Questions Flashcards
The body compensates for the increase in O2 demand by increasing MV. This is primarily accomplished by what means?
Increasing TV with slight increase in respiratory rate
FRC is greatly reduced in pregnancy leading to rapid desaturation during apnea. T/F
True
What causes dilutional anemia
Plasma volume increases by 50% but red cell volume increases by a smaller amount.
Primary treatment for aortocaval compression
LUD
GI changes in the paturient causes
Esophageal sphincter to relax
Early changes are primarily caused by
Progesterone
A patient is scheduled for an elective procedure which requires general anesthetic. She is 22 weeks pregnant what is required?
RSI
Relaxin causes what?
Softening of the cervix
Inhibition of uterine contractions
Relaxation of pelvic joints
Ion trapping in the fetus occurs most commonly with which of the following combination?
Weak base in presence of decrease in fetal pH
Which order reflects vascular absorption from most to least?
Paracervical
Caudal
Lumbar
Spinal
Under normal conditions blood as a whole from the umbilical cord will bypass the liver of the fetus as it initially enters the fetus
True
Probably causes of fetal tachycardia
Thyrotoxicosis, fetal anemia, recovery from asphyxia
What is not a cause of fetal tachycardia?
Cord compression
What is not a probable cause of fetal bradycardia?
Prematurity
Early decel
Occurs with contraction has smooth shape not a bad sign.
An accurate description of late decel is
Occurs after the start of the contraction has a smooth shape is a BAD sign
List four different treatments for fetal bradycardia and or late decels. Ultimate fallback plan?
Fluids ephedrine/phenylephrine
Turn down epidural
LUD RUD
O2
Emergent c/s if this doesnt work
RA and MS symptoms worsen with pregnancy. T/F
False improve
Acute vs chronic cocaine abuse and MAC
Decreased chronic
Increased acute
Drug of choice for htn with cocaine
Labetalol
Which of the following would you expect to be the plan for delivery for an HIV+ paturient?
C/S with antiviral therapy
How would drug dosing change in HIV patient?
Decrease doses
Scoliosis and harrington rods extending below what level are NOT contraindications to epidural?
L1
Infection, trauma, and failure to administer insulin could all lead to what?
Excarbation of insulin deficiency in the diabetic patient
Obstetric patients with diabetes are more likely to need C/s t/f
T
Aortic Stenosis?
Mitral Stenosis?
Normal HR SVR Preload
Mitral Regurg?
Aortic insufficiency?
Increased HR Preload
Decreased SVR
Patients with which disease are most likely to develop complications with continuous laboring epidurals?
Aortic stenosis
What is not a listed complication of VBAC?
Placenta Previa
What has painless vaginal bleeding?
Placenta previa
What may have bleeding or may not if baby is block cervix so bleeding is not seen?
Placental abruption
Watch maternal state and severity of bleeding when considering regional
Tachy, pale, dont do regional do GETA
Should surgical field be above heart for VAE?
NOPE!
Describe pain during 2nd stage of labor
Pain is somatic and due to distention and frank injury to the perineum and pelvic floor
Comes from S2-4
What is dosage and concentration of test dose? What effects?
3 ml lidocaine 1.5% so 45mg and 1:200,000 epi so 15 mcg
Cant lift legs 5 min inj SAB
Circumoral numbness, tinnitus, increased HR IV
List 3 advantages and 2 disadvantages to epidural opioids
Advantages: Increased onset time, duration, density, no motor block, decreases SE of local, synergy, used for long term pain control, decreased concentration of LA
Disadvantages: Disguises poor epidural, Narc SE, cant be used in 2nd stage of labor
Epidurals are contraindicated in VBACs due to possibility of delaying recognition and treatment of complications T/F
F
Catheter is threaded out of the epidural needle 2cm and will no longer advance. Next action?
Withdraw the needle and catheter entirely, withdraw catheter from needle and start over.
What are some reasons for inadequate block of labor epidural?
Inadequate dose of LA, patient increased metabolism or tolerance of LA or opiates
Catheter migration
Unilateral block
What are the hallmark signs associated with PDPH?
Postural HA severe when sitting up and resolves when lying flat
What treatment is over 90% effective for PDPH
Blood patch 20 - 30 ml of own blood
Obese patient consider what?
Ramping Longer needles Positioning as supine leads to hypoxia Higherpeak pressures C/S- hypoxia due to pannus over abdomen and chest wall.
