Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Emergency Medicine > vaginal bleeding > Flashcards

vaginal bleeding Flashcards

You may prefer our related Brainscape-certified flashcards:
Royal College: Emergency Medicine flashcards
1
Q 
2-3 mo pregnant women complaining of severe abdominal pain and bleeding 
BP70/30
HR130
RR22
O298%
POC glu 80 
ETA 4-6 mins
A

any woman that comes in with abdominal pain and bleeding need ectopic on ddx

belly full of blood on ULS with + pregnancy test

fluid collects in morrison’s pouch any trauma pt or hypotensive pt will see this space

need type and cross need a surgeon and operating room

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Most ectopics happen in the

A

ampulla

scarring form STDs cause the fetus to get stuck

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

blood work up in a pt with ectopic

A

not especially helpful

Blood  WBC 8K, Hgb 11.9; Urine  WBC 10-20 + LE

in a UA we are looking for undiagnosed UTI not helpful for ectopic

CBC +/- chemistry (if in case pt requires methotrexate later),
UA (check for infxn like undetected pyelo or STI – associated with preterm labor). A lot of preterm labor deliveries we see can be traced back to an infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

how does the cervix differ from the ULS

A
  1. Cervix cant respond to active bleeding – if it is ripped in any way, you will bleed to death (like if you have a pregnancy there)

no hemostasis in the cevix

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what are the ectopics we miss

A

The ectopics that we miss are in the cervical area

fimbriae in the ovary – they are hard to detect b/c on US they are sitting next to a lot of other structures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Ectopics hiding near the uterus will present with

A

More difficult to diagnose - both can appear intrauterine.

More likely to cause catastrophic bleeding.

iHigher rates in ART patients.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Cornual Ectopic

A

close to the insertion of the uterine artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

RF for cervical ectopic

A

prior instrumentation, fibroids, IUDs, IVF, uterine structural abnormalities (Asherman’s Syndrome, DES)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Heterotopic Pregnancy

A

one is in the uterus and one is not

i. 1 in 4,000 pregnancies
ii. 1 in 100 pregnancies in patients using assisted reproductive technology

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

endocaveterial ULS

A

always start with the transabdominal view

2 large bore IV
type and cross
OB on board

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

ULS pitfalls

A

i. Make sure you are oriented correctly!
ii. Find the uterine cavity.
iii. Find the endocervical canal.
iv. Always look in the adnexa and ovaries.

Always scan trans-abd AND trans vaginal

When in doubt, get a formal study!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Threatened miscarriage

A

just have bleeding

closed OS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

pain, OS may or may not be closed, bleeding, some tissue left behind

A

Incomplete miscarriage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

labs on pregnant ptds

A

CDC type and screen
STD

need to know if there is incompatibility
don’t want mom to build a response

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Quantitative beta hCG

A

Primarily used to trend an early pregnancy.ii. Indicates when we should see an IUP.

above 7500 -abd uLS
5000-transvaginal

if you have a completely early uterus with a Low HcG –> suspicious .

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

hcg for

A

iii. Ectopic pregnancies have been reported from 5-200,000 mIU.

with super high suspect molar pregnancies or multiple gestations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

threatened miscarriage

workup

A

Address the possibility of ectopic pregnancy, and include the patient in this discussion.

Standard labs include CBC, CMP, UA, STI testing, Rh status, and quantitative hCG for trending purposes.

iii. Ultrasound.
iv. 48-hour follow-up either in the ED or with an OB provider.
v. Strict return precautions.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what can you assess in a patient coming 30+ weeks pregnant with blleding and pain

A

gestational age
abruption
looking a

anything outside a labor and delivery suite is precipitous delivery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

two placental catastrophes

A

previa= over the cervix usually painless

abruption= part of the placenta has separated away from the uterine wall

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

classic abruption and sxs and dx tests

A

uterine cramping or pain with bleeding. Can occur from sheer forces as well

ULS not very sensitive for abruption

  1. CBC, type/crossmatch
  2. Coagulation profile
  3. Renal function studies

maternal wellness and fetal variability on fetal heart rate strips

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

RF for abruption

A
  1. MCC HTN
  2. Maternal trauma
  3. AMA
  4. Multiparity
  5. Smoking
  6. Cocaine use
  7. Previous abruptions

can go into DIC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what is the major problem with cord prolapse

A

deprieving oxygen and blood to the fetus

As uterus is contracting, there are decelerations which means the cord is being squeezed which means there are times baby is not getting O2 so there is a lack of circulation

need to elevate the presenting part

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

tx of cord prolapse

A

a. Elevate the foot off the cord and put pt in trendelenberg and take pt to the OR

Infusing the bladder with saline - although not as helpful if a presenting part is visible.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

how do you know is the cord isn’t in danger

A

success with pulsations in the cord

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

you do not want to pull the baby being delivered unitl

A
  1. DO NOT PULL until the umbilicus is delivered.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

should be delivered

A

Infant should deliver face down.

premi more likely to be breeched

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

presentation of shoulder dystocia

A

Buddha like faces – very plethoric, can appear purplish

“Turtle sign”

if the head comes out and back in

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

what could indicate a possible shoulder dystocia

A

Fetal macrosomia- is used to describe a newborn who’s significantly larger than average.

Precipitous delivery
 (less than 3 hours)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

how to resolve should dystocia

A

NO fundal pressure/hold pushing until repositioned.

knees to chest in the mom

Want suprapubic pressure and turn the baby to dislodge the shoulder

c section preferred

a. McRobert’s Maneuver
b. Suprapubic pressure
c. Delivering the posterior shoulder
d. Rubin, Woods Corkscrew
e. Zavenelli Maneuver

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

what are we worried about in houlder dystocia

A

Worry about brachial plexus injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Post-Partum Care

for devilry of the umbilical cord

A

Do not pull on the umbilical cord.

B/c it detaches and then the placenta stays up there. Can put you at risk for PPH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Postpartum Hemorrhage

A

atony of the uterus ( occurs when the uterus fails to contract after the delivery of the baby)

  1. Greater than 500 cc blood.
  2. Leading cause of obstetric death worldwide. In the US, second after VTE.

nipple stimulation will cause uterine contraction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Manual Interventions

Resuscitating PPH

A

Fundal massage (stimulates the uterus to contract down), explore for lacerations, manual uterine exploration for retained products

nipple stimulation will cause uterine contraction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

medical interventions FOr PPH

A

Oxytocin, methylergonovine (ergot alkaloid), misoprostil —> will cause vasoconstriction

Resuscitation with fluids and blood.

TXA (Tranexamic acid) now second-line.
1. Used for DUB and also used in PPH

makes you clot which isn’t ideal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

non pregnant cause of bleeding

A

i. Fibroids
vii. Infection
iii. Systemic disease
iv. Cancer
v. Dysfunctional uterine bleeding
vii. Look for symptomatic anemia.
viii. Consider evaluation for systemic illness.
perimenopause

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

fibroids

A

easy to detect on ULS

painful and heavy periods

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

contraception that can cause bleeding

A

a. Intrauterine device
i. Spotting and bleeding a known complication.
ii. Still check for pregnancy!

b. Hormonal therapies
i. Medroxyprogesterone
ii. Oral contraceptives
iii. Still check for pregnancy!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

assessment needs to cover

A

a. Pregnancy status: negative
b. Hemoglobin level: not anemic
c. Status of the os: closed and no lesions
d. Size of the uterus: no fibroids
e. Skin: warm, dry, without bruising
f. Mucosa: no petechiae or bleeding
g. Discharge instructions: follow-up and return precautions.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Vaginal bleeding summary

A

Vaginal bleeding is an ectopic until you prove it is not!

Look for ABNORMAL VITAL SIGNS!

c. Screen for vaginal trauma and intimate partner violence.
d. Think about systemic disease.
e. Educate your patient to ensure safe follow-up.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

screening for systemic disease in a female bleesing

A

CBC with smear, PT and PTT

Adolescents with menorrhagia: von Willebrand’s Disease

Secondary immune thrombocytopenias

SLE, antiphospholipid syndrome, thyroid disease

Viral associated thrombocytopenias:

HIV, Hep C, CMV

ITP: diagnosis of exclusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

when is estimating the gestational age inaccurate with fundal heigh and LMO

A

Multiple gestations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

how else can you estimate gestation age?

A

ULS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

how do you measure a BPD

A

Biparietal diameter

Measure perpendicular to the falx through that thalamus. Outer edge to inner edge of skull

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

pathogens in pyeo pregnancy

A

E.coli, Klebisiella, Group B strep.

increased risk in pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

what diseases are we worried about in pregnancy

A

STI
PYELO
PNA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

what does ALARA

A

ALARA: as low as reasonably achievable.

With respect to imaging

Risk highest in the first trimester and least in the third.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Higher rates of dissemination with this type of PNA in pregnancy

A

coccidyomycosis

48
Q

Higher rates of morbidity and mortality; complications to the fetus with this type of pNA in pregnancy

A

varicella

49
Q

High rates of respiratory failure with this type of PNA in pregnancyt

A

Influenza

50
Q

what do you need to know about the increase risk of appy in pregnancy

A

Perforation rates increase with trimester.

risk of perf incraeases with trimester and increases risk to the fetus

imaginign ULS and MRI first

51
Q

what test should be done to assess potential trauma to the fetus

A

Kleihauer–Betke

measures fetal hgb in mothers blood

52
Q 
new onset hypertension
excessive uterine size for dates
very elevated hCG levels
abnormal ULS
preeclampsia prior to 20 weeks
A

molar pregnancy

53
Q

evaluation of a premature rupture of the membrane

PROM

A

iii. Nitrazine Paper: amniotic fluid has a pH of 6.5/7 or higher.

and ferning pattern on smear
Ferning: arborization of salt crystals in amniotic fluid.

54
Q

when would a cervical exam be contraindicated

A

CONTRAINDICATED if you suspect placenta previa.

55
Q

RF for Peripartum Cardiomyopathy

A

hypertension
preeclampsia
multiple gestations, advanced maternal age, African descent
use of prolonged tocolytics

56
Q

sxs of preipartum cardiomyopathy

A

Peripartum Cardiomyopathy

57
Q

causes of

preipartum cardiomyopathy

A

Causes include autimiimune, virally mediated
cytokine inflammatry repsonse
stress of pregnancy, genetics, nutrition, myocite apoptosis, elevated prolactin levels

58
Q

approach to pregnant pt with dyspnea

A

Scrutinize the blood pressure, heart rate, and O2 sat.
Look for DVT.
Scan for PE if indicated.
Look for signs of heart failure.

59
Q

Three medication for managing preeclampsia

A

: labetalol, nifedipine, hydralazine.

60
Q

management of preterm labor

A

Tocolytics: Still given but not proven!

Calcium channel blockers now popular.
Do not use more than one agent
Corticosteroids: Proven! Give them!

Dexamethasone or betamethasone.
Fetal lung maturity.

Antibiotics: Proven, but only with ruptured membranes.
Increase the latency period in PPROM.

61
Q

pelvic pain in female ddx

A

PID, ovarian cysts, torsion, endometriosis
Renal stones, renal infections
Appendicitis, diverticulitis, hernia

62
Q

RF for ectopic pregnancy (6)

A
  1. Current intrauterine contraception (IUD)
  2. Hx of ectopic pregnancy, utero exposure to diethylstilbestrol
  3. Hx genital infxn, including PID, chlamydia, gonorrhea
  4. Hx of tubal surgery i.e. tubal ligation
  5. IVF, infertility
  6. Smoking
63
Q

ddx of ectopic pregnancy

A
  1. Acute appendicitis
  2. Miscarriage
  3. Ovarian torsion
  4. PID
  5. Ruptured corpus luteum cyst or follicle
  6. Tubo-ovarian abscess
  7. Urinary calculi
64
Q

presentation of ectopic

A
  1. Vaginal bleeding (only in 2/3 of pts!)
  2. Abdominal pain
  3. Normal or slightly enlarges uterus
  4. Cervical motion tenderness
  5. Hypotension/syncope
  6. Palpable adnexal mass
65
Q

mngmt of ectopic

A
  1. No evidence of tubal rupture
  2. Minimal pain or bleeding
  3. Starting B-hCG <1,000 and falling
  4. Ectopic or adnexal mass less than 3cm or not detected
  5. No embryonic heartbeat
  6. Then:
    a. Admit or discharge & follow serial hCGs
    b. Diagnostic laparoscopy
    c. Presumptive methotrexate
66
Q

Painless, bright red bleeding in 2nd or 3rd semester

what are you worried about

A

Placenta Previa

DON’T do a digital or speculum exam

iv. STAT abdominal U/S
v. Call OB stat for possible C/S

67
Q

pt comes in with chief complain of pain in 2nd or 3rd trimester and vaginal bleeding

on PE she has a Tender uterus
and Hypertonic, hyperactive uterine contractions

A

Premature separation of a normally implanted placenta from the uterine wall
ii. Often misdiagnosed at preterm labor

68
Q

Placental Abruption ddx

A

placenta previa

preterm labor

69
Q

complication of placental abruption

A
  1. Maternal death from hemorrhage or DIC
  2. Fetal death, fetal distress
  3. Fetomaternal transfusion
  4. Amniotic fluid embolism
  5. Hypotension
70
Q

rf for placenta abruption

A
  1. MCC HTN
  2. Maternal trauma
  3. AMA
  4. Multiparity
  5. Smoking
  6. Cocaine use
  7. Previous abruptions
71
Q

management of placental abruption

A
  1. Crystalloids to maintain volume status & FFP for coagulopathy
  2. Emergency OB consult whenever suspected!
  3. Stat U/S for fetal viability  emergency delivery
  4. Rhogam, tetanus
72
Q

Management of 1st trimester bleeding

A

Quantitative B-hcg >1800-2000
no sac on ULS
ectopic or SAB

U/S shows a gestational sac

  a.  Follow for threatened abortion 
   b. Consider subchorionic hemorrhage  
    hematoma b/w chorion &amp; uterine wall
73
Q

Bright endometrial stripe suggests on evaluation of 1st trimester bleeding

A

SAB

74
Q

Gestation sac >2cm should have a

A

embryo

75
Q

Embryo > 5mm crown rump should have a

A

Heart beat

76
Q

if fetal heart beat present in mother with 1st trimester bleeding

A
  1. <35yo mother  2% risk of miscarriage
  2. > 35yo mother  16% risk of miscarriage

pt stable
Follow serial quantitative B-hcg q 48hrs
Confirm quant B-hcg double in 48hrs
Confirm IUP when B-hcg >1800-2000

77
Q

CC of SAB

A

i. MCC chromosomal abnormalities (50-60%)
ii. AMA
iii. Prior poor OB hx  SABS, fetal demise, multiple gestations, uterine s/x
iv. Concurrent medical d/o  thyroid, DM, HTN, coagulopathies, P4 deficiency, SLE
v. Maternal infxn  HIV, syphilis, TORCH, GC/CT, UTI, vaginitis
vi. Exposures-> heavy metals, chemicals, tobacco, EToH, caffeine (>200mg/d)
vii. Meds antidepressants: paroxetine, venlafaxine

78
Q

MCC of bleeding during 1st trimester

A

SAB

79
Q

HELLP syndrome

A
  1. Hemolysis
  2. Elevated Liver Enzymes
  3. Low Platelet count

(Often no HTN +/- proteinuria )

80
Q

diagnoses of HELLP

A

CLINICAL

get
CBC, CMP, LFTs

81
Q

presentation of HELLP

A

N/V, viral like, generalized malaise

Epigastric pain, HA

** any pregnant woman who presents w/ malaise or viral type illness in 3rd trimester should be eval w/ labs asap!

82
Q

pe of HELLP

A

RUQ pain & tenderness  rupture of liver capsule= hematoma

83
Q

TX of HELLPO

A
  1. Prompt delivery of baby!
  2. Magnesium sulfate –> decrease risk of seizures
  3. Blood transfusions –> anemia
  4. DIC –> fresh frozen plasma
  5. Anti-HTN –> i.e. labetalol, hydralazine, nifedipine
84
Q

Causes of PID

A

i. Salpingitis, endometriosis, tubo-ovarian abscess, pelvic peritonitis
ii. Neisseria gonorrhea, chlamydia trachomatis (may have been asymptomatic)
iii. Untreated cervicitis

85
Q

RF of PID

A

i. Multiple sex partners
ii. Unprotected intercourse
iii. Hx of STIs
iv. Frequent vaginal douching
v. Younger age

86
Q

clinical findings with PID

A

i. Lower abdominal pain
ii. abnml vaginal discharge
iii. vaginal bleeding
iv. post-coital bleeding
v. dyspareunia
vi. irritative voiding sxs
vii. malaise, N/V

87
Q

PID PE

A

i. Lower abd TTP, abd guarding/rebound (peritonitis)
ii. CMT, uterine/adnexal TTP, adnexal mass or fullness (TOA)
iii. RUQ tenderness and jaundice

88
Q

labs for suspected PID

A

i. hcG–>ectopic, SAB
ii. saline/KOH wet mounts–> trich
iii. endocervical swabs –> GC/CT, HIV, HEP
iv. CBC, ESR, CRP, liver panel

89
Q

parenteral tx for PID

A

cefotetan or cefoxitin + doxycycline

Clindamycin or gentamycin

Ofloxacin or levofloxacin w/wo metronidazole

90
Q

Oral/outpt

A

cefotetan or cefoxitin + probenecid + doxycycline w/wo metronidazole

91
Q

alternative to doxy for PID

A

a. Azithromycin alternative to doxy

92
Q

viollin strings is a classic appearance for

A

fitz hugh curtis syndrome

93
Q

MC cystic growth in vagina

A

Bartholin Gland Cyst/Abscess

94
Q

tx for Bartholin Gland Cyst/Abscess

A

depends on size, pain, infxn

i. Home tx
ii. I&D, word catheter placement
iii. Abx if cellulitis is present
iv. Marsupialization if recurrent

95
Q

PID vs appy

A

PID: pain is NOT migratory
PID: pain is bilateral
PID: NOT associated with nausea and vomiting

96
Q

Sudden onset of severe unilateral pelvic pain or dull aching pain w/ sharp exacerbations

and vomiting

A

torsion

get formal U/S to look at flow

ii. Pt w/ ovarian mass
iii. Pt w/ pelvic adhesions

97
Q

tx of torsin

A

Adnexal torsion is a SURGICAL EMERGENCY

OR immedeatly

98
Q

Superficial cellulitis of breast tissue that results in breast pain, swelling warmth, erythema, malaise, fever, chills

A

Mastitis/Breast Abscess

99
Q

which populations do we usually see mastitis with

A

Often in first few wks of breastfeeding

Usually affects lactating women

100
Q

Caused by a blocked milk duct that didn’t empty during nursing

A

Stap aureus infxn

101
Q

RF for mastitis

A

i. Breast feeding
ii. Sore or cracked nipples
iii. Breastfeeding only one position
iv. Wearing tight fitting bra
v. Fatigue
vi. Previous hx of mastitis

102
Q

tx for mastitis if no response to anbxs

A

U/S if no response to supportive care or abx (mastitis vs abscess)

systemic emptying, anti-inflammatories, abx
Continue breast feeding!!

103
Q

what should be on your tray for ED delivery

A

2 large hemostats
scissors
cord clamp
towels

syringe for cord gas

104
Q

association between hypothermia and mortality

A

acidosis, respiratory distress, NEC, intraventricular hemorrhage

The smaller you are, the faster you lose heat. BIG problem less than 30 weeks

105
Q

A ruptured cyst can causes abnormal vital signs and an acute abdomen in sudden unilateral pain think

A

e. A ruptured cyst can causes abnormal vital signs and an acute abdomen.

Cysts that are >8 cm, multiloculated, or solid are concerning for malignancy

106
Q

chronic hypertension in pregnancy defined as

A

Defined HTN present before 20th wk of pregnancy or present before pregnancy

ii. Mild HTN: > 140-180/90-100
iii. Severe HTN: >180/100
iv. Major risk factor: development of preeclampsia or eclampsia later in pregnancy

107
Q

preeclampsia

A

Preeclampsia is characterized by hypertension, greater than 140/90 mmHg, on two occasions at least 4 hours apart and proteinuria ≥300 mg in 24 hours in patients
at 20 weeks’ gestation until 4 to 6 weeks after delivery.

108
Q

in the absence of proteinuria in a otherwise preeclampsic woman what can indicate this dx

A

In the absence of proteinuria, thrombocytopenia with platelet count less than 100,000,

elevation of liver enzymes twice normal,

new renal insufficiency with a creatinine of 1.1 or a doubling of serum creatinine,

pulmonary edema,

or new-onset mental status disturbances or visual disturbances can be used to make the diagnosis of preeclampsia.

109
Q

what are some sxs of Preeclampsia

A
  1. Facial edema, pulmonary edema, Ascites
    a. Unresponsive to rest in supine position
  2. BP > 160/110
  3. Progressive renal insufficiency (Cr >1.1)
  4. Cerebral or visual disturbances –> HA, scotomata
  5. Epigastric or RUQ pain
  6. Evidence of hepatic dysfunction–>transaminases doubled
  7. Thrombocytopenia
  8. Rapid weight gain (2lbs/wk)
  9. Hyperreflexia or clonus at ankle –>worrisome!
110
Q

Risks for preeclampsia

A
  1. Placental abruption
  2. ARF
  3. Cerebral hemorrhage
  4. Hepatic failure or rupture
  5. Pulmonary edema
  6. DIC
  7. Progression to eclampsia (one of four leading causes of maternal death)
111
Q

labs with preeclampsia

A
  1. CBC
  2. Platelets –> thrombocytopenia
  3. PT, PTT–> coagulopathy
  4. LFTS –> hepatocellular dysfunction
  5. Serum Cr/ CrCl –>decreased renal function
  6. 24hr urine –>protein
112
Q

in a CBC if you see increased HCT on a pt with preeclampsia what are you worried about

A

increased Hct signals indicate worsening vasoconstriction & intravascular volume

113
Q

what is eclampsia

A

i. Presence of convulsions/ grand mal seizures in a woman w/ preeclampsia NOT explained by a neuro d/o

114
Q

when is eclampsia most commonly seen

A

ii. Most cases occur w/I 24hrs of delivery

115
Q

what are the complications with eclampsia

A
  1. Musculoskeletal injury
  2. Hypoxia
  3. Aspiration
116
Q

tx of eclampsia

A
  1. Urgent OBGYN consult!
  2. Usually self-limited
    a. Not dangerous unless >20min
    b. Avoid delivery of baby
  3. Tongue blade, gentle restraints, airway, IV access, foley catheter, EKG
  4. Tx directed to initiation of Mg sulfate to prevent further studies

Emergency Medicine (28 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions