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OB > Medical Legal Concerns And Risk Management > Flashcards

Medical Legal Concerns And Risk Management Flashcards

1
Q

Why is there controversy on the progress and outcome of labor and effect on the fetus

A

Increase instrument usage
Increase CS deliveries
Prolonged labor
Fetal occiput posterior presentation

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2
Q

Why is there controversy behind epidurals

A

Motor blockade may prevent mother from pushing
Higher incidence of occiput posterior position of fetus
Decreased threshold for instrument assisted deliveries
Residents perform them

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3
Q

Complications from regional

A 
Maternal fever
Backpain
Neuro sequelae
PDPH
Neonatal effects
Hypotension
Inadequate analgesia
Infection/hematoma
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4
Q

Maternal fever is caused by

A

Longer duration of labor with epidural
Epidural without epi has no higher incidence
Sepsis of infants is low

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5
Q

Back pain is associated with

A

Greater weight and short statue
Not with epidural attempts
Not related to neuraxial anesthesia
Continuation of antepartum pain

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6
Q

Resolution in cases of epidural abscess/hematoma

A

Monitor, early diagnosis, prompt treatment

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7
Q

Regional block considered causative until proven other with what complications

A

Neurologic

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8
Q

Inversely proportional to provider experience

A

PDPH

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9
Q

T of F all HAs are not PDPH

A

T

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10
Q

Spinal needle design and size affects which complication

A

PDPH

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11
Q

Caused by epidural or labor pain

causes occiput posterior which causes patient to request epidural

A

Neonatal effects

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12
Q

Most common effect of spinal for CS

Treat early and aggressively

A

Hypotension

Defined as SBP <100

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13
Q

Differential diagnoses for PDPH

A 
Nonspecific
Migraine
Meningitis
Pregnancy induced HTn associated with HA
Cerebral tumor
Subarachnoid hemorrhage (HELLP)
Subdural hematoma
Cerebral vein thrombosis
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14
Q

Recognizing what resulted in the increased use of regional for elective and emergency CS
And has led to a decrease in maternal mortality

A

That regional is preferable even when fetus status is not reassuring

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15
Q

Why are there challenges for litigation with GA

A

Awareness and recall risk
Avoidance of sedatives as premeds
Low concentration of IAs
Use of muscle relaxants
Reduction of dose of anesthetics
Partial neuraxial blockade requiring conversion to GA
Wrong assumption that baseline sympathetic tone is responsible for tachycardia

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16
Q

Leading causes of maternal death

A 
Unsafe abortion
Cardiac conditions
Infections
Hemorrhage embolism
PIH
Complications from delivery
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17
Q

What contributes to upward trend of MMR

A

Inconsistent OB practice
Increasing antenatal chronic conditions such as HTN, DM, obesity
Lack of good data and related analysis outcomes

18
Q

What anesthesia is associated with the highest rate of maternal mortality

A

GA for CS from failed intubation or aspiration

GA higher risk with OB pt

19
Q

Delayed recognition, delayed diagnosis, and treatment of problems lead to poor outcomes

A

Theme 1 of OB closed claims

20
Q

Failed communication could lead to delay in appropriate treatment, multiple providers, treating the same problem or no on treating the problem leading to a poor outcome

A

Theme 2

21
Q

Conflicting documentation may lead to poor outcomes and or anesthesia provider being named in claim; good documentation demonstrates appropriate care given and/or may keep anesthesia provider from being named in claim

A

Theme 3

22
Q

Unexpected or unrecognized hemorrhage may lead to death or brain damage

A

Theme 4

23
Q

Lack of vigilance may lead to permanent deficits or brain death

A

Theme 5

24
Q

Major complications related to anesthesia

A

Aspiration pneumonitis
Maternal death or brain damage - problem with difficult intubation and pulmonary aspiration
Neonatal brain damage or death
Maternal nerve injury

25
Q

Claims for minor injuries such as these are on the rise

A

HA, back pain, pain during anesthesia, emotional distress

26
Q

How to establish malpractice

A

There must be duty, breach, injury, proximate cause

27
Q

Must be shown that a duty to provide care existed

A

Duty

28
Q

HCP failed to meet his or her duty to provide reasonable care

A

Breach

29
Q

Patient experienced injury that resulted in damages

A

Injury

30
Q

Negligence of HCP caused patient’s injury

A

Proximate causes

31
Q

How can anesthesia avoid litigation

A

Communication
Documentation
Vigilance

32
Q

The leading cause of errors and patient harm

A

Communication

33
Q

How to improve communication

A

Team huddles
Multidisciplinary rounds
Debriefings
Structured method for passage of critical information

34
Q

How does miscommunication play a factor into informed consent

A

Specific patient request ignored

Patient not informed of specific complication

35
Q

Explicitly mention and document

A

Entire range of risks
Educate patient about unpredictable course of events and possible complications
Alternative treatment discussed

36
Q

When are consents best done

A

In advance of labor

37
Q

Remember to get written consent for labor epidurals

A

T

38
Q

How does documentation lead to poor litigation outcomes

A

Conflicting docs

39
Q

The act of being alert and watchful for potential danger of difficulties

A

Vigilance

40
Q

Continual patient assessment, review of surgical field, anticipation, preparedness for potential adverse events, respond in timely manner to changes

A

Vigilance

OB (10 decks)

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