White - Test 2 Flashcards
Tension Headache
Mild to moderate headache, lasting 30 minutes to 7 days
Often bilateral, non-pulsating, and not aggravated by physical activity
Migraine
Recurrent moderate to severe headache, lasting 4 to 72 hours
Often unilateral, pulsating, and aggravated by physical activity
Associated with nausea, photophobia, and phonophobia
Musculoskeletal
Mild to moderate headache accompanied by neck and/or shoulder pain
Preeclampsia/Eclampsia HA
Hypertension and/or HELLP (hemolysis, elevated liver enzymes, low platelet count) syndrome
Headache often bilateral, pulsating, and aggravated by physical activity
Posterior reversible (leuko)encephalopathy syndrome “PRES”
Severe and diffuse headache with an acute or gradual onset
Possible focal neurologic deficits and seizures
Stroke (cerebral infarction/ischemia and subarachnoid hemorrhage) HA
Ischemic or hemorrhagic.
Cerebral infarction/ischemia: new headache that is overshadowed by focal signs and/or disorders of consciousness.
Subarachnoid hemorrhage: abrupt onset of an intense and incapacitating headache.
Often unilateral accompanied by nausea, nuchal rigidity, and altered consciousness.
Subdural Hematoma HA
Headache usually without typical features
Often overshadowed by focal neurologic signs and/or altered consciousness
Carotid artery dissection HA
Late developing headache that is constant in nature
Bilateral or unilateral location
Cerebral venous and sinus thrombosis HA
Nonspecific headache that may have a postural component.
Often accompanied by focal neurologic signs and seizures
Brain Tumor HA
Progressive and often localized headache
Often worse in the morning
Aggravated by coughing/straining
Idiopathic intracranial HTN (pseudotumor cerebri/benign intracranial HTN) HA
Progressive non pulsating headache
Aggravated by coughing/straining
Associated with increased CSF pressure and normal CSF chemistry
Spontaneous Intracranial hypotension HA
No history of dural trauma
Diffuse, dull headache worsening within 15 minutes of sitting or standing
Associated with neck stiffness, nausea, tinnitus, and photophobia
CSF opening pressure < 60 mm H2O in the sitting position
Pneumocephalus HA
Frontal headache
Often an abrupt onset immediately after dural puncture
Symptoms can worsen with upright posture
Meningitis HA
Headache is most frequent symptom
Often diffuse
Intensity increases with time
Associated with nausea, photophobia, phonophobia, general malaise, and fever
Sinusitis HA
Frontal headache with accompanying facial pain
Development of headache coincides with nasal obstruction
Purulent nasal discharge, anosmia, and fever
Caffeine Withdrawal HA
Onset of headache within 24 hours of cessation of regular caffeine consumption
Often bilateral and pulsating
Relieved within 1 hour of ingestion of caffeine 100 mg
Lactation Headache
Mild to moderate headache associated temporally with onset of breast-feeding or with breast engorgement
Ondansetron Headache
Mild to moderate headache associated with ondansetron intake
PDPH HA symptoms
Headache within 5 days of dural puncture
Worsens within 15 minutes of sitting or standing
Associated with neck stiffness, tinnitus, photophobia, and nausea
The hallmark of a PDPH is this postural component.
PDPH: contraindications to the administration of an epidural blood patch are related to complications of placing a needle in the central neuraxis or the injection of blood into the epidural space, they include:
- known coagulopathy (e.g., concurrent pharmacologic anticoagulation)
- local cutaneous infection or untreated systemic infection
- increased ICP caused by a space-occupying lesion
- patient refusal
A patient with postdural puncture headache experiences an ___________of symptoms when she moves from the horizontal to the upright position, possibly owing to __________ intracranial pressure and secondary cerebral vasodilation, which affect pain-sensitive intracranial structures.
increase, loss of
No therapies reliably prevent the development of postdural puncture headache after unintentional dural puncture with an epidural needle. T or F?
True
What is the initial therapy for postdural puncture headache?
Conservative treatment is indicated in the presence of mild-to-moderate discomfort, and includes: bed rest, hydration, and simple analgesics. Caffeine (500 mg intravenously or 300 mg orally) has also been used in the treatment of PDPH, but the therapeutic effect is transient.
The gold standard therapy for postdural puncture headache is?
Epidural blood patch.
**the classic presentation is sudden onset of a severe headache that is unlike any previous headache (“worst headache of my life”).
Subarachnoid hemorrhage
Amniotic Fluid Embolism: signs/symptoms and when it occurs?
Amniotic fluid embolism is rare and may occur during labor, vaginal, or operative delivery and it is occasionally associated with placental abruption.
Signs and symptoms of amniotic fluid embolism include: o Anxiety o Dyspnea o Hypoxia o Hypotension o Cardiovascular collapse o Coagulopathy
The pathogenesis of amniotic fluid embolism is likely related to what?
an anaphylactoid reaction to the amniotic fluid and not purely an embolic event.
Clinical management of amniotic fluid embolism?
Clinical management is supportive and includes airway management, hemodynamic resuscitation, and appropriate treatment of coagulopathy.
What is an Amniotic fluid embolism?
Amniotic fluid embolism is a rare catastrophic and life-threatening complication of pregnancy that occurs when there is disruption in the barrier between the amniotic fluid and the maternal circulation.
Causes of ischemic stroke include?
cerebral venous sinus thrombosis, preeclampsia/eclampsia, thromboembolism related to valvular heart disease, and profound and persistent hypotension (e.g. cervical arterial dissection, amniotic fluid embolism).
Preeclampsia: What is the hallmark and why do we treat it?
The hallmark of preeclampsia is an abnormal placentation-implantation.
Can lead to Disseminated Intravascular Coagulation “DIC”
Treatment for preeclampsia? (for seizures)
Magnesium sulfate is the anticonvulsant of choice because it is more effective and has a better safety profile than benzodiazepines, phenytoin, or lytic cocktails.
Management of Preeclampsia? (what should they do on the daily, what do you monitor, what do you want to control, and what do you want to prevent at all cost)
- Bed rest
- monitor BP, reflexes, weight, and proteinuria
- Control BP (diastolic < 90-100)
- Seizure prophylaxis by mag sulf
Management of Eclampsia? (4)
- Supplemental O2
- Mag sulf + benzo
- Monitor fetal status
- Initiate steps to delivery
Magnesium sulfate dose?
Magnesium 4–6 g IV followed by 1–2 g/h IV as a continuous infusion (goal is to maintain serum concentrations of 2.0–3.5 mEq/L)
Toxicity with mag sulfate?
7–10 mEq/L associated with loss of deep tendon reflexes
10–13 mEq/L associated with respiratory paralysis
≥15 mEq/L associated with altered cardiac conduction
>25 mEq/L associated with cardiac arrest
Epidural Anesthesia How much surgical anesthesia time does it allot you?
This combination normally results in approximately 90-120 min of surgical anesthesia.
What LA does not need sodium bicarbonate mixed with it?
Sodium bicarbonate cannot be added to bupivacaine as it results in precipitation when the pH is raised.
Multimodal analgesia?
The rationale of multimodal analgesia is the optimization of additive or synergistic effects of different modes of analgesia or drug classes, while reducing the dose and minimizing the side effects of individual drugs with different mechanisms of action.
What is Placenta accrete?
refers to a placenta that is abnormally adherent to the myometrium but has not invaded the myometrium.
-Placenta accreta is the most common indication for a cesarean hysterectomy.
What is Placenta increta?
the placenta has invaded the myometrium.
What is Placenta percreta?
is invasion through the serosa.
**When may hemorrhage occur with a delivery?
Massive hemorrhage may occur when removal of the placenta is attempted after delivery.
**Peripartum hemorrhage remains a leading cause of maternal mortality worldwide.
What is Placenta Previa and what are the clinical signs?
occurs when the placenta covers the cervix.
- The classic clinical sign of placenta previa is painless vaginal bleeding during the second or third trimester (the lack of abdominal pain and/or absence of abnormal uterine tone helps distinguish placenta previa from placental abruption)
If the placenta does not seperate easily, what may occur?
- If the placenta does not separate easily, placenta accreta may exist. In such cases, massive blood loss and the need for cesarean hysterectomy should be anticipated.
What is placental abruption?
complete or partial separation of the placenta from the decidua basalis before delivery of the fetus.
Criteria for the diagnosis of preterm labor include?
gestational age between 20 and 36 weeks’ gestation and regular uterine contractions accompanied by a change in cervical dilation, effacement, or both (or initial presentation with regular contractions and cervical dilation of 2 cm or more)
less than 10% of women with the clinical diagnosis of preterm labor actually give birth within 7 days of presentation
Tococolytic treatment?
The ACOG has stated that evidence supports the use of tocolytic treatment with beta-adrenergic receptor agonist therapy, calcium entry blocking agents, or NSAIDs for short-term prolongation of pregnancy (up to 48 hours) to allow for antenatal maternal corticosteroid administration.
