29 - preg. in ED

Question 1

normal test changes in preg

Answer 1

• WBC higher
• increased coag
• CO up 30-40%
• systolic murmur
• ST changes
• increased GFR
• cholestasis

Question 2

2 main safe imaging studes

Answer 2

US and MRI

Question 3

DVT and PE risk

Answer 3

• PE 15x higher
• physio changes can mimic PE
• D-dimer present in preg and therefor limited use

Question 4

main test to Dx PE in preg**

Answer 4

• *-for acute - portable ECHO is choice
• all others - CXR
• doppler US
• if both neg - can do half dose VQ scan

Question 5

3 Tx info for preg

Answer 5

1. heparin - LMW
2. warfarin is teratogenci
3. life threatening should get thrombolytic

Question 6

risk factors for abuse in preg

Answer 6

1. prior abuse
2. low income
3. unmarried
4. alcohol in partner
5. unplanned preg

Question 7

3 major IVF emergencies

Answer 7

1. ectopic preg
2. heterotopic preg - 2 in 2 different sites
3. ovarian hyperstim. syndrome
   - increase cap permeability and depletion of intravascular volume

Question 8

Sx and signs of ovarian hyperstim

Answer 8

mild - distension, N/v, diarr, ovaries enlarge
mod - ascites on US
sever - clinical ascites, hydrothorax, hemoconc., low perfusion of kidney

Question 9

Tx of ovarian hyperstim

Answer 9

• self resolving
• correct and maintain volume
• support renal
• prevent throbosis - LMWH

Question 10

admit criteria for hyperstim

Answer 10

1. no intake
2. hemo unstable
3. resp compromise
4. peritoneal signs
5. tense ascites
6. hemoconc.
7. decreased O2 sats

Question 11

outpatient mgmt of hyperstim

Answer 11

1. limit activity
2. weigh daily
3. monitor fluid intake
4. daily follow up
5. orna anal

Question 12

6 hypertensive emergs

Answer 12

1. gest. hypertension
2. pre-eclampsia
3. eclampsia
4. chronic HTN
5. superimposed
   6 HELLP

Question 13

def. gest. HTN

Answer 13

• 140/90
• no proteinuria
• BP returns withint 12 weeks

Question 14

2 main crit. for preeclampsia

Answer 14

1. 140/90

2. protenuria

Question 15

def. of eclampsia

Answer 15

• grand mal seizures
• unrelenting severe HA or visual dist.
• ## 10% of seizures before onset of HA

Question 16

def. superimposed

Answer 16

new onset proteinuria in those with chronic HT

Question 17

def. HELLP

Answer 17

Hemolysis
Elevated Liver enzymes
Low platelets
- decreased organ perfusion
-

Question 18

mgmt of preeclampsia

Answer 18

• admit if new or worsening
• decrease activity
• delivery is cure
• antihypertensive meds

Question 19

mgmt of severe pre and eclampsia

Answer 19

• deliver if over 32 weeks
• IV Mg sulfate to prevent seizures
• if toxi reverse effects with Ca gluconate
• hydralazine and labetalol for HTN

Question 20

outcomes in blunt abdo trauma

Answer 20

• abruption, rupture, death or distress, preterm labor

Question 21

outcome in penetrating trauma

Answer 21

high rate of fetal demise

Question 22

mgmt in trauma

Answer 22

mom is first

1. ABCs
2. place in LL decubitus
3. check for signs of perfusion
4. displace gravid uteruse for CPR
5. IV fluids and possible pressors
6. tocolytics?
7. secondary survey

Question 23

Tx of cystitis and pyelo

Answer 23

asx baceruria - 3 days aBx
cystitis - 7-10days Abx - ceph or amox
pyelo - admit and IV aBx

Question 24

how does asthma change in preg

Answer 24

1/3, better, worse, same
- oral steroids- check with OB
otherwise the same

Question 25

what is hyperemesis gravidarium

Answer 25

more than usual: wieght loss>5%, ketonuria, dehydration, hypokalemia

Question 26

Tx of hyperemesis

Answer 26

• hydrate
• IV meds
• lyte balance

Question 27

what is postpartum endometritits

Answer 27

polymicrobial infection

- Csection is greatest risk

Question 28

Tx of postpartum endometritits

Answer 28

• outpatient amox-clav

- broad spectrum for more severe