Crash Course Module 8

Question 1

most common injuries in obstetric anesthesia claims in ASA Closed-Claims database

Answer 1

maternal nerve injury & neonatal brain damage

Question 2

more maternal nerve damage claims with ____________ delivery

Answer 2

vaginal

Question 3

LES pressure

Answer 3

20cm H2O

Question 4

what pH can cause a granulocytic reaction that continues beyond the acute phase

Answer 4

aspirates with a pH < 2.5

Question 5

mendelson’s syndrome

Answer 5

pH <2.5 and volume greater than 25 ml (0.4 ml/kg)

Question 6

bronchospasm signs in intubated patient

Answer 6

↑ peak airway pressures

wheezing

↑ expiratory time

↑ ETCO2 with upsloping waveform

↓ tidal volumes

Question 7

ARDS CXR findings

Answer 7

Abnormal chest x-ray can be seen 12-24 hours after clinical signs

bilateral opacities not explained by effusions

Question 8

mechanical ventilation in managing ARDS

Answer 8

Limit plateau pressure to 30 cm H20
Least effective TV (6 ml/kg)

Question 9

Bicitra

Answer 9

30 mL

non-particulate antacid given at least 20 min prior to induction, buffers gastric fluid and raise pH

Question 10

Pepcid mechanism of action

Answer 10

inhibits gastric acid secretion

Question 11

reglan mechanism of action

Answer 11

given at least 20 min prior to induction, buffers gastric fluid and raise pH

Question 12

obstetric nerve injuries include

Answer 12

compression of the lumbosacral trunk and palsies of the obturator, femoral, lateral femoral cutaneous, sciatic and peroneal nerves

Question 13

central nerve injuries are usually

Answer 13

bilateral

peripheral are usually unilateral

Question 14

peripheral nerve palsies often occur from

Answer 14

compression in the pelvis by the fetal head

Question 15

risk factors for peripheral nerve palsies

Answer 15

prolonged second stage of labor, difficult instrumental delivery, nulliparity, prolonged lithotomy position

Question 16

risk factors for neuro injury in childbirth

Answer 16

Prolonged 2nd stage
Nulliparity
Epidural (stretch and compression injuries masked)
Positioning/ time in lithotomy
Operative delivery
Malpresentation, occiput posterior, fetal macrosomia

Question 17

lateral femoral cutaneous nerve injury

Answer 17

Question 18

femoral nerve injury

Answer 18

Question 19

cranial nerve palsy is caused by

Answer 19

major loss of CSF following dural puncture with a large needle

Question 20

cranial subdural hematoma may be caused by

Answer 20

Decreased CSF pressure can cause rupture of bridge meningeal veins causing a cranial subdural hematoma

Question 21

can patients with spina bifida occulta receive neuraxial

Answer 21

Neuraxial is generally safe but varies from source to source
Imaging is preferred and practitioner dependent
Recommend to insert needle remote from site of malformation seen on imaging
Patients are athigher risk of post dural puncture headache

Question 22

epidural hematoma risk factors

Answer 22

Difficult epidural, coagulopathy, spinal deformity, spinal tumo

Question 23

epidural hematoma > 6 hrs since s/s and diagnosis

Answer 23

patients often don’t recover

Question 24

most common bacteria a/w epidural abcess

Answer 24

staph

Question 25

s/s epidural abscess

Answer 25

Present 4-10 days postpartum
Severe Backache and localized tenderness
Fever, headache, neck stiffness
WBC and ESR increased

Question 26

cauda equina syndrome

Answer 26

Pressure or swelling of the lumbar nerves
Hematoma

Question 27

what causes cauda equina syndrome

Answer 27

Intrathecal injection of hyperbaric 5% lidocaine and sometimes other locals

Question 28

arachnoiditis

Answer 28

Neurologic condition that causes pain, stinging or burning in the back, perineum, legs, arms and feet worse case paraplegia

Question 29

horner’s syndrome

Answer 29

Question 30

most common postpartum complication of neuraxial anesthesia

Answer 30

PDPH

Question 31

most primary headaches are

Answer 31

tension and migraines

Question 32

pneumocephalus

Answer 32

Injection of air into the subdural or subarachnoid space

Associated with sudden onset of severe headache, sometimes neck pain, back pain or changes in mental status

Can mimic PDPH but usually resolves in 1 week

Question 33

ICHD-3 definition of PDPH

Answer 33

Headache occurring within 5 days of lumbar puncture caused by a CSF leak through the dural puncture

One of the following symptoms: headache, neck stiffness, tinnitus, photophobia or nausea

Question 34

patho of PDPH

Answer 34

Loss of cushioning effect of CSF causes the brain to sag and creates tension on pain sensitive meninges (most apparent in the upright position)

Loss of CSF causes intracranial hypotension which leads to Reflex cerebral vasodilation

Question 35

how does epidural blood patch work

Answer 35

Injected blood becomes a small epidural hematoma that decreases the pressure gradient and the rate of CSF leak from the intrathecal space

Blood increases lumbar CSF pressure, restores intracranial CSF pressure and possibly reflex cerebral vasoconstriction

Question 36

most common cause of trauma-related death in pregnancy

Answer 36

MVA

Question 37

risk factors for trauma in pregnancy

Answer 37

younger than 25 years old, low socioeconomic status, minority, drugs and alcohol, domestic violence

Question 38

most common mechanisms of death in pregnant trauma patients

Answer 38

hemorrhagic shock and brain injury

Question 39

which kind of trauma is more fatal

Answer 39

penetrating

Question 40

if no circulation within ____________ minutes of cardiac arrest, perform cesarean if > ____________ weeks

Answer 40

No circulation within 4 min of cardiac arrest, cesarean if >20 weeks within 5 min of arrest

Question 41

risk factors for difficult face mask

Answer 41

age older than 55, BMI > 26kg/m2, presence of a beard, lack of teeth, snoring history