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OB Final Exam > Module 8: Part 3 (47-69) > Flashcards

Module 8: Part 3 (47-69) Flashcards

1
Q

Two thirds of the primary headaches are ____ and ___

A

tension-type and migraines

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2
Q

___ ____ are often circumferential and constricting, a/w scalp tenderness and mild to moderate in severity

A

Tension type

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3
Q

usually pulsating in a unilateral location, nausea and photophobia, aura possible & often history of this type of headache

A

migraine headaches

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4
Q

type of HA where its musculoskeletal &worsened by maternal physical exertion during labor and lack of sleep

A

Secondary HA

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5
Q

Neck and shoulder pain without HX of dural puncture

A

Secondary HA

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6
Q

Headache is a serious premonitory sign in over 50% of women who develop ___

A

eclampsia (headache, visual disturbances, n/V, seizures, stupor and coma)

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7
Q

variable signs but can have evidence of increased ICP (headaches, somnolence, vomiting, confusion) and focal abnormalities

A

subdural hematoma

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8
Q

classic presentation with sudden onset of severe headache, decreased LOC

A

Subarachnoid hemorrhage

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9
Q

Pneumocephalus: (3)

A
  • air in subdural or subarachnoid space
  • sudden severe headache
  • sometimes neck/back pain or mental changes
  • can mimic PDPH but usually resolves in 1 week
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10
Q

Caffeine Withdrawal & Lactation headache

A

secondary HA

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11
Q

PDPH procedural risks (4)

A
  • Gauge of needle (25 vs 17 g tuohy)
  • Pencil point vs. cutting (Quincke)
  • Orient bevel parallel to long axis (70% ↓PDPH vs. perpendicular)
  • LORT (air or saline)

Quinke = Cut

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12
Q

PDPH patient risks (6)

A

Young age
Female
Low BMI ?
Vaginal > cesarean delivery
Prior history of headache
Previous history of PDPH

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13
Q

ICHD-3 definition of PDPH
(6)

A
  • Headache within 5 days of lumbar puncture caused by CSF leak via dural puncture
  • immediately or within minutes of moving upright (sitting, standing)
  • Resolves within a minute of moving supine
  • One of these: h/a, neck stiffness, tinnitus, photophobia, nausea
  • Hearing loss (can improve within 1 hour of blood patch)
  • Usually remits spontaneously within 2 weeks or after autologous blood patch
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14
Q

Pathophysiology of PDPH

A
  • Continued CSF Leak from intracranial compartment d/t dural puncture
  • CSF loss > production
  • Lose CSF’s cushioning effect: brain sag; tension on sensitive meninges (most apparent when upright)
  • intracranial hypoTN → Reflex cerebral vasodilation
  • Cerebral hyperemia
  • Headache symptoms

Cerebral hyperemia: cerebral blood flow > need

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15
Q

downsides of PDPH (5)

A
  • Inability to care for baby/get out of bed
  • Repeat hospitalization
  • blood patch, Inconvenience, Cost
  • Diplopia or hearing loss: permanent or take months to recover
  • Persistent headaches, backaches and cranial nerve symptoms
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16
Q

PDPH TX (7)

A

Main goal: prevention

  • Talk to pt
  • Conservative: Bed rest, hydration, abdominal binder, caffeine (PO/IV)
  • Meds: muscle relaxants, pain meds, gabapentin, saline, morphine
  • Leaving the spinal cath in for 24H may ↓epidural patch use (catheter blocks the hole)
  • Prophylactic blood patch, early (within 24 hours) or late (after 24 hours)
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17
Q

Epidural blood patch

A
  • Treatment of choice esp if cranial symptoms
  • 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
18
Q

percentage of pts that get good relief with epidural blood patch for PDPH

A

70%

19
Q

epidural blood patch risks

A

Risks are the same as epidural plus low back pain/hip pain

20
Q

epidural blood patch complications

A

Infection

Neurologic:

  • Lumbovertebral syndrome
  • arachnoiditis
  • radicular back pain

Compressive:

  • lumbovertebral
  • subdural hematoma
  • cauda equina

same as epidural plus low back pain/hip pain

21
Q

Patient should stay in the supine position after blood patch for how long?

A

for 1-2 hours, also avoiding Valsalva and heavy lifting

22
Q

Epidural Blood Patch:
Most will get almost immediate relief, some delayed up to ___hours.
Possible neck pressure, back pain/pressure for hours to days.

A

8 hours

Second blood patch after 24 hours
if not relieved: neuro consult

23
Q

Second blood patch after ___ hours , if not relieved may need neuro consult

A

24 hrs

24
Q

Trauma affects __-___% of pregnancies

A

5-7%

25
Q

___-____% of all maternal deaths in US due to trauma
Leading cause of non-obstetric maternal and fetal mortality

A

45-50%

26
Q

Most common causes of trauma in pregnancy

A

MVA (most common cause of injury-related death) 49-70%
Domestic violence 11-25%
Falls 9-23%

27
Q

risk factors for trauma in pregnancy

A

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

28
Q

Hemorrhagic shock and brain injury are the most common mechanisms of ___ in pregnant trauma patients

A

death

29
Q

Obstetric injuries

A

placental abruption, uterine rupture, preterm labor and direct fetal injury

30
Q

Blunt trauma is ___ times more common than penetrating

A

10

31
Q

Maternal and fetal mortality higher in this type of trauma

A

penetrating

32
Q

ATLS in pregnancy
The best initial treatment for the fetus is…

ATLS: Advanced Trauma Life Support

A

optimum maternal resuscitation & early fetal assessment

33
Q

ATLS survey (8)

A
  • Maternal airway/cspine
  • Breathing/PaCO2 /oxygen
  • Circulation (LUD, pregnancy anemia; hypoTN & tachycardia are late signs of hemorrhage in pregnant women)
  • Focused abdominal sonography in trauma (FAST)
  • Brief exam for fractures
  • Fluid resuscitation
  • Damage control surgery
  • Deadly triad (hypotherm, metabolic acidosis, coagulopathy)
34
Q

Lab tests for ATLS

A
  • Evaluation based on type & severity
  • Coags, type/screen/cross, electrolytes, glucose, lactate, toxicology
  • Kleihauer-Betke test: identify fetal blood in the maternal circulation after maternal injury
35
Q

Fetal-maternal (trans-placental)
hemorrhage

A
  • up to 50% of maternal traumas
  • can occur after trauma & cause maternal isoimmunization
  • Rh(-) mom & Rh(+) fetus
  • Rh incompatibility (later pregnancies)
36
Q

The deadly Triad

A

hypothermia, metabolic acidosis, and coagulopathy

(esp in long surgical procedures)

37
Q

Cardiac Arrest in Pregnancy (6)

A
  • CPR
  • Large bore IVs in the upper extremities
  • Difficult airway, LUD
  • Stop Magnesium; give Calcium
  • Defib: remove fetal monitor
  • No circulation within 4 min, C/S if >20 weeks within 5 min of arrest
  • Continue resuscitation after C/S
38
Q

Mnemonic for Causes of Maternal Collapse - BEAU-CHOPS

A
  • Bleeding/DIC
  • Embolism (coronary, pulmonary, amniotic fluid)
  • Anesthetic complications
  • Uterine atony
  • Cardiac disease (MI, ischemia, aortic dissection, cardiomyopathy)
  • HTN/pre-e/eclampsia
  • Other: ACLS algorithms
  • Placental abruption/previa
  • Sepsis
39
Q

Peri-Mortem Cesarean delivery

A
  • Delivering diverts more blood to mom
  • Decompress the IVC
  • Improve efficacy of chest compressions
  • Initiate C/S 4 min into resuscitation

Peri-Mortem C/S: deliver fetus from a mother who is near death/cardiac arrest; to improve maternal chances of resuscitation & fetal survival

40
Q

late signs of hemorrhage in pregnant women

A

hypoTN and tachycardia

41
Q

damage control surgery

A
  • controls hemorrhage; NO early definitive injury repair
  • Control Major surgical bleeding
  • pack thoracic & abdominal cavities = hemostasis
  • GI diversion
  • body cavities temporarily closed
  • volume resuscitation w/ blood products rather than crystalloids

eventual return to OR to definitively repair injuries

OB Final Exam (15 decks)

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