OB Flashcards
What is the diagnosis for mild pre-eclampsia?
1) two readings SBP over 140 and/or DBP over 90, need 2 readings at least 4 hrs apart
2) proteinuria
- 24 urine protein more than 300 mg
- or spot urine protein / Cr ratio of 0.3
3) more than 20weeks GA
What is severe preeclampsia
1) SBP over 160 or DBP over 110, ideally 2 measurements taken 4hrs apart
2) Cr over 1.1 or doubled baseline
3) new CNS deficits (headache, vision changes)
4) pulm edema
5) liver, elevated LFTs 2x normal
6) Epigastric or RUQ pain
7) thrombocytopenia <100
Methemoglobinemia
- cause?
- physiology?
- how affects pulse ox
- levels and toxicity
- treatment
- cause: benzocaine and prilocaine
- decreased oxygen carrying capacity and impaired oxygen delivery to tissues.
- oxygen/Hgb curve to the left
- methemoglobin absorbs the same amount of light at both 660nm and 960nm, same as pulse ox, resulting in 85% sat reading
- toxicity
Under 30 no hypoxia
30- 50%: signs of hypoxia
More than 50: coma and death - treatment is methylene blue, unless patient has G6PD, then you give 100% O2 and consider exchange transfusion . Methylene blue requires G6PD to be effective, may cause hemolysis in patients deficient
What is G6PD deficiency?
Inhibits regeneration of glutathione in RBC
- RBC more susceptible to oxidative damage
- gets cleared from circulation faster, in 60days instead of 120 days
- x linked disorder
- can find Heinz bodies in peripheral blood smear
When is therapeutic hypothermia indicated post-cardiac arrest?
comatose pt after ROSC after resuscitated for a:
- out of hospital V fib (class 1)
- in-hospital with initial (class 2b rhythm)
- out of hospital arrest where the initial rhythm was PEA (class 2b)
How do you induce therapeutic hypothermia
Cooling blankets Ice packs Infuse cold fluids Reduce temp to 32 - 34 deg C Monitor core body temp (esophageal, bladder or PAC temp probe) Maintain hypothermia for 12-24hrs
What is Cushing response?
- high BP
- low HR
- irregular respirations
Some sources say instead of irregular respirations you will see widened pulse pressure
What does it indicate neurologically if a pupil is dilated and non reactive to light?
Suggests CN3 (occulomotor) compression secondary to uncal herniation
How does mannitol decrease ICP
- osmotically shifts fluid from intracranial to intravascular compartment
- decreases CSF production
- increases reflex cerebral vasoconstriction (2/2 decreased blood viscosity)
When would mannitol hurt more than help?
Can worsen cerebral edema if blood brain artist is not intact
Can worsen expansion of intracranial hematoma when there is intracranial bleeding (osmotic diuretics can lead to shrinkage of surrounding brain allowing for expansion of hematoma)
List serum magnesium levels and their physiologic effect
1.5 - 2.5mEq/L = normal 4-7 = therapeutic 7-10 = loss of patellar reflexes, hypotension, CNS depression 13 - 15 = respiratory paralysis 16 - 25 = EKG, widened QRS 20 - 25 = cardiac arrest
What intervention do you do if patient has widened QRS
Causes: elevated ICP or elevated Mg
If Mg toxicity
- stop drip
- check Mg level
- check DTR
- prepare to treat seizure
- calcium gluconate
- diuretic for renal excretion
If someone sticks themselves with a needle from HIV pt, what do you tell them
- wash our wound
- risk of transmission 0.3% with percutaneous exposure
- see employee health to draw blood for testing
- post-exposure PPX
What is DIC?
- disseminated intravascular coagulation = pathological activation of the coagulation cascade
- wide spread formation of clots in the blood vessels
- consumption of coagulation factors, thrombocytopenia, hemolytic anemia, diffuse bleeding, thrombotic phenomena
- increased PT and PTT
- decreased fibrinogen < 100mg/dL
- fibrin degradation products, high D-dimer
if in DIC, when is appropriate to given cryo?
fibrinogen levels under 50 mg/dL
