TL block 6 Flashcards
1
Q
Wernicke encephalopathy
A
ataxic gait, AMS, oculomotor dysfunction
-if you give alcoholics glucose w/o thiamine
2
Q
Electrolyte abnormalities in chronic alcoholics
A
hypoCa
hypoMg
hypoPhos
hypoglycemia
***when giving glucose, give thiamine 1st to avoid Wernicke’s encephalopathy
3
Q
Contraindications to low fresh gas flows in a circle system
A
-intoxicated alcohols: exhaled CO and methane, acetone
-uncompensated diabetic states
-carbon monoxide poisoning
4
Q
Assoc w/ high rates of postop pulm complications
A
-dependent functional status
-ASA 3 or 4
-prolonged operative time
-age > 60
-COPD
-smoking
**male gender and lower BI assoc w/ postop PNA
5
Q
why is hypothermia so devastating in newborns?
A
hypothermia is assoc w/ metabolic acidosis -> acidosis is assoc w/ inc in PVR and dec in SVR -> inc flow across PFO and PDA -> maintaining fetal circulation
(same thing w/ hypoxia and inc in PVR)
6
Q
Eisenmenger complex
A
L to R shunting becomes R to L shunting
7
Q
Edward Syndrome
A
Trisomy 18
-microcephaly, prominent occiput, micrognathia, congenital heart dx, intellectual disability, sz, renal anomalies, capillary hemangiomas
8
Q
pulse ox goals for newborns
A
60-65% one minute of life
85-95% by 10 minutes of life
9
Q
APGAR Score
A
Appearance: Color
Pulse: 0, <100, >100
Grimace: none, grimace, coughing
Activity: flaccid, flexion only, active
RR: no effort, slow, normal crying
0-2
10
Q
chest compressions: RR neonates
A
3:1 3 chest compressions to 1 breath
-only if HR < 60
11
Q
What congenital heart dx is assoc w/ aortic root dilation?
A
Bicuspid aortic valves
12
Q
Pyloric stenosis, initial resuscitation
A
10-20 cc/kg of normal saline w/ 20 mEq/L of potassium
-do not use glucose containing fluids w/ large volume resuscitation b/c hyperglycemia -> do glucose containing fluids after rescucitation
13
Q
End point of resuscitation for pyloric stenosis
A
Cl > 100
K > 3
no more clinical signs of hypovolemia
14
Q
postop concern for pyloric stenosis
A
**postop apnea
-alterations in CSF pH and central chemoreceptors reponse to CO2
-minimize opioids and hyperventilation
15
Q
newborns: mild dehydration: weight loss, UOP, and urine specific gravity
A
5% weight loss
UOP < 2cc/kg/hr
urine specific gravity < 1.02
16
Q
newborns: moderate dehydration: weight loss, UOP, urine specific gravity
A
10% weight loss
UOP < 1 cc/kg/hr
urine specific gravity: 1.02-1.03
17
Q
newborns: severe dehydration: weight loss, UOP, urine specific gravity
A
15% weight loss
UOP <0.5 cc/kg/hr
urine specific gravity: >1.03
18
Q
newborn dehydration rehydration stratechy
A
1st: 20-30 cc/kg isotonic fluid bolus
2nd: 25-50 cc/kg over 6-8 hrs
reaminder of deficit over 24 hours
19
Q
prevention for infant postop apnea
A
caffeine
theophylline (metabolized to caffeine)
20
Q
Strongest RF for newborn postop apnea
A
prematurity
21
Q
NPO time for carbonated beverages like soda
A
2 hours
22
Q
Age what age does peds sympathetic nervous system mature to an adults?
A
7-8 years old
23
Q
MC presenting sign of high/total spinal in infants or kids?
A
Apnea! (resp m paralysis)
-b/c immature symp NS -> no bradycardia or hypoTN
24
Q
5d infant intubated, gastric distention, unable to place NG tube, exp volume significantly lower than insp volume
A
Tracheoesophageal fistula!
push ETT In deeper
25
Side effects to PGE1 to maintain PDAs
APNEA
-hypoTN
-fevers
-CNS irritability
**dec SVR and PVR
26
which onen is more common: gastroschisis or omphalocele?
omphalocele
27
which one as a higher risk of heat loss, repaid dehydration and infxn: omphalocele or gastroschisis?
gastroschisis
28
Electrolyte issues w/ refeeding syndrome
-hyperglycemia
-hyperinsulinemia
-hypercarbia
-hypoK (inc insulin)
-hypoMg
-***hypophos
-thiamine def
29
Sepsis initial fluid resuscitation
30 cc/kg
30
MOA of organophosphate poisoning
AChE inhibitors
31
What syndrome is a destruction of VG Ca channels?
Lambert-Eaton myasthenic syndrome
32
What dx is a desetruction of postjunctional ACh receptors?
myasthenia gravis
33
Hepatic steatosis and TPN
-common b/c glucose calories can exceed caloric requirements
-> store excess surgar as fat in the liver
-AST/ALT rise -> usually return to normal after TPN adjustments
34
Def of septic shock
after adequate fluid resuscitation req pressors to get MAP >65 and lactate > 2
35
qSOFA csore
RR > 22 (1 pt)
AMS (1 pt)
systolic BP < 100 (1pt)
total of 3
-scores 2 or higher are assoc w/ worse outcomes
36
Equation for amount of sodium bicarb needed to correct acidosis in pt
Sodium bicarb mEq = (0.2 * weight kg * base excess)
37
why hypoTN w/ severe acidosis
catecholamines don't bind receptors as well w/ severe acidosis
38
ARDS Network mechnical vent goals
TV 6 cc/kg of ideal body weight w/ PLATEAU pressures < 30
39
Pulm issues w/ drowinging
-wash out of surfactant -> inc permeability of the alveolar-capillary membrane, dec lung compliance, V/Q mismatch
40
Which has a higher flow rate: tibial or humeral IO lines?
humeral!
41
IV:IO ratio of meds and fluids
1:1
-often need a pressure bag for IO though due to increased pressure
42
IO access w/ fastest uptake of drugs and fluids
manubrium of the sternum
43
IO infxn rates
0.6%, very rate
-femoral CVC have 15%
44
Hemodynamic prerequisites to name someone brain dead
Temp > 36 C
Systolici BP > 100
45
To minimize ventilator associated PNA
-daily sedation weaning trials w/ SBT to assess readiness to extubate
-use NIPPV instead of intubating when appropriate
-HOB at 35-40 degrees
-early mobilization
-avoid changing ventilator circuit
-subglottic secretion drainage ports on ETT
46
Stress ulcer ppx and ventilator assoc PNA
-can actually have an increase in VAP w/ PPIs and H2 blockers b/c dec in acidity allows bacteria in stomach to increase -> inc PNA
47
If concern for multi-drug resistant pathogens tx should include:
MRSA converage (Linezolid or Vanco)
plus
TWO anti-pseudomonal agents
48
RF for multi-drug resistant pathogens causing ventilator-assoc PNA
-5 or more days of hospitalization
-prior IV abx w/i 90 days
-septic shock at time of occurrence
-ARDS or acute renal replacement therapy prior to onset
49
Major cause of tetanus associated morbidity and mortality
Autonomic dysfunction
-initially sweating, vasoconstriction, severe tachycardia and HTN -> which rapidly alternate w/ bradycardia and hypoTN
50
Treatment of CN toxicity if concurrent carbon monoxide poisoining
Hydroxocobalamin (Vit B12)
or thiosulfate
-no nitrites b/c of CO poisoning
51
Tigecycline
covers MRSA and gram negative organisms
52
Linezolid
MRSA and Vanc resistant enterococcus
53
Meds that worsen myasthenia gravis
NMB
fluoroquinolones
aminoglycosides
Mg sulfate
penicillamine
54
What levels does a TAP block cover?
T7-L1
55
Normal serum osmolality
280-290 mOsm/kg
56
Serum osmolality for hyperglycemic hyperosmolar state
> 320
57
symptoms for hyperosmolar hyperglycemia state
altered mental status! stupor, coma, sz
***b/c of hyperosmolarity -> cerebral fluid loss to buffer -> coma/sz
58
SIADH lyte abnormalities
Urine osm > 100
FeNa > 1%
Urine Na > 20
low serum uric acid and BUN
dilution, euvolemic hyponatremia Na < 135
59
Sites for IO placement
manubrium of sternum
proximal humerus
proximal tibia
distal tibia
60
Pacemaker 5 position
PCR
1. Paced
2. sensed
3. action taken
4. rate modulation
5. location of multisense pacing
61
What is minimally invasive coronary artery bypass?
surgical method for LAD revascularizatin vita anastomosis to LIMA via L thoractomy
62
Contraindications to minimally invasive coronary artery bypass
-blood clot in L subclavian (b/c use LIMA)
-cardiogenic shock due to acute LAD occlusion (minimally invasive takes longer time for dissection)
63
Hypoplastic L heart syndrome
-LV hypoplastic
-ASD
-severely stenotic mitral and aortic valves
-PDA
-hypoplastic ascending aorta
64
what would cause a complete loss of ipsilateral brainstem auditory evoked potentials?
Transection of CN VIII
65
Which evoked potentials are most resistant to anesthesia techniques?
Brainstem auditory evoked potentials
66
Which evoked potentials are the MOST sensitive to anesthetic technique?
Visual evoked potentials
67
Coags TPN
increased PT
-require Vit K supplementation and commonly assoc w/ acute liver injury
68
Echogenicity of tissues on u/s determined by:
density of the tissue
-greater echogenicity = greater intensity (brightness)
69
Technique to rapidly reverse suspected high spinal
CSF lavage
-remove 20-30cc of CSF -> replace it with sterile saline
70
Monitoring during parathyroidectomy
-intraop PTH monitoring (1/2 life of 3-5 minutes, goal is reduction of at least 50%
-postop Ca monitoring
71
Predictors of hypoxemia during one lung ventilation
-high FEV1 prior to surgery
-hypoxemia w/ 2 lung ventilation
-R sided surgery
-supine position during surgery
-high perfusion in operative lung w/ V/Q scan
72
which lung is the dependent lung in one lung ventilation?
the one that is being ventilated, the non-operative lung
73
hyperthermia, tachycardia, diaphoresis, arrythmia, agitation, and confusion dx?
Thyroid Storm
74
How to tell thyroid storm apart from Anticholinergic toxicity
diaphoresis! Thyroid storm people sweat, Anticholinergic tox "dry as a cracker"
75
Duchenne muscular dystrophy anesthesia concerns
-GI tract hypomotility, gastroparesis
-impaired swallowing
-inc risk of aspiration
76
Treatment for lambert eaton syndrome
3,4 diaminopyridine
immunosuppresion
steroids
77
attempted epidural placement, variable motor blockade, dense sensory blockade, and sympathetic block out of proportion to an epidural block
subdural block
78
Physiologic factors that attenuate SSEP monitoring
-hypoTN
-hypothermia
-hypocarbia
-hypoxemia
-anemia
**hyperthermia red latency
79
Risk factors for transientn neurologic symptoms
-intrathecal lidocaine
-lithotomy position
-pt positioning for knee arthroscopy
-outpatient status
80
Treatment for transient neurologic syndrome
NSAIDs and will resolve w/i 3 days of surgery
81
RF for GERD during pregnancy
-gestational age
-GERD symp prior to pregnancy
-multipartity
**BMI IS NOT ONE*
82
Gastric emptying slowing in pregnacy
ONLY during labor itself!
83
Sodium citrate
increases gastric pH
-no effect on gastric emptying
84
AHI scores for OSA
5-15: mild
15-30: mod
>30: severe
85
Medications for central sleep apnea
Acetazolamide
Theophylline
-stimulates breathing
86
Differentiate b/w OSA and central sleep apnea
Snoring more common in OSA
87
which prior uterine surgery is more likely to cause uterine rupture w/ labor?
Upper segment scar >> lower
88
RF for uterine rupture
-prior uterine surgery
-uterine hypercontractility
-oxytocin use
-PG use
-prolonged labor
-dystocia
-multiparity
-multiple gestations
-congenital uterine anomalies
-polyhydramnios
-trauma
89
def of post partum hemorrhage
blood loss > 1000cc either vaginal or c/s
90
RF for uterine atony
-multiparity
-multiple gestations
-polyhydramnios
-chorioamnionitis
-prolonged labor
-oxytocin-induced labor
91
Terbutaline side effects
-tachycardia
-hypokalemia
-hyperglycemia (despite inc in insulin) -> inc in glycogen breakdown
92
Indomethacin side effects when used as a tocolytic
-plt dysfunction
-renal dysfunction
-premature PDA closure (when used after 32 weeks)
93
what is fetal fibronectin testing used for?
as a screen for preterm labor -> if negative rate of preterm labor is < 1% for the next week
94
Amniotic fluid embolism stsages
1. severe pulm vasospasm -> R heart dysfxn/failure -> low cardiac output -> V/Q mismatch, hypoxemia, hypoTN
2. severe pulm edema -> L heart dysfxn/failure
-consumptive coagulopathy
-if pt still pregnant -> emergency c/s due to severe hypertonus of uterus
95
Labor analgesisa plan for pts taking buprenorphine
-continue during labor -> divide the daily dose into multiple times per day
-neuraxial anesthesia
-has inc postpartum pain scores compared to controls -> can inc buprenorphine up to 32mg per day
96
side effects of terbutaline
-hypoTN
-tachycardia
-inc cardiac output
-hyperglycemia
-hypoK
-pulm edema
97
preterm labor, weeks?
< 37 week
98
Normal pregnancy ABG
PaO2: 105isih
PaCO2: 30
bicarb: 20
pH: 7.44
99
acid-base changes in pregnancy
-Inc PaO2 (inc in MV, improves alveolar ventilation)
-Dec PaCO2 (inc in MV) -> resp alkalosis
-Dec in bicarb (compensatory metabolic acidosis)
-decrease in base excess
-pH: alkalotic
-p50 increases (Hg curve shifts to the right)
100
Base excess
-amount of acid required to restore a liter of blood to a normal pH w/ a PaCO2 of 40
-if high: inc level of bicarb in blood
-if low: lower bicarb in blood (metabolic acidosis or compensated resp alk)
101
RF for placental abruption
-maternal HTN
-maternal cocaine/tobacco use
-paternal tobacco use
-trauma
-adv maternal age
-parity
-hx of prior abruption
-chorioamnionitis
102
Variable decelerations OB
umbilical cord occlusion
-healthy fetus can tolerate mild to moderate w/o decompensation
-w/ sustained, severe variable -> hard to maintain cardiac output
103
sinusoidal fetal heart rate pattern
fetal anemia
104
Fetal response to terbutaline for preterm labor
maternal hyperglycemia -> fetal hyperglycemia -> fetal hyperinsulinemia -> after born baby is hypoglycemic
-fetal tachycardia
-myocardial ischemia or hypertrophy
105
Amniotic fliud embolism criteria:
1. hypoTN or cardiac arrest
2. hypoxia
3. coagulopathy or hemorrhage
106
When is amniotic fluid embolism likely to occur?
-onset of labor
-during c/s
-w/i 30 minutes postpartum
107
treatment for amniotic fluid emoblism
resuscitative and supportive!
-airway support (ETT)
-vasopressors/inotropes
-coagulopathy (pRBCs, FFP, cryo, plts)
108
Why do pregnant women desat so quickly?
-Decreased FRC and high O2 utilization
109
Pregnancy and closing capacity
NO EFFECT!
-obesity and pregnancy no effect, only changes w/ age over 40
110
normal umbilical artery blood gas sample
pH: 7.2-7.3
pCO2: 50-55
pO2: 20
bicarb: 20-25
base excess -2.7 to -4.7
111
most sensitive and specific sign of uterine rupture?
Non-reassuring fetal heart rate patterns
112
RF for uterine rupture
-grand multiparity > 5 births
-previous c/s
-prev myomectomy
-induction of labor w/ oxytocin
-fetal malpresetation
113
Hemodynamic changes in pregnancy
-Inc cardiac output
-Inc HR
-Inc SV
-inc intravascular volume
-inc plasma volume
-inc RBC mass
-NO change in CVP
-DEC SVR
-dec afterload
114
Asherman's syndrome
intrauterine adhesions or intrauterine synechiae) occurs when scar tissue forms inside the uterus and/or the cervix. These adhesions occur after surgery of the uterus or after a dilatation and curettage
115
P50 pregnancy and fetus
Normal p50: ~27
pregnancy p50: ~30
fetal p50: 21
-so R shift of Hg curve in pregnancy to increase O2 offload -> L shift of fetal Hg curve to inc O2 acceptance from mom
116
Def of proteinuria for preeclampsia
Urine Pr:Cr ratio > 0.3
24 hr collection > 300mg
1+ dipstick
117
Preeclampsia def
> 20 weeks gestation HTN >140/90 4 hrs apart with:
-proteinuria (urine Pr:Cr > 0.3, 300mg 24 hrs, +1 dipstick)
-plts < 100k
-visual changes
-pulm edema
-AST/AST x2
-Cr > 1.1
118
SE of adding epi to bupi for epidural
-increasing muscular blockade
-possible tocolytic effects (beta 2 agonism)
-dec placental BF (alpha 1 agonism)
-dec minimum local anesthetic conc of epidural bupi
119
Methylergonovine MOA
ergot alkaloid
-inc intracellular Ca -> uterine contractions
120
Methylergonovine SE
-sudden HTN
-bradycardia
-coronary vasospasm
-cardiogenic pulm edema
121
Carboprost MOA
stimulates smooth m and uterine contraction by prostaglandin-like effects
122
Carboprost SE
nausea, diarrhea, bronchospasm
123
Oxytocin side effects
-hypoTN w/ bolus
-arrhythmias (ST changes)
-hypertonic uterine contractions
-nausea
-HA
124
Misoprostol MOA
-prostaglandin analogue -> binds myometrial cells to cause myometrial contractions
125
When is misoprostol used?
ripen the cervix and induce labor
126
for amniotic fluid embolism, what site are the factors/inflammatory mediators entering maternal circulation?
placenta
endocervical veins
uterine trauma site
127
Amniotic fluid emoblism criteria
1. hypoxemia
2. hypoTN or cardiac arrest
3. coagulpathy or severe hemorrage
128
O2 delivery to fetus determined by:
-O2 carrying capacity: O2 saturation and maternal Hg
-uteroplacental BF
129
neuraxial anesthesia and uterine Blood flow
-Increases! -> b/c pain relief, dec sympathetic activity and dec maternal hyperventilation
130
which coag factors increase the most in pregnancy
factor VII
fibrinogen
131
albumin and pregnancy
decrease!
-inc in intravasc volume with no change in albumin prod -> dec
132
Normal fetal heart rate
120-160
133
fetal heart rate healthy variability
5-25
if variability <5 or >25 -> non-reassuring
134
def of a deceleration in fetal heart rate monitoring
>15 decrease in HR
135
Metabolism of chloroprocaine
Plasma esterases
136
dx if fetal decreased variability
-fetal hypoxia
-fetal sleep state
-maternal opioid use
-fetal neuro abnormality
137
After what gestational age is a pregnant pt at increased risk of aspiration
18 weeks
138
RF for aspiration pneumonitis
pH of fluids < 2.5
volume of aspirate > 0.4 cc/kg
particulates in the aspirate
139
Gastric emptying and pregnancy
-not delayed until the start of labor
140
What medications are used to inc gastric pH?
sodium citrate
citric acid
141
Why inc risk of aspiration with pregnancy
-dec LES tone
-inc intragastric pressure (gravid uterus)
142
how long after delivery does risk of aspiration decrease?
48 hours
143
H2 antagonists
famotidine
ranitidine
144
APGAR
Appearance: 0 cyanotic 2 fully pink
Pulse 0: none, 1: <100, 2: >100
Grimace: 0 no resp to stimulation, 2 full grimace and cry
Activity: 0: none, 1: flexion 2: active
Respirations: 0: not breathing 1: weak, irregular, shallow, gasping 2: full strong regular cry
145
Uterine blood flow
UBF = BP/ Uterine vascular resistance
-if decrease in uterine arterial pressure (hemorrhage, hypovolemia, sympathetic blockade [epidural]) or increase in uterine venous pressure (caval compression, uterine contraction) -> placental perfusion is decreased
**BP most important to maintain flow
-if no decrease in BP -> uterine BF better w/ analgesia and improvement in fetal acid base status (no hypervent -> hypervent from pain shifts O2-Hg curve to the left)
146
Stages of labor
I: onset of labor w/ regular contractions until cervix completely dilated
II: fully dilated to baby delivered
III: baby delivered to placenta delivered
147
What spinal levels need to be covered for stage 1 of labor?
T10-L1
148
What spinal levels for second stage of labor?
T12-L1 PLUS S2-4
149
most common cause of pregnancy-related maternal mortality in the USA?
cardiovascular conditions
150
Unfractionated heparin and pregnancy
Bioavailability decreases
-inc protein binding
-inc heparinases -> inc breakdown
-inc plasma volume
-inc renal clearance
151
Therapeutic unfractionated heparin in pregancy
10,000 U or more subq every 12 hours -> PTT goal 1.5-2.5x 6 hours after injxn
152
unfractionated heparin ppx dose
5k-7k every 12 hours 1st and 2nd trimester
1k every 12 hours 3rd trimester
-PTT should be normal
153
Recommendation on holding low dose subq heparin (5-7k) before neuraxial
4-6 hours prior or coags
154
Recommendation on holding moderate dose subq heparin (7.5k-10k) before neuraxial
12 hours and coags should be assessed
155
Recommendation on holding therapeutic heparin
24 hours and coags should be assessed
156
IV pain med of choice for 2nd stage labor
remifentanil -> metabolized too rapidly and redistributed too quickly to accumulate in fetal blood stream
157
Highest cardiac output w/ pregnancy, when and how much?
immediately after delivery -> autotransfusion
2.5x cardiac output
158
How long for cardiac output to approach prepregnant values?
2 weeks postpartum: ~10% above prepregnancy
up to 24 weeks to full normal
159
Which factors decrease during pregnancy?
XIII and XI
160
flow-volume loop pregnancy
NORMAL
161
Best time to do surgery during pregnancy
2nd trimester
-minimize risk of abnormal organogenesis
-minimize risk of preterm labor
162
What is the earliest age fetal heart rate monitoring is possible?
18-20 weeks gestation
163
At what age does fetal heart rate variability occur?
25-27 weeks
164
Pregnant but not-OB surgery concerns after 18 weeks
-inc aspiration risk-> H2 blockers + antacid
-L uterine displacement during surgery
-have tocolytics available
-consider intraop fetal monitoring -> if unable minimum is pre and post op
-minimize insufflation pressures (10-15) to prevent dec in uterine perfusion
-mild hypocarbia (etCO2 32-36)
165
Ketamine and pregnancy
during 1st 2 trimesters >2mg/kg can cause uterine hypertonus
166
neonate's HR <60
CPR rate of 3:1, rate of 120 events per minute (90 chest compressions, 30 breaths)
167
Epi dosing neonate
10-30 mcg/kg
168
stage I of labor
stage I: latent and active phase of labor
-active phase: acceleration v deceleration phases
-latent: regular painful contractions w/o cervical dilation
-once active phase: dilate 1-1.5 cm/hour
169
most common cause of prolonged latent labor
"unripe" cervix when labor begins
170
Issues causing prolongation of labor in active phase
2 types: not dilating at the appropriate rate, or arrest of dilation
-usually linked to cephalopelvic disproportion
171
At what pH is a fetus considered acidotic and need an emergency c/s?
< 7.20
172
anesthetic plan for ex utero intrapartum treatment procedure?
uterine relaxation w/ avoidance of uterotonics
-usually GA w/ anesthetic goal of MAC 2-3, or lower dose volatiles w/ nitroglycerin supplementation
-fent, NMB, atropine can also be given to the fetus IM after partial delivery
173
Goals for DIC treatment
Hg >7
PT/PTT < 1.5
plts >50k
fibrinogen > 300
-deliver fetus -> GA can't do neuraxial
174
Fibrinogen levels in pregnancy
DOUBLE
non-pregnant ~200
pregnant ~400
175
protein C and S pregnancy
-protein C increased resistance
-protein S levels decrease
-resistant has 2s already -> protein C
176
electrolyte abnormality w/ high dose oxytocin
hypoNa (similar structure to ADH) -> volume overload is sensed by atria -> ANP -> natriuresis -> hypoNa (in addition to dilutional from inc water reabsorb)
177
SE from high dose oxytocin
-hypoNa (similar to ADH)
-N/V
178
RF for meconium passage -> inc risk of meconium aspiration
later gestational age
179
When should maternal steroids be given to further lung development?
24-34 weeks
180
Pruritis: epidural v CSE?
higher in CSE!
181
epidural v CSE: can provide complete analgesia in 1st stage of labor w/ opioids alone, no sympathectomy or motor blockade
CSE! intrathecal opioids provide adequate analgesia
182
What decreases uterine blood flow?
-hypoTN maternal
-uterine contractions
-uterine vasoconstriction (severe hypocapnia, alpha agonists, preeclampsia)
-uterotonics!
183
which inhaled anesthetic doesn't cause uterine relaxation?
nitrous oxide
184
postpartum, HA w/ sz, no eclampsia
Cerebral venous/sinus thrombosis
-due to thrombosis in cerebral venous complex (dural venous sinuses or verebral vwins)
dx w/ MRI
185
frontal HA soon after dural puncture
pneumocephalus
-may be positional (worse when upright)
186
time frarme for PDPH
24-48 hours typically, within 5 days definitively
187
RF for GERD w/ pregnancy
-gestational age
-hx of heartburn before pregnancy
-multiparity
188
Drugs that don't cross placenta
tHINGS don't cross
Heparin
Insulin
NDNMB
Glycopyrrolate
Succ
189
Possible causes of preeclampsia
-narrow of spiral arteries -> endothelial activation
-paternal genetic factors (paternal family hx inc risk)
-immunologic factors (pts w/ HIV have dec risk)
190
How long after taking heparin does a pt need a plt count for a spinanl?
5 days!
191
GA v spinal for cerclage placement?
-spinal generally preferred unless membranes bulging -> GA decrease intrauterine pressure as long as intubation and extubation conducted to avoid coughing and straining
-hyperflexed spine for spinal placement also inc intraabd pressures
-can use LMA if <18 weeks
-if >22 weeks -> need FHR monitoring
-PONV ppx, N/V inc pressures
192
Utertonics post delivery
all deliveries get uterontics! ppx oxytocinn for all
193
OB pt: chronic HTN v gestational HTN
chronic: < 20 weeks gestation
gestational: > 20 weeks gestation w/o signs of proteinuria or end organ dysfxn (would make it PEC)
194
when does gestaional HTN typically resolve?
postpartum week 12
195
what abx toxic to kidneys when taken w/ ACE inh?
aminoglycosides and amphotericin B
196
What to measure to dx carcinoid syndrome?
24 hr urinary 5-hydroxy-indole-acetic-acid (5-HIAA)
-release of serotonin from metastatic carcinoid tumors
- >30mg for dx (norm 3-15)
197
Cardiac involvement w/ carcinoid syndrome?
TR!
198
What are you testing for w/ 24-hour vanillymandelic acid?
Pheo (same w/ urinary normetanephrines)
