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Summer '20 Adv. Principles I > Pain Pathways (Dr. Mo material) > Flashcards

Pain Pathways (Dr. Mo material) Flashcards

1
Q

At 15-20 weeks, which test can indcate neural tube defects or downs syndrome?

A

Maternal alpha-fetoprotein

Increased in neural tube defects

Decerased in Downs Syndrome

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2
Q

Cx dilatation, level of descent, and orientation of ________ presentation during various stages of labor.

A

Cx dilatation, level of descent, and orientation of occipitoanterior presentation during various stages of labor.

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3
Q

Define the 3 Stages of Labor:

A

Stage 1 –> Beginning of regular contractions to full cervical dilation (10 cm)

Latent: Regular Uterine Contractions-4 cm dilation

Active: 4cm - 10 cm (complete dilation)

Stage 2 –>complete cervical dilation-delivery of baby

Stage 3 –> Delivery of baby - delivery of placenta

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4
Q

Hyperventilation –> decrease PCO2 < 20 mmHg; transient hypoventilation; maternal and fetal hypoxemia; reduce uterine blood flow and ____ ____.

A

Hyperventilation –> decrease PCO2 < 20 mmHg; transient hypoventilation; maternal and fetal hypoxemia; reduce uterine blood flow and fetal acidosis

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5
Q

In first stage of labor, _________ caused by uterine contraction and Cx dilatation

A

In first stage of labor, Visceral pain caused by uterine contraction and Cx dilatation

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6
Q

During second stage of labor:

  1. Pain through by _____ _____ (S2-S4)
  2. _______ _____ caused by stretching of vagina and perineum by descent of fetus
A

During second stage of labor:

  1. Pain through by pudendal nerve (S2-S4)
  2. Somatic pain caused by stretching of vagina and perineum by descent of fetus
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7
Q

A.During late 1st and 2nd stage, pain impulses travel via ________ ______ and enter the neuraxis at the S2,3,4. Cause of pain is distension of lower vagina, vulva and perineum.

A

A.During late 1st and 2nd stage, pain impulses travel via pudendal nerves and enter the neuraxis at the S2,3,4. Cause of pain is distension of lower vagina, vulva and perineum.

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8
Q

_____and ______ from the genitalia are mediated by the ________ (not lateral spinothalamic tract)

A

Pain and temperature from the genitalia are mediated by the autonomic nervous system (not lateral spinothalamic tract)

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9
Q

What is the level of anesthesia for C-Section?

A

A.Level of anesthesia for C-section is T4

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10
Q

Picwickian Syndrome Treatment?

A

A.Obesity-hypoventilation syndrome leading to

  1. Hypercapnia
  2. Hypoxemia
  3. Somnolence; poor sleep at night
  4. Pulmonary HTN
  5. Systemic HTN
  6. RVH / LVH
  7. Dependent edema
  8. Cyanosis-induced polycythemia
  9. Rales
  10. Pulmonary edema

B.Treatment

  1. Oropharyngeal appliances
  2. Positive pressure nasal mask
  3. Surgery
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11
Q

What kind of lung disease do PFT indicate in obesity?

A

1.PFT indicative of “restrictive lung disease”

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12
Q

1.In morbid obesity, closing capacity exceeds FRC –> V/Q mismatch –> _____ ______

A

1.In morbid obesity, closing capacity exceeds FRC –> V/Q mismatch –> arterial hypoxemia

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13
Q

Signs of Fetal Distress

A
  1. Repetitive late deceleration
  2. Loss of beat-to-beat variability
  3. Fetal heart rate < 80
  4. Fetal scalp pH < 7.20
  5. Meconium stained amniotic fluid
  6. Oligohydramnios
  7. Intrauterine growth retardation
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14
Q

In management of regional anesthesia complications what would you do for hypotension?

A

A.Hypotension

1.Ephedrine, oxygen, left uterine displacement and IV fluids. Small doses of phenylephrine can also be used

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15
Q

In management of regional anesthesia complications what would you do for unintentional IV injection?

A

A.Unintentional IV injection

  1. Place supine with left uterine displacement
  2. Thiopental or propofol to stop seizures
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16
Q

In management of regional anesthesia complications what would you do for unintentional Intrathecal injection?

A

A.Unintentional intrathecal injection

  1. Place supine with left uterine displacement
  2. Ephedrine and fluids
  3. Intubation and ventilation in high spinal
17
Q

In management of regional anesthesia complications what would you do for a post dural puncture headache?

A

A.Postdural puncture headache

  1. Bed rest
  2. Hydration
  3. Oral analgesic
  4. Caffeine

Then blood patch if not resolved

18
Q

A.Inhalation agents

1.Cause uterine ______ –> increase blood loss

A

A.Inhalation agents

1.Cause uterine ______ –> increase blood loss

19
Q

A.Parentral agents

1.Opioids ________decrease progression of labor

A

A.Parentral agents

1.Opioids minimally decrease progression of labor

20
Q

What does alpha 1 and beta 2 stimulation to to the uterus?

A

D.Vasopressors

  1. a1 stimulation –> uterine contraction
  2. b2 stimulation –> uterine relaxation
  3. Small dose on phenylephrine INCREASE blood flow by INCREASE BP
21
Q

What is oxytocin for?

Complications?

A

D.Oxytocin

  1. Use to induce labor and to prevent postpartum blood hemorrhage
  2. Complication: fetal distress, uterine tetany, maternal water retention, hypotension, reflex tachycardia
22
Q

What are used to treat uterine atony?

A

D.Ergot alkaloids

1.Use to treat uterine atony

23
Q

What are Prostaglandins used to treat?

A

D.Prostaglandins (PG F2a)

1.Use to treat PPH

24
Q

Magnesium: MOA, S/E, Tx for toxicity.

A

H.Magnesium

  1. Use to stop premature contraction and to prevent eclamptic seizures
  2. Side effects: hypotension, heart block, muscle weakness and sedation. Also INCREASES blockage of non-depolarizing agents. Cardiac and respiratory arrest can occur

ØTreatment

a. D/C
b. Calcium
c. Lasix

25
Q

WHat are beta 2 agonist for?

A

H.b2 agonist

1.Use to stop premature contractions

26
Q

In first stage of labor where is it initially?

THen progresses to where?

A

1.Pain is initially T11-T12 then progress to T10-T12 and L1 during active labor.

27
Q

Fisrst Stage Pain Pathway

A
  1. Latent: little dilatation, softer Cx
  2. Active: regular dilatation in response to uterine contractions

1.Pain is initially T11-T12 then progress to T10-T12 and L1 during active labor.

2.Visceral pain caused by uterine contraction and Cx dilatation

3.Level of spinal anesthesia is needed for T10-L1

28
Q

Second Stage Pain Pathway

A

A.Second stage: Begins at fully dilated Cx (10 cm) and ends with expulsion of fetus

1.Pain through by pudendal nerve (S2-S4)

2.Somatic pain caused by stretching of vagina and perineum by descent of fetus

3.Pain involves T10- S4 dermatomes

4.Level of spinal anesthesia is needed for S2-S4

29
Q

A.1st stage: Cause of pain is uterine contractions and exceeds _______pressure and dilate Cx.

A

A.1st stage: Cause of pain is uterine contractions and exceeds 25 mmHg pressure and dilate Cx.

30
Q

A.Visceral afferent accompanying sympathetic nerves entering where?

A

A.Visceral afferent accompanying sympathetic nerves entering T10, T11, T12 and L1

31
Q

Uterus and Cx pain pathway?

A

Uterus and Cx

T10 to L1-2

Pain impulses carried in visceral afferent C fiber

32
Q

Perineum path pathway?

A

Perineum

S2,S3,S4

Pain impulses carried by somatic nerve fiber; pudendal nerves

33
Q
A

Summer '20 Adv. Principles I (7 decks)

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