AEMC OB FAQs Flashcards
How soon after an epidural test dose will you see intravascular vs intrathecal symptoms?
intravascular: 45-60sec
intrathecal: 3-5minutes
What makes the onset of 3% Chloroprocaine so rapid?
The higher concetnration
- delivering more moleculues will result in a faster onset
If you have a type and screen do you need a type and cross?
No, only if the type and screen shows antibodies
Discuss ion trapping
local anesthetics are weak bases and will easily diffuse across lipid bilayers in the placenta and enter the fetus
-the fetal ciculation is slightly more aciditic than moms (7.2); so once the local anesthetic is in fetal circulation it will ionize and be unable to cross back over the placenta
-the accumulation of local anesthetic in fetal circulation will distress the baby and cause further acidosis, worsening the cycle.
How does pH impact fetal survical and neurologic outcomes?
pH < 7.2 is associated with acidosis and poor outcomes
What is the most important thing to do immediately post-spinal insertion?
LUD
Do not use methergine for what 2 conditions
why
HTN and cardiac disease
can cause severe vasoconstriction (direct alpha agonist), arrhythmias and coronary spasm
How much of an increase in intravascular volume in mom (L) and why?
1L … to offset blood loss with delivery
Why does mom have increased gastric emptying time?
bc progesterone causes decreased motility
What causes mom to have increased gastric acid and pressure?
due to gastrin secretion from the placenta
why do moms always have reflux?
bc the weight of the uterous changes the angle of the GE junction in combination with decreased LES tone
3 Liver changes in mom
- hypercoagulable but compensated DIC
- fibrinogen increases (200-400)
- 25% decrease in PCHE from week 10- 6 weeks PP
Shortest and fastest local anesthetic
Chloroprocaine (metablized by esterases)
Local anesthetic with the lowest fetal concentration
chloroprocaine (metablized by esterases before it can cross placenta to baby)
Longest acting local anesthetic
tetracaine
main local anesthetic to produce methemoglobin
priolocaine
How is the CSF return affected by pregnancy?
It’s not
T/F- mom has increased fluid requirements to prevent hypotension
true
How does pregnancy affect the elimination half-life of propofol?
It’s unaltered
How does prenancy affect the duration of sux?
it doesnt (or slightly decreased)
T/F- pregnancy reduces the sensitivy to sux (need less)
true
(i thought you would need more due to increased volume of distrubution?)- im going to go with - dose needed is unchanged bc u have a decreased sensitivity + increase in total body fluid/water)
How are vec and roc affected by pregnancy?
increased sensitivity (need less)
&
shorter half life
Terbutaline (brethine)
MOA
S/E (6)
Beta-2 agonist
- ↑cAMP in uterous > activates protein kinases and turns off myosin light chain kinases > relaxation
tachycardia, temors, pulmonary edema, palpitations, hypokalemia, restlessness
Ritodrine MOA
3 patients you would not use this in
Beta-2 agonist
- ↑cAMP in uterous > activates protein kinases and turns off myosin light chain kinases > relaxation
PIH, pulmonary HTN (wouldnt it be good for that?), hyperthyroidism)
