume you are intravascular and remove catheter
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When should you preform a test dose
a) during a contraction as it will help the LA spread to give you a real idea of where tip is b) between contractions c) it doesn't matter when you do it, just that you do it |
between contractions
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Your first attempt at placing an epidural catheter on a pt who has had previous back surgery landed you in the subarachnoid space what is/are your option(s)
a) remove catheter and redo at a different level b) leave catheter in place but label it clearly as a spinal catheter c) give intermittent boluses of 1-2 ml 0.25% lidocaine & check every 45 min for a while d) decide pt must have a general |
remove catheter and redo at a different level
leave catheter in place but label it clearly as a spinal catheter give intermittent boluses of 1-2 ml 0.25% lidocaine every 45 min for a while |
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Is it normal to have T1-T4 blocks with CSE? yes/no
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Yes
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If your epidural block is above T10, what might it interfere with?
a) breathing b) ability to push c) ability to talk |
ability to push
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T/F The biggest problem with continuous epidural analgesia is recurrence of pain later in labor
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TRUE, it is almost always d/t patchy, unilateral block that was obscured in early stage of labor because it was OK for visceral nerves
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Your pt says they want a "walking epidural" like their neighbor had, you know that (choose any or all that apply)
a) in the early stage of labor its OK b) it's only a somatic block c) a small dose of LA with opioid is what you will give d) it will provide between 1-2 hrs of pain relief |
a) in the early stage of labor its OK
b) it's only a somatic block d) it will provide between 1-2 hrs of pain relief NO Local anesthetic! Opioid ONLY!!! |
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Pruritus is a common side effect from opioids placed in regional catheters, there is more/less itching from opioid placed in epidural catheter compared to spinal catheter
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LESS
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When comparing an epidural to a CSE
their is (choose any or all that apply) a) no difference in effect on FHR b) no difference in incidence of emergency C-section for FHR changes c) no difference in APGAR scores |
a) no difference in effect on FHR
b) no difference in incidence of emergency C-section for FHR changes c) no difference in APGAR scores |
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T/F 1/3 of all pregnant women can have uteroplacental insufficiency even without HOTN
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TRUE
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Which of the following are amides
a) 2-Chloroprocaine b) Lidocaine c) Ropivacaine d) Bupivacaine |
b) Lidocaine
c) Ropivacaine d) Bupivacaine |
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2-Chloroprocaine (choose all that apply)
a) is metabolized in the liver b) short acting c) metabolized by pseudo-cholinesterase d) has an increased incidence of back pain associated with it |
b) short acting
c) metabolized by pseudo-cholinesterase d) has an increased incidence of back pain associated with it |
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Which of the following is most cardiotoxic
a) Lidocaine b) Bupivacaine c) Ropivacaine d) 2-Chloroprocaine |
Bupivacaine
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Ropivacaine ( choose any or all that apply)
a) is the ideal local anesthetic for labor b) has minimal motor block c) minimal risk of maternal toxicity d) minimal placental transfer e) minimal HOTN associated with it |
a) is the ideal local anesthetic for labor
b) has minimal motor block c) minimal risk of maternal toxicity d) minimal placental transfer e) minimal HOTN associated with it |
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Bupivacaine's onset
a) 12-20 minutes b) 3-5 minutes c) 20-30 minutes |
12-20 minutes
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Which LA has less motor and more sensory block?
Lidocaine or Bupivacaine |
Bupivacaine EXCEPT with increased concentration
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Bupivacaine ( choose any or all that apply)
a) highly protein bound b) narrow margin between neuro & cardio toxic c) duration of 60 minutes d) duration of 2 hours |
highly protein bound
narrow margin between neuro & cardio toxic duration of 2 hours (epidural) |
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2-Choroprocaine (choose any or all that apply)
a) is an excellent choice for STAT C-Section b) Fast on/Fast off c) Duration of 30 minutes d) can block efficacy of bupivacaine/opioids given intra-axial |
a) is an excellent choice for STAT C-Section
b) Fast on/Fast off c) Duration of 30 minutes d) can block efficacy of bupivacaine/opioids given intra-axial |
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Lidocaine/Bupivacaine has a higher placental transfer, and more motor block
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Lidocaine
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Baricity
a) applies to spinals b) applies to epidurals c) applies to both spinal & epidurals |
applies to spinals
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Postdural puncture headache risk
a) greater in spinal b) greater in CSE c) greater in epidural d) the same in spinal, epidural & CSE |
the same in spinal, epidural & CSE about 1-2%
BUT increased to 50% with a wet tap with an epidural needle |
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Your pt is complaining of a headache.
you notice she has two puncture sites on her back and think, PDPH, what is your differential diagnosis? ___________________________ |
If headache remains after pt changes position it is NOT a PDPH, if it goes away when she lays down then it is a PDPH
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You are about to give your test dose via the epidural catheter and your pt c/o feeling lightheaded, & has ringing in her ears, you suspect
a) you've hit a nerve when placing catheter b) she may have HOTN c) she is just nervous |
she may have HOTN
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Fetal signs that there may be maternal HOTN are (choose any or all that apply)
a) FHR decelerations b) decreased FHR variability c) both of the above |
a) FHR decelerations
b) decreased FHR variability |
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Your pt is hypotensive just after you placement of regional analgesia how do you proceed (choose any or all that apply)
a) place pt in left uterine displacement position b) give IVF bolus c) give ephedrine or neo d) place pt in lateral position e) give oxygen |
b) give IVF bolus
c) give ephedrine or neo d) place pt in lateral position e) give oxygen |
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Your pt is lying down awaiting a spinal C-section c/o SOB BP 75/40, HR 60 what do you give
a) ephedrine b) phenylephrine |
ephedrine (want to avoid reflex bradycardia common with phenylephrine)
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Your pt is about to undergo an emergent C-section, there are late decels noted on the FHR monitor, with a rate of 60 what do you do?
a) give phenylephrine, it will cross the placenta & get to the baby b) give ephedrine, it will cross the placenta & get to the baby |
give ephedrine, it will cross the placenta & get to the baby
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Your pt is about to undergo an emergent C-section, her heart rate jumps to 120 with a low BP what do you do? (choose any or all that apply)
a) give phenylephrine, b) give ephedrine c) administer O2 d) give IVF bolus |
give phenylephrine
administer O2 give IVF bolus |
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How do you treat pruritus related to spinal opioid? (choose any or all that apply)
a) nubain b) naloxone c) benedryl |
nubain
naloxone benedryl |
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Nubain is an
a) agonist at mu b) antagonist at mu c) agonist at kappa d) antagonist at kappa |
antagonist at mu
agonist at kappa |
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Although rare Maternal respiratory depression (choose any or all that apply)
a) most likely seen with CSE b) most likely seen with plain epidural c) if seen will be within first 25 minutes after injection d) will happen immediately |
most likely seen with CSE
if seen will be within first 25 minutes after injection |
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Why would you not want to use morphine in an epidural for labor?
_________________________ |
Because there are 2 windows for Resp depression
between 3-4 hours and then again in 12hrs |
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There is an increased risk for neurotoxicity in pregnant women because (choose any or all that apply)
a) decreased plasma proteins b) increased plasma proteins c) increased swelling of vasculature |
decreased plasma proteins (which makes more drug available, because it isn't protein bound)
increased swelling of vasculature (which increases chance of hitting vessel) |
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What is the treatment for VT/VF with Bupivacaine cardiotoxicity?
_____________ |
Bretyllium
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Your pt complains that she can't breath, you ask her to squeeze your hands, you suspect a high spinal, when do you know that you might not be able to just get by if you raise her head to keep spinal from advancing further?
____________________ |
When she can no longer phonate & squeeze your hands (level probably about T2 at this time)
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Signs and symptoms of a high spinal
(choose any or all that apply) a) agitation b) dyspnea c) dyphonia d) HOTN e) Tachy then Brady |
a) agitation
b) dyspnea c) dyphonia d) HOTN e) Tachy then Brady |
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T/F a total spinal is very likely to happen in a pre-existing epidural that failed, who then had a spinal placed
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TRUE, it puts them over the edge
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Epidural/CSE higher risk for back pain
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Epidural (remember 2-Chloroprocaine also has high incidence of back pain)
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T/F Intra-axial opioids do their work in the dorsal horn of spinal cord (rexed lamina 1,2, (substantia gelatinosa) 5)
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TRUE THAT!!!!
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What properties of local anesthetics determines the amt of epinephrine will effect level & duration of block
a) lipid solubility b) pKa c) water solubility d) density |
lipid solubility
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Morphine/Fentanyl which has a higher lipid solubility
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Fentanyl
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Morphine/Fentanyl which one has a longer onset and more spread
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Morphine
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Sufentanyl/Fentanyl which one is most lipid soluble
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Sufentanyl
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Morphine/Fentanyl which one has higher number of side effects
|
Morphine itching (80%), N/V (53%)
urinary retention ( 43%) |
|
|
Signs & symptoms of a PDPH are (choose any that apply)
a) N/V b) neck pain c) fever d) tachycardia |
a) N/V
b) neck pain |
|
|
Conservative treatment for PDPH involves (choose any that apply)
a) IVF b) caffeine c) bedrest d) pain meds |
a) IVF
b) caffeine c) bedrest d) pain meds |
|
|
The most effective treatment for a PDPH is _____________________
|
Epidural blood patch (85%)
|
|
|
T/F there is an increased risk for a PDPH with a CSE
|
FALSE
|
|
|
Epidural block is best suited for
a) labor b) c-section |
labor, because there is no motor block, can be redosed as needed
|
|
|
Spinal anesthesia is best suited for
a) labor b) c-section |
c-section, more dense block, not spotty, works a lot faster
|
|
|
What level is adequate for a C-section
a) T-10 b) T- 4 c) T-2 d) T- 8 |
T- 4
|
|
|
T/F The first anesthetic for delivery was administered by Dr. James Simpson in 1846
|
TRUE
|
|
|
T/F Dr. John Snow delivered anesthesia for child birth to Queen Victoria
|
TRUE
|
|
|
Hellp syndrome involves (choose all that apply)
a) breakdown of red blood cells b) elevated liver enzymes c) low platelet counts d) hypertension |
a) breakdown of red blood cells
b) elevated liver enzymes c) low platelet counts d) hypertension |
|
|
Why would pulmonary HTN & aortic stenosis be relative contraindications to a regional anesthetic?
____________________________ |
Pt's with these diseases need a preload to function, a regional drops preload, in addition pt may already be dehydrated
|
|
|
Fetal Risk factors for emergency C-Section
are _________prolapse, ________ presentation, __________to progress |
cord prolapse breech presentation failure to progress
|
|
|
Maternal risk factors for emergency C-Section include
___________previa, placental __________, uterine ___________ |
placenta previa placenta abruptio uterine rupture
|
|
|
Grade I emergency is
a) maternal or fetal compromise not immediately life threatening b) immediate threat to life of mother or fetus c) No compromise but early delivery needed d) delivery time to suit woman/staff |
immediate threat to life of mother or fetus
|
|
|
Grade 2 emergency is
a) maternal or fetal compromise not immediately life threatening b) immediate threat to life of mother or fetus c) No compromise but early delivery needed d) delivery time to suit woman/staff |
maternal or fetal compromise not immediately life threatening
|
|
|
Grade 3 emergency is
a) maternal or fetal compromise not immediately life threatening b) immediate threat to life of mother or fetus c) No compromise but early delivery needed d) delivery time to suit woman/staff |
No compromise but early delivery needed
|
|
|
Grade 4 emergency is
a) maternal or fetal compromise not immediately life threatening b) immediate threat to life of mother or fetus c) No compromise but early delivery needed d) delivery time to suit woman/staff |
delivery time to suit woman/staff
|
|
|
2-Chloroprocaine can cause neurotoxicity/nerve paralysis if it gets into
a) spinal space b) epidural space |
spinal space
|
|
|
T/F studies have shown that regional anesthesia can lead to delays in incision time for emergency
C-Sections |
TRUE
|
|
|
Which of the following anesthetics can produce anesthesia via an epidural adequate enough for the urgent C-Section the fastest?
a) Bupivacaine b) Lidocaine w/epi c) 2-Chloroprocaine |
2-Chloroprocaine (in 3 minutes)
Lidocaine w/epi in 5 minutes Bupivacaine has long onset |
|
|
The majority of anesthesia related maternal mortality is due to
a) aspiration b) inadequate airway c) hemorrhage |
inadequate airway
|
|
|
Pre-eclampsia symptoms (choose all that apply)
a) headache b) HTN c) decreased protein/protein urea d) coagulopathy |
a) headache
b) HTN c) decreased protein/protein urea d) coagulopathy |
|
|
T/F Your colleague has given you report on Mrs. Jones' epidural and states that it's adequate, you take him at his word
|
False, always check the block yourself!!
|
|
|
With a difficult airway scenario where you can not intubate, but can ventilate the most prudent thing to do is (assume mother & baby not in immediate danger)
a) wake pt up & intubate using fiberoptic or glidescope b) mask the pt for the C-Section as it won't take that long c) insert an LMA |
wake pt up & intubate using fiberoptic or glidescope
|
|
|
Respiratory changes in pregnancy include (choose all that apply)
a) airway edema b) increase in Vt c) decreased FRC |
a) airway edema
b) increase in Vt c) decreased FRC |
|
|
Cardiac changes that occur during pregnancy include (choose all that apply)
a) increased CO b) pulmonary regurg c) mitral regurg |
a) increased CO
b) pulmonary regurg c) mitral regurg |
|
|
Intra-abdominal pressure
a) decreases LA requirement b) can cause aspiration c) both of the above |
a) decreases LA requirement
b) can cause aspiration |
|
|
Aortal caval compression starts at
a) 13 weeks b) 30 weeks c) 20 weeks |
13 weeks
|
|
|
Advantages of a CSE include (choose all that apply)
a) initial strong block b) fast onset c) redosing is available d) can give smaller doses e) good for shorter people |
a) initial strong block
b) fast onset c) redosing is available d) can give smaller doses e) good for shorter people |
|
|
Epinephrine in a spinal anesthetic (choose any or all that apply)
a) increases action of LA b) increases intensity of LA c) both of the above |
a) increases action of LA
b) increases intensity of LA |
|
|
Why is it a good idea to use epinephrine in an epidural test dose?
_______________________ |
Because it serves as a great way to check for intravascular injection
|
|
|
Is aspirating back on a syringe when checking for possible intravascular injection a reliable test? yes/no
|
No, you can aspirate & not get blood back but still be injecting into vascular space
|
|
|
Length of action for bupivacaine is
a) 45-90 min b) 30 min c) 90-300 min |
90-300 min
|
|
|
The routine test dose includes ____cc 1.5% ______________ w/ 1:______ epinephrine
|
3cc 1.5% Lidocaine with 1:200k epi
|
|
|
The first sign of hypotension in a pregnant woman is
______________________ |
Nausea!
|
|
|
Treatment of hypotension includes (choose all that apply)
a) lt uterine displacement b) IVF bolus c) Ephedrine/Neo |
a) lt uterine displacement
b) IVF bolus c) Ephedrine/Neo |
|
|
A total spinal
a) total motor block b) total senory block c) above C3 d) affects phrenic nerve |
a) total motor block
b) total senory block c) above C3 d) affects phrenic nerve |
|
|
T/F Spinal has an increased risk for seizures as compared to Epidural
|
False!!! DUE TO LARGE AMT OF ANESTHETIC GIVEN
|
|
|
There is a high incidence of back pain in pregnant women what are some of the risk factors for it
a) higher weight b) lower height c) younger age d) prior history |
a) higher weight
b) lower height c) younger age d) prior history THERE IS NO CORRELATION WITH EPIDURAL ANESTHESIA OR C-SECTION |
|
|
Meningitis is a relative/absolute contraindication
|
relative
|
|
|
Reasons for using 0.5 MAC
a) low concentration is safe for baby b) low concentration does not relax uterus c) will help prevent maternal awareness |
a) low concentration is safe for baby
b) low concentration does not relax uterus (so that uterus can clamp down & prevent hemorrhage) c) will help prevent maternal awareness |
|
|
Aortal caval compression starts at
a) 13 weeks b) 30 weeks c) 20 weeks |
13 weeks
|
|
|
Advantages of a CSE include (choose all that apply)
a) initial strong block b) fast onset c) redosing is available d) can give smaller doses e) good for shorter people |
a) initial strong block
b) fast onset c) redosing is available d) can give smaller doses e) good for shorter people |
|
|
Epinephrine in a spinal anesthetic (choose any or all that apply)
a) increases action of LA b) increases intensity of LA c) both of the above |
a) increases action of LA
b) increases intensity of LA |
|
|
Why is it a good idea to use epinephrine in an epidural test dose?
_______________________ |
Because it serves as a great way to check for intravascular injection
|
|
|
Is aspirating back on a syringe when checking for possible intravascular injection a reliable test? yes/no
|
No, you can aspirate & not get blood back but still be injecting into vascular space
|
|
|
Length of action for bupivacaine is
a) 45-90 min b) 30 min c) 90-300 min |
90-300 min
|
|
|
The routine test dose includes ____cc 1.5% ______________ w/ 1:______ epinephrine
|
3cc 1.5% Lidocaine with 1:200k epi
|
|
|
The first sign of hypotension in a pregnant woman is
______________________ |
Nausea!
|
|
|
Treatment of hypotension includes (choose all that apply)
a) lt uterine displacement b) IVF bolus c) Ephedrine/Neo |
a) lt uterine displacement
b) IVF bolus c) Ephedrine/Neo |
|
|
A total spinal
a) total motor block b) total senory block c) above C3 d) affects phrenic nerve |
a) total motor block
b) total senory block c) above C3 d) affects phrenic nerve |
|
|
T/F Spinal has an increased risk for seizures as compared to Epidural
|
False!!! DUE TO LARGE AMT OF ANESTHETIC GIVEN via epidural space
|
|
|
There is a high incidence of back pain in pregnant women what are some of the risk factors for it
a) higher weight b) lower height c) younger age d) prior history |
a) higher weight
b) lower height c) younger age d) prior history THERE IS NO CORRELATION WITH EPIDURAL ANESTHESIA OR C-SECTION |
|
|
Meningitis is a relative/absolute contraindication
|
relative
|
|
|
Reasons for using 0.5 MAC
a) low concentration is safe for baby b) low concentration does not relax uterus c) will help prevent maternal awareness |
a) low concentration is safe for baby
b) low concentration does not relax uterus (so that uterus can clamp down & prevent hemorrhage) c) will help prevent maternal awareness |
|
|
T/F If the time from the induction of GA to delivery is NO longer than 5 minutes APGAR scores are comparable to those of infants born using regional technique
|
TRUE
|
|
|
Induction of anesthesia to Delivery time should be
a) 3 minutes b) 5-8 minutes c) no greater than 10 minutes |
5-8 minutes
|
|
|
With regional technique uterine incision to delivery time should be
a) 3 minutes b) 5-8 minutes c) no greater than 10 minutes |
3 minutes
|
|
|
How is the fetus protected from the thiopental that is used for induction (choose any or all that apply)
a) first pass effect b) fetal liver absorbs a good portion of the drug c) drug is diluted via drug free blood from the IVC & SVC |
a) first pass effect (85% of fetal blood passes thru liver before going to brain)
b) fetal liver absorbs a good portion of the drug (drug is not metabolized) c) drug is diluted via drug free blood from the IVC & SVC |
|
|
If a woman is having a repeat C-Section what would be the best choice of anesthesia & why? __________
________________________ |
Regional, because of of scarring from previous C-Section that may delay delivery time
|
|
|
T/F the significance of neurobehavioral test scores for child development has not been proven
|
TRUE
|
|
|
What is one of the biggest downfalls of a INTRATHECAL injection of Duramorph?
a) Respiratory depression b) Burning c) Pruritus d) Nausea & vomiting b) |
Pruritus but if keep dose under 0.2mg may not see this
|
|
|
T/F Obese pregnant women are more likely to end up having a C-Section
|
True, because obesity increases risks for HTN, DM, congenital malformations, placental abruption, difficulty with regional techniques
|
|
|
APGAR scoring
The newborn's HR is less <100 score of? _____ |
1
|
|
|
APGAR scoring
The newborn's HR is >100 score of? _____ |
2
|
|
|
T/F If the time from the induction of GA to delivery is NO longer than 5 minutes APGAR scores are comparable to those of infants born using regional technique
|
TRUE
|
|
|
Induction of anesthesia to Delivery time should be
a) 3 minutes b) 5-8 minutes c) no greater than 10 minutes |
5-8 minutes
|
|
|
With regional technique uterine incision to delivery time should be
a) 3 minutes b) 5-8 minutes c) no greater than 10 minutes |
3 minutes
|
|
|
How is the fetus protected from the thiopental that is used for induction (choose any or all that apply)
a) first pass effect b) fetal liver absorbs a good portion of the drug c) drug is diluted via drug free blood from the IVC & SVC |
a) first pass effect (85% of fetal blood passes thru liver before going to brain)
b) fetal liver absorbs a good portion of the drug (drug is not metabolized) c) drug is diluted via drug free blood from the IVC & SVC |
|
|
If a woman is having a repeat C-Section what would be the best choice of anesthesia & why? __________
________________________ |
Regional, because of of scarring from previous C-Section that may delay delivery time
|
|
|
T/F the significance of neurobehavioral test scores for child development has not been proven
|
TRUE
|
|
|
What is one of the biggest downfalls of a INTRATHECAL injection of Duramorph?
a) Respiratory depression b) Burning c) Pruritus d) Nausea & vomiting |
Pruritus but if keep dose under 0.2mg may not see this
|
|
|
T/F Obese pregnant women are more likely to end up having a C-Section
|
True, because obesity increases risks for HTN, DM, congenital malformations, placental abruption, difficulty with regional techniques
|
|
|
APGAR scoring
The newborn's HR is less <100 score of? _____ |
1
|
|
|
APGAR scoring
The newborn's HR is less >100 score of? _____ |
2
|
|
|
APGAR scoring
The newborn's respirations are shallow, irregular & slow, he is gasping for air score is? ________ |
1
|
|
|
APGAR scoring
You suction the newborn and he grimaces to the suctioning, score? ___ |
1
|
|
|
APGAR scoring
The newborn is cyanotic at birth score? _______ |
0
|
|
|
APGAR scoring
You notice at birth that the baby is acrocyanotic, score? |
1 (acrocyanotic = pink trunk, extremities are blue)
|
|
|
APGAR scoring
If the newborn has limp or absent muscle tone the score? _______ |
0
|
|
|
APGAR scoring
There is some muscle tone but it is limited, score? _____ |
1
|
|
|
APGAR scoring
The newborn has robust crying, score? ______ |
2
|
|
|
APGAR scoring
you notice that the newborn looks very cyanotic, score? ____ |
0
|
|
|
APGAR scoring
You are suctioning the newborn and he cough's or sneezes, score? _____ |
2
|
|
|
APGAR scoring
No HR, score? ______ No RR, score? ______ |
0
0 |
|
|
Which prophylactic prevention of HOTN is the most successful
a) Prehydration with 1000ml b) Prehydration with ephedrine (IM) c) Prehydration with mechanical displacement d) Prehydration with mechanical displacement + ephedrine |
Prehydration with mechanical displacement + ephedrine
|
|
|
Neonate
a) the infant in the first minutes to hours after birth b) the infant during the first 28 days of life c) the neonate period through 12 months of age |
the infant during the first 28 days of life
|
|
|
Newborn
a) the infant in the first minutes to hours after birth b) the infant during the first 28 days of life c) the neonate period through 12 months of age |
the infant in the first minutes to hours after birth
|
|
|
When does the foramen ovale close?
a) at clamping of cord b) when LAP > RAP c) when the SVR increases, PaO2 increases |
when LAP > RAP
|
|
|
When does the ductus venosus close?
a) at clamping of cord b) when LAP > RAP c) when the SVR increases, PaO2 increases |
at clamping of cord
|
|
|
When does the ductus arteriosus close?
a) at clamping of cord b) when LAP > RAP c) when the SVR increases, PaO2 increases |
when the SVR increases, PaO2 increases
|
|
|
Why does Pulmonary vascular resistance decrease in first 24-48 hours after birth?
|
Expansion of lungs, direct exposure to O2, and reabsorption of lung water
|
|
|
T/F Alveolar-to-arterial (ALV/Art) normally decreases with age
|
TRUE
|
|
|
Which of the following factors increases pulmonary vascular resistance?
a) Hypocarbia b) Hypercarbia c) Hyperinflation d) Acidosis e) Oxygen |
Hypercarbia
Hyperinflation Acidosis |
|
|
Which of the following factors decreases pulmonary vascular resistance?
a) Oxygen b) sympathetic stimulation c) low hematocrit d) Hypocarbia |
Oxygen
low hematocrit Hypocarbia |
|
|
Parasympathetic/Sympathetic system is more developed in newly born infants
|
Parasympathetic
|
|
|
T/F The fetal lungs are expanded in utero
|
TRUE, but not by air! Instead the air sacs are filled with fluid
|
|
|
T/F As a result of increased oxygen in the alveoli at birth blood vessels in the lungs relax
|
TRUE, this increases pulmonary blood flow and decreases flow thru the ductus arteriosus
|
|
|
Will the lack of oxygen result in sustained constriction of the pulmonary arterioles? yes/no
|
YES, when they remain constricted it leads to PERSISTANT PULMONARY HYPERTENSION (PPH)
|
|
|
Primary Apnea
a) results in an initial period of rapid breathing followed by primary apnea b) can be resolved by tactile stimulation c) causes blood pressure to fall d) is not reversible |
results in an initial period of rapid breathing followed by primary apnea
can be resolved by tactile stimulation |
|
|
Secondary Apnea
a) results in an initial period of rapid breathing followed by primary apnea b) can be resolved by tactile stimulation c) causes blood pressure to fall d) is not reversible |
causes blood pressure to fall
is not reversible ASSISTED VENTILATION MUST BE PROVIDED |
|
|
T/F The heart rate of newly born begins to fall at about the same time that the baby enters primary apnea
|
TRUE
|
|
|
T/F Respirations are the first vital sign to cease with lack of oxygen
|
True
|
|
|
Indications that a newly born may need more aggressive assessment & possible intervention include (choose all that apply)
a) Meconium in the amniotic fluid or on skin b) absent or weak cry in response to stimulation c) persistent cyanosis d) preterm birth |
a) Meconium in the amniotic fluid or on skin
b) absent or weak cry in response to stimulation c) persistent cyanosis d) preterm birth |
|
|
In the first 30 seconds after birth the infant has a weak cry in response to stimulation, what should your next response(s) be (choose any or all that apply)
a) provide positive ventilation b) provide warmth c) Give O2 with face mask d) dry, stimulate, reposition |
b) provide warmth
c) Give O2 with face mask d) dry, stimulate, reposition |
|
|
After stimulating the newly born baby his HR <100, and his breathing continues to deteriorate what is the appropriate action(s) (choose any or all that apply)
a) Positive pressure ventilation b) re-stimulate because you are just in the second 30 second period & he will probably turn around c) administer chest compressions |
Positive pressure ventilation
|
|
|
In the 2nd 30 second period the infant doesn't respond to positive pressure ventilation and his HR < 60, what do you do (choose any or all that apply)
a) provide positive pressure ventilation b) administer chest compressions c) administer epinephrine |
a) provide positive pressure ventilation
b) administer chest compressions c) administer epinephrine |
|
|
What is the "triad" used to assess the newly born (choose three)
a) HR b) BP c) RR d) color |
HR
RR color |
|
|
T/F gasping and apnea are signs that indicate the need for assisted ventilation
|
TRUE
|
|
|
What is the correct way to assess HR in the newly born (choose any or all that apply)
a) listen to the precordium (with stethescope) b) feel for a brachial pulse c) feel for pulsations at the base of the umbilical cord |
listen to the precordium (with stethescope)
feel for pulsations at the base of the umbilical cord |
|
|
T/F HR should be consistently >100 in an uncompromised newly born
|
TRUE
|
|
|
T/F Acrocyanosis is a normal finding at birth and is not a reliable indicator of hypoxemia
|
TRUE (slide 33)
|
|
|
Pallor in the newly born may be a sign of (choose any or all that apply)
a) severe anemia b) hypovolemia c) hypothermia d) acidosis |
a) severe anemia
b) hypovolemia c) hypothermia d) acidosis |
|
|
When must resuscitation must be initiated
a) after the first APGAR score is assigned b) before the first APGAR score is assigned |
before the first APGAR score is assigned
|
|
|
T/F The APGAR score is used to help determine whether a newly born baby needs to be resuscitated
|
FALSE
|
|
|
The APGAR score is usually scored
a) at 1 & 3 minutes b) at 1 & 10 minutes c) at 1 & 5 minutes |
at 1, 5 & may be done at 10 minutes as well
|
|
|
The 1 minute APGAR score reflects
a) amount of neonatal asphyxia and condition before delivery b) the adequacy of initial resuscitation |
amount of neonatal asphyxia and condition before delivery
|
|
|
The 5 minute APGAR score reflects
a) amount of neonatal asphyxia and condition before delivery b) the adequacy of initial resuscitation |
the adequacy of initial resuscitation
|
|
|
The newly born baby in your case has a APGAR score of 5-7 (choose all that apply)
a) have suffered mild asphyxia just before birth b) usually respond to vigorous stimulation and blow-by O2 c) might require bag mask ventilation |
a) have suffered mild asphyxia just before birth
b) usually respond to vigorous stimulation and blow-by O2 c) might require bag mask ventilation |
|
|
The newly born baby in your case has an APGAR score of 3-4 (choose all that apply)
a) is moderately depressed at birth b) typically cyanotic c) usually responds to bag-mask venitilation |
a) is moderately depressed at birth
b) typically cyanotic c) usually responds to bag-mask venitilation |
|
|
The newly born baby in your case has an APGAR score of 0-2 (choose all that apply)
a) severely asphyxiated b) requires immediate resuscitation c) requires immediate intubation d) requires only bag-mask ventilation |
a) severely asphyxiated
b) requires immediate resuscitation c) requires immediate intubation |
|
|
Maternal factors that should make you anticipate resuscitation needs are
a) Bleeding in 2nd or 3rd trimester b) age <16 or >35 years c) No prenatal care d) Preeclampsia |
a) Bleeding in 2nd or 3rd trimester
b) age <16 or >35 years c) No prenatal care d) Preeclampsia |
|
|
When preparing for a high risk delivery
a) There must be at least 2 persons capable of neonatal resuscitation b) There must be at least 1 person capable of neonatal resuscitation, with another readily available |
There must be at least 2 persons capable of neonatal resuscitation
|
|
|
In every birth situation
a) There must be at least 2 persons capable of neonatal resuscitation b) There must be at least 1 person capable of neonatal resuscitation, with another readily available |
There must be at least 1 person
capable of neonatal resuscitation, with another readily available |
|
|
If suctioning is necessary after birth
a) clear secretions from nose first and then mouth b) clear secretions from mouth first and then nose c) use a bulb syringe d) use a neonate suction catheter |
clear secretions from mouth first and then nose
use a bulb syringe |
|
|
T/F pharyngeal suctioning can cause laryngeal spasm and vagal bradycardia and delay onset of spontaneous breathing
|
TRUE
|
|
|
T/F A newborn is always suctioned at birth to remove secretions to allow for adequate ventilation
|
FALSE! If the baby is vigorous DO NOT SUCTION
|
|
|
When amniotic fluid is meconium stained suctioning is required
a) only if meconium is thin b) only if meconium is thick c) always whether it is thin or thick |
always whether it is thin or thick
|
|
|
The newly born baby has meconium stained amniotic fluid, depressed resp., HR <100
a) intubate immediately b) suction infant first and then intubate c) suction after intubation, while withdrawing ETT d) repeat intubation & suctioning until little more meconium is removed or until HR drops |
intubate immediately
suction after intubation repeat intubation & suctioning until little more meconium is removed or until HR drops |
|
|
T/F suctioning the vigorous infant does not improve outcome and may cause complications
|
TRUE
|
|
|
T/F If the infant's HR or resp. are severely depressed it may be necessary to positive pressure ventilate even with evidence of meconium in the airway
|
TRUE
|
|
|
If tactile stimulation fails to establish spontaneous & effective respirations
a) the infant is in primary apnea & requires positive pressure ventilation b) the infant is in secondary apnea & requires positive pressure ventilation c) more vigorously stimulate the infant |
The infant is in secondary apnea & requires positive pressure ventilation
DO NOT STIMULATE INFANT MORE VIGOROUSLY |
|
|
Indications that a newly born baby needs positive pressure ventilation are
a) apnea b) gasping c) HR <100 d) persistent central cyanosis despite 100% O2 |
a) apnea
b) gasping c) HR <100 d) persistent central cyanosis despite 100% O2 |
|
|
T/F visible chest expansion is a more reliable sign of appropriate inflation pressures of a newly born baby's lungs than manometer readings
|
TRUE, because HIGHER inflation pressures may be required for the first several breaths
|
|
|
What is the primary sign of effective ventilation during resuscitation of a newly born baby
a) improving color b) increasing HR c) spontaneous breathing d) improving muscle tone |
increasing HR
the other choices are also indicators but not the PRIMARY indicator |
|
|
Self-inflating ventilation bags
a) refill independent of gas flow b) do not need to be squeezed to deliver O2 c) must be squeezed to deliver O2 |
refill independent of gas flow (d/t to recoil)
must be squeezed to deliver O2 |
|
|
T/F Flow inflating bags
inflate only when gas is flowing into it, and pt outlet is partially occluded |
TRUE
|
|
|
Proper ETT depth in a newly born baby is determined by what formula
|
Depth at lip (cm) = Wt (kg) + 6cm
|
|
|
T/F Chest compressions are indicated for a HR <60 despite adequate ventilation with 100% O2 for 30 seconds
|
TRUE
|
|
|
Compressions on a newly born should be delivered ____________
|
Lower 1/3 of sternum with a depth of approx 1/3 diameter of the chest
|
|
|
Compressions to ventilation ratio on newly born should be __________
|
3:1 with 90 compressions and 30 ventilations /min
|
|
|
Continue compressions on newly born until
a) spontaneous HR is > 100 b) spontaneous HR is > 60 |
spontaneous HR is > 60
|
|
|
What is the best way to correct bradycardia in a newly born baby
a) epinephrine b) adequate ventilation c) both a & b |
adequate ventilation
|
|
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If after 30 seconds of positive pressure ventilation and compressions do not increase infants HR >60
what would you do _____________ |
Give epinephrine
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T/F Suspect hypovolemia in a newly born infant that fails to respond to resuscitation
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TRUE give volume expander 10ml/kg
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What is one factor that would stop you from giving a newly born infant narcan? ________________
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Being born to a mother who is a drug abuser!!!! will put infant into withdrawal
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Treatment for coarctation of the aorta is _________________
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Prostaglandin E1 it dilates ductus arteriosus in neonates & infants CAUTION may produce apnea in infants
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Omphalocele
a) failure of the gut to return to abdominal cavity b) abdominal contents not covered by membrane c) abdominal contents covered by membrane d) high incidence of other anomalies e) low incidence of other anomalies |
failure of the gut to return to abdominal cavity
abdominal contents covered by membrane high incidence of other anomalies |
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Gastroschisis
a) abdominal wall dissolves d/t interruption of omphalamesenteric artery b) abdominal contents not covered by membrane c) abdominal contents covered by membrane d) high incidence of other anomalies e) low incidence of other anomalies |
abdominal wall dissolves d/t interruption of omphalamesenteric artery
abdominal contents not covered by membrane low incidence of other anomalies |
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Pyloric stenosis ( choose any or all that apply)
a) usually seen in 1-2 mth olds b) nonbilious projectile vomiting c) have hypochloremic met. alkalosis |
usually seen in 1-2 mth olds
nonbilious projectile vomiting have hypochloremic met. alkalosis |
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If amniotic fluid contains meconium & infant has absent or depressed respirations, decreased muscle tone or HR< 100 what should be done immediately after birth?
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Direct layngoscopy & intubation for suctioning of residual meconium
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