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Personal OB > Class 1 Complications > Flashcards

Class 1 Complications Flashcards

1
Q

What is the most common cause of Intrinsic obstetric paralysis?

A

-Cephalopelvic disproportion (huge head / little pelvis) that leads to lumbosacral trunk compression (nerve compression)

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2
Q

What two things contribute to prego backache?

A
  • ↑ lumbar lordosis (counterbalance)

- ↑ laxity of pelvic joints

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3
Q

3 complications of neuraxial blocks.

A
  • Nerve injury
  • PDPH
  • High, total spinal
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4
Q

How are nerves damaged during neuraxial block?

A
  • Hematoma
  • Abcess
  • Chemical nerve injury
  • Needle trauma
  • Positioning injury
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5
Q

Hematomas occur w/ what type of patients and when?

A
  • Hemostatic abnormality or coagulopathy

- Upon insertion or removal of catheter

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6
Q

Preggos w/ PIH platelets should be over _______ and not dropping while ____ _____ should be normal before block is placed

A
  • 100k

- PT, PTT

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7
Q

When can a block safely be given with a patient on theraputic heparin? prophylatic heparin?

A
  • Theraputic - 24 hours after last dose

- Prophylatic - 12 hours after last dose

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8
Q

If a patient is given heparin with a catheter in place, when can it safely be removed?

A

-12 hours after last dose

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9
Q

When can you safely give heparin w/ a catheter in place? and what should be avoided if you do give heparin?

A
  • 2-4 hours after placement

- Concurrent NSAIDS

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10
Q

Signs of epidural hematoma?

A
  • Bilat leg weakness
  • Loss of bowel / bladder
  • Back pain
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11
Q

When must a hematoma be surgically decompressed for full neurological recovery?

A

-within 6 hours

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12
Q

25% of lumbar epidural catheters colonize w/ bacteria after _______ days w/o signs of _______ _______.

A
  • 1-5 days

- Local infection

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13
Q

After a infection is present, how long before symptoms occurs, and what are they

A
  • 4-10 days

- Pain and loss of function

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14
Q

What is the treatment for abscess and when should it be done before permanent damage occurs?

A
  • ABX and Laminectomy

- 6-12 hours

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15
Q

Signs of epidural abcess

A
  • Back pain
  • Exquisite local tenderness
  • Fever
  • Malaise
  • ↑ WBC
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16
Q

Progression of abcess can lead to what?

A
  • Neuro deficit

- Osteomyelitis

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17
Q

Why is the epidural space resistant to toxicity?

A
  • Very vascular

- Intact membrane between subarachnoid space

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18
Q

What is Transient neurological symptoms (TNS)? What causes it? and in what position?

A

-Pain and dysesthesia in butt, legs or calves after a block, resolves in 72 hours.

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19
Q

What causes (TNS) and in what position?

A
  • Lidocaine spinals

- Lithotomy position

20
Q

Where is the conus? and where does the chord end?

A
  • Conus T12-L3

- Chord ends @ L1/L2

21
Q

If you hit the spinal chord with a needle what should you do? and not do?

A
  • Immediately withdraw

- Do not inject

22
Q

What nerve injury is common with lithotomy stirrups? What injury is common?

A
  • common peroneal nerve

- Foot drop

23
Q

What nerve injuries are common with the lithotomy position? What problems arise

A
  • Femoral (difficult climbing stairs)

- Obturator (↓ sensation upper thigh, weak hip abduction)

24
Q

What is the onset and duration of a PDPH?

A
  • 12-48 hours after dura puncture

- Duration days to weeks

25
Q

What determines severity of PDPH?

A
  • Size of hole

- Type of needle

26
Q

What is normal CSF volume? How much is made per day?

A
  • 150 mls

- 450 CSF made per day

27
Q

What causes PDPH?

A
  • Loss of as little as 20 mls of CSF
  • Cerebral vasodilation
  • Sagging intracranial contents
28
Q

PDPH risk factors?

A
  • Young age
  • Needle size and type
  • Previous PDPH
29
Q

What is the hallmark of PDPH?

A

-Continuous head pain when sitting and standing. and relieved when by lying down.

30
Q

When does a pneumcephalus headache occur?

A
  • When LOR air injects intrathecal

- Instant headache / short duration

31
Q

What is the most common periop headache?

A

-Caffeine headache

32
Q

Name the headache? Fever, nuchal rigidity, systemic illness

A

Meningitis

33
Q

Name the headache? Rare, Throbbing, Not relieved by bed rest, seizure.

A

Cortical vein thrombosis

34
Q

Name the headache? Rupture of arterio venous malformation, focal neurological signs

A

Subarachnoid hemorrage

35
Q

Name the headache? Related to Arnold-chiari. Looks sicker, changes in LOC

A

Subdural hematoma

36
Q

Risk of not treating PDPH

A
  • Chronic Headache
  • Permanent impairment
  • Convulsion
  • Brainstem death
37
Q

Non-invasive PDPH treatment

A
  • Bedrest
  • Hydration
  • ABD binders
  • Analgesia
  • Cerebral vasoconstrictors
  • ACTH
38
Q

When do you stop giving the blood patch?

A
  • When headache is gone

- Pressure in ears

39
Q

Why is prophylactic blood patch controversial?

A

-Total spinal anesthesia

40
Q

What symptoms can occur w/ total spinal?

A
  • Hypotension
  • Dyspnea
  • Aphonia
41
Q

What can cause a total spinal

A
  • migrated epidural catheter
  • Dural puncture
  • Spinal after failed epidural (all medicine kicks in)
42
Q

What position is LUD?

A

Left uterine displacment

43
Q

How do you manage total spinal?

A
  • LUD and trendelenberg
  • Naloxone
  • Epinepherine may be needed
  • Maternal sedation 1-3 hours
44
Q

What accounts for 1/3 of all anesthetic lawsuits in OB?

A

-Aspiration

45
Q

What 3 things would you suspect aspiration?

A
  • Hypoxia
  • Pulmonary edema
  • Bronchospasm
46
Q

Aspiration prevention in pregos.

A
  • Cricoid pressure
  • NPO 6 hours for planned C/S
  • Sodium Citrate (raise gastric PH)
  • H2 blockers
  • Reglan

Personal OB (7 decks)

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