Differentials

Question 1

Maternal Bleeding Post-Delivery

Answer 1

Uterine atony
Retained placental parts
Uterine rupture
Placental accreta
Coagulopathy/DIC
AFE
Tear in the cervix or vaginal tissues

Four T’s mnemonic can be used to identify and address the four most common causes of postpartum hemorrhage (uterine atony [Tone]; laceration, hematoma, inversion, rupture [Trauma]; retained tissue or invasive placenta [Tissue]; and coagulopathy [Thrombin]).

Question 2

Hypercapnia during laparoscopy

Answer 2

peritoneal insufflation normal increase
inadequate ventilation
CO2 emphysema
Capnothorax
Co2 embolism
pneumothorax
malignant hyperthermia
V/Q mismatch
-patient position
-cardiopulmonary disturbances
-increased abdominal position
Migration of ETT

Question 3

Maternal cardiac arrest during csection

Answer 3

MI/Infarction
Local anesthetic toxicity
Pulmonary Embolism
Rupture of subcapsular hematoma (esp if pre-E)
Intracranial hemorrhage
Amniotic Fluid Embolism
Hypovolemia - rapid sympathectomy from regional anesthesia
Tension Pneunothorax if central line was placed

Question 4

Neonatal Seizure

Answer 4

Hypoglycemia
Intracranial hemorrhage
Hypoxic ischemic encephalopathy
Cerebral edema
Hypocalcemia
Hypomagnesemia
Benign seizures
Obstetric history of TORCH (toxo, rubella, cmv, herpes)
Sepsis

Question 5

PACU Hypoxia and/or AMS

Answer 5

1) Post-operative airway obstruction and apnea (over narcosis or over-benzod)
2) Atelectasis
3) Pulmonary Edeema
4) Aspiration
5) Inadequate reversal of NMB
6) Hypo/hyperglycemia
7) Electrolyte abnormalities
8) Arrythmias
9) MI
10) Stroke

Question 6

Low UOP After renal transplant

Answer 6

• Hypovolemia
• Hypotension
• Acute graft rejection
• Cyclosporine toxicity
• renal artery thromboembolism
• Renal vein thrombosis
• Drug induced constriction of afferent arterioles
• ATN
• Mechanical obstruction of the graft vessels or ureters
• Obstruction of the foley catheter

Question 7

Hypotension and increased airway pressures immediately following induction

Answer 7

1) Mainstem intubation
2) tension pneumothorax or capnothorax if laparoscopic
3) Increased vagal tone esp if insufflated
4) Co2 embolism if laparoscopic
5) Anaphylaxis
6) Severe bronchospasm

Question 8

Elevated peak airway pressures

Answer 8

Elevated peak pressures without associated elevation in plateau pressures are associated with increased airway resistance to flow

1) airway obstruction
2) bronchospasm
3) secretions or plugging
4) increased inspiratory flow rate
5) coughing, and biting on ETT

Question 9

Elevated plateau pressures

Answer 9

Decreased lung compliance

ARDS, PNA, pulmonary edema, pneumothorax or tension pneumothorax, auto-PEEP