29 - preg. in ED Flashcards
normal test changes in preg
- WBC higher
- increased coag
- CO up 30-40%
- systolic murmur
- ST changes
- increased GFR
- cholestasis
2 main safe imaging studes
US and MRI
DVT and PE risk
- PE 15x higher
- physio changes can mimic PE
- D-dimer present in preg and therefor limited use
main test to Dx PE in preg**
- *-for acute - portable ECHO is choice
- all others - CXR
- doppler US
- if both neg - can do half dose VQ scan
3 Tx info for preg
- heparin - LMW
- warfarin is teratogenci
- life threatening should get thrombolytic
risk factors for abuse in preg
- prior abuse
- low income
- unmarried
- alcohol in partner
- unplanned preg
3 major IVF emergencies
- ectopic preg
- heterotopic preg - 2 in 2 different sites
- ovarian hyperstim. syndrome
- increase cap permeability and depletion of intravascular volume
Sx and signs of ovarian hyperstim
mild - distension, N/v, diarr, ovaries enlarge
mod - ascites on US
sever - clinical ascites, hydrothorax, hemoconc., low perfusion of kidney
Tx of ovarian hyperstim
- self resolving
- correct and maintain volume
- support renal
- prevent throbosis - LMWH
admit criteria for hyperstim
- no intake
- hemo unstable
- resp compromise
- peritoneal signs
- tense ascites
- hemoconc.
- decreased O2 sats
outpatient mgmt of hyperstim
- limit activity
- weigh daily
- monitor fluid intake
- daily follow up
- orna anal
6 hypertensive emergs
- gest. hypertension
- pre-eclampsia
- eclampsia
- chronic HTN
- superimposed
6 HELLP
def. gest. HTN
- 140/90
- no proteinuria
- BP returns withint 12 weeks
2 main crit. for preeclampsia
- 140/90
2. protenuria
def. of eclampsia
- grand mal seizures
- unrelenting severe HA or visual dist.
- ## 10% of seizures before onset of HA
def. superimposed
new onset proteinuria in those with chronic HT
def. HELLP
Hemolysis Elevated Liver enzymes Low platelets - decreased organ perfusion -
mgmt of preeclampsia
- admit if new or worsening
- decrease activity
- delivery is cure
- antihypertensive meds
mgmt of severe pre and eclampsia
- deliver if over 32 weeks
- IV Mg sulfate to prevent seizures
- if toxi reverse effects with Ca gluconate
- hydralazine and labetalol for HTN
outcomes in blunt abdo trauma
- abruption, rupture, death or distress, preterm labor
outcome in penetrating trauma
high rate of fetal demise
mgmt in trauma
mom is first
- ABCs
- place in LL decubitus
- check for signs of perfusion
- displace gravid uteruse for CPR
- IV fluids and possible pressors
- tocolytics?
- secondary survey
Tx of cystitis and pyelo
asx baceruria - 3 days aBx
cystitis - 7-10days Abx - ceph or amox
pyelo - admit and IV aBx
how does asthma change in preg
1/3, better, worse, same
- oral steroids- check with OB
otherwise the same
what is hyperemesis gravidarium
more than usual: wieght loss>5%, ketonuria, dehydration, hypokalemia
Tx of hyperemesis
- hydrate
- IV meds
- lyte balance
what is postpartum endometritits
polymicrobial infection
- Csection is greatest risk
Tx of postpartum endometritits
- outpatient amox-clav
- broad spectrum for more severe
