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Principles II- Josh > Notes from OB review day > Flashcards

Notes from OB review day Flashcards

Josh's guide to mastering the pregos effects on her body systems (taken from review day)

1
Q

Coags/Hem system
Plasma volumes increase how much during pregnancy

A

1000-1500ml

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2
Q

Coags/Hem system

what happens to albumin

A

decrease amounts

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3
Q

Coags/Hem system

drugs that are protein bound like propofol, will have what occur as a result of pregnancy

A

An increased amount of free drug.

decreased amounts of albumin

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4
Q

Coags/Hem system
what happens to
Hct
Plasma coag factors

A

Hct- decreases (dilutional)

Coags- increased amount of coag factors

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5
Q

Coags/Hem system
what happens to platelets

A

up and down

* not much change*

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6
Q 
**********************
Coags/Hem system
in recap what occurs to the following
RBC
Plasma
Hct
Hgb
Coags
A 
RBC-- increase 20%
Plasma-- increase 40-50%
Hct- decrease
Hgb- decrease
Coags- increases
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7
Q 
Pulmonary system
MV
TV
RR
PCO2
A

MV- increased (up to 50%
TV- increased (up to 40%)
RR- increased (up to 10%)
PCO2- decreased

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8
Q

Pulmonary system

what type of OETT do you want to use with the prego

A

a smaller one!!

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9
Q

Pulmonary system

what type of airway don’t you want to use in the prego?

A

Nasal trumpets

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10
Q

Pulmonary system

how long must you preoxygenate the prego

A

a full 5 min

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11
Q

Pulmonary system

what are the prego’s prone to doing during intubation

A

desaturation quickly

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12
Q

Pulmonary system

what happens to FRC

A

decreases 20%

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13
Q 
Pulmonary system
what happens to the
FEV
VC
and closing capacity
A

no changes

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14
Q

Pulmonary system
what occure to lung compliance

A

Nothing really (very minimal changes)

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15
Q

Pulmonary system
what is the first thing we do to the prego on the OR table? what next? then what?

A

LUD
then O2
then other equipment

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16
Q

GI system

what happens to the anatomical location of the stomach during pregnancy

A

pushed up (towards head) and a 45 degree twist

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17
Q

GI system
why is the prego at an increased risk for aspiration

A

decreased LES tone

decreased gastric motility

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18
Q

GI system

what is the incidence of GERD in the prego

A

30-50%

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19
Q

GI system
what bad syndrome can the prego get from aspiration? and what are it’s characteristics?

A

Mendelson’s syndrome
low Ph
High gastric volume

is chemical pneumonitis caused by aspiration during anaesthesia, especially during pregnancy.

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20
Q

GI system
what is given to prevent aspiration in the prego

A

Zantac (ranitidine) H2 antagonist
Reglan (Metoclopramide)
Bicitra (non-particulate antacid)

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21
Q

GI system
most common sugery with prego

A

Appendectomy

Cholecystectomy

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22
Q

GI system

all prego’s are an aspiration risk what 3 things must we always do in regard to intubating these women

A

prophylaxis (aspiration)
RSI
Sellickic’s maneuver (BURP) (don’t say cricord pressure use your big boy words)

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23
Q

Hepatic System

what happens to LFTs, bilirubin, alk phos with pregnancy

A

no to minimal changes

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24
Q

Hepatic System

what is a good test to asses for cholecystitis

A

bile acids

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25
Hepatic System | what happens to AST and ALT
increased (pathological causes)
26
Hepatic System | HELLP means what?
Hemolysis (RBC) Elevated LFTs Low Platelets
27
Hepatic System | are the prego's hypercoagable
yes
28
Stages!! | what are the stages of ppregnancy
1st- contractions to 10cm 2nd- full dilation to delivery of baby 3rd- delivery of baby to delivery of placenta
29
*************** | Visceral pain comes from where?
contractions and dilation of cervix
30
***************************** somatic pain comes from where? what nerves
stretching of vagina and perineum | perenodel nerves
31
*************** | when is the appropriate time for an epidural
4-6 cm dilated
32
***************** | why is an epidural better than a spinal for the prego
b/c we want the mom to push (we want her to participate in birth) epidural allows participation spinal doesn't allow participation
33
********************** CV system fetal bradycardia
<120 bpm
34
*********************** CV system fatal tachycardia
> 160
35
CV system | normal fetal HR
110 (120)-160
36
CV system | beat to beat variation
normal fetal HR
37
CV system | early decel
occurs before each contraction | normal fetal movement
38
CV system | late decel
after contraction | r/t low blood flow or utero placental deficiency
39
CV system | CO increases up to __% by week 10 and __ to __% post delivery
10% | 60-80%
40
CV system what happens to diastolic b/p systolic?
dys- decreases | sys- no changes
41
CV system | 2 main complications
Anemia | supine hypotension syndrome
42
CV system | if a prego says they have nausea what should you do?
treat b/p | LUD
43
******************** CV system what may the heart look like on an xray with the prego
enlarged
44
**************************** CV system what type of effusions are common in the prego
pericardial effusion
45
********************** CV system what may be auscultated in the prego
low grade murmur | this is due to extra fluid and is NORMAL
46
CV system | what occurs due to spinal and epidural? how is this treated
vasodilation and hypotension | bolus with fluids
47
CNS System | what hormone causes sedation?
progesterone
48
CNS System | with pregnancy MAC is decreased how much?
40%
49
CNS System there may be an exaggerated effect to what meds inparticular in the prego (so you will always use smaller doses than in the general population)
Local anesthestics
50
CNS System | what happens to endorphins
increased
51
**************************************** CNS System the CSF pressure increases with what?
contractions (do spinals between them)
52
Blood flow in relation to palcenta | how much blood flow is going through it?
500-700 ml
53
Blood flow in relation to palcenta | does the placenta have autoregulation?
nope, relies solely on moms circulation
54
Blood flow in relation to palcenta decreased BF can occur when what 4 things happen
1) hypotension 2) stress 3) supine 4) hypoventilation
55
Blood flow in relation to palcenta | decreased blood flow can lead to what?
maternal hypoxia | hypercabia
56
Blood flow in relation to palcenta what is needed for best placental perfusion hypocarbia hypercarbia normocarbia
normocarbia
57
******** | Ephedrine indirect or direct
indirect
58
******** | phenylephrine direct or indirect
direct
59
``` APGAR how many categories? what is the scoring in each category? normal scores? when is it done? ```
5 0-1-2 8-10 (rarely ever a 10) 1 min and 5 min
60
********************************* APGAR what is the 1 min assessment for? what is the 5 min assessment for?
1 min- babies response to birth process? | 5 min- babies own response (or response to living on own)
61
********************************* | what is EBL for a c-section and what must you remember about it?
1-2 liters | it is normal and ok
62
how much time do you have to start neonate recessatation? what is it called?
60 seconds | "the golden minute"
63
Renal System what happens to GFR in weeks 16-26? what about 3rd trimester?
16-26- 80% increase | 3rd trimester- 50-60% decrease
64
Renal System what happens to BUN and Creatinine? why does this occur
decrease up to 50% BUN 8 Creat 0.5 occurs due to dilution

Principles II- Josh (17 decks)

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