Pre-Eclampsia Flashcards

1
Q

What is Pre-eclampsia?

A

Widespread arteriolar vasoconstriction causes hypertension, tissue hypoxia, and endothelial damage

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2
Q

Mild pre-ecl vs severe

A

BP > 140/90 two elevated BPs taken four hours apart
Proteinuria: > 300 mg over 24 hours
Non pedal edema

Severe:
160/110
Severe proteinuria >5 gm over 24 hours
Evidence of severe end organ damage

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3
Q

If a patient seizes with eclampsia-what are you doing?

A

50-100 mg sodium thiopental, bolus of IV mag 4-6 gm followed by an infusion of 2 gm/hr
Establish airway, monitor BP, pulse ox, and EKG
Cure: delivery of fetus and placenta

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4
Q

Which assay could you use to assess platelets in pregnant women?

A

PFA 100-most rapid and simple assessment of platelet aggregation. uses epinephrine and ADP

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5
Q

With pts on Magnesium, KIM what about their baby?

Mg also causes what with sensitivity to muscle relaxants and why?

A

Could have weakness and decreased muscle tone
Also causes increased maternal sensitivity to both depolarizing and non-depolarizing muscle relaxants. It does this because it inhibits release of ACh at NM junction and decreases sensitivity of motor endplate to aCH.

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6
Q

What are therapeutic levels of Mg? When do you lose deep tendon reflexes? When do you get SA and AV nodal block? Cardiac arrest when?

A

4-6
You lose deep tendon reflexes at 10
SA and AV block at 15
Cardiac arrest at 20

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7
Q

What can you give to counteract Mag? How much?

A

Calcium gluconate counteracts the cardiac effects, but both gluconate or chloride could help overall.
Calcium gluconate: 1 gm
Calcium chloride 300 mg

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8
Q

Pre-op in pts with pre-ec?

A

Assuming it is not emergent-Make sure theyve been given a fluid bolus and repeat platelet count (KIM that these pts on Mg are prone to pulmonary edema)
Provide aspiration ppx with H2 blocker and 30 mL of a nonparticulate antacid
Cosnider a line. in severe pre-eclamptics, or in those with uncontrolled BP

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9
Q

Intra-op with a patient with pre-ec what can you expect?

A

YOu can expect BP swings (hyper and hypotensive) KIM that the pre-ecl pateint is more sensitive to pressors. random-you can raise arms to facilitate venous return.

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10
Q

Epidural vs Spinal in Pre-eclamptic:

A

in a stable, non-coagulopathic patient, spinal should be fine, but you can do epidural if you’re worried about the sympathectomy

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11
Q

GA in pre-ec:

A

aspiration prophylaxis: oral nonparticulate antacid, H2 blocker, Metoclopramide
pre-oxygenate
Can consider giving labetalol or ntg to blunt sympathetic response
Sodium thiopental vs succinylcholine?
HAVE SMALLER TUBES AVAILABLE
REMEMBER THAT MG POTENTIATES THE EFFECTS OF NEUROMUSCULAR BLOCKERS

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12
Q

Post op in pt with pre-ec;

A

Be aware of post op development of eclampsia. pt should be monitored for 24-48 hours after delivery due to risk of mg therapy and to be watched for seizures.

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