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116 Cards in this Set
- Front
- Back
Cephalic, breech and shoulder are potential:
A. lie B. Position C. presentation |
c
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Cephalic presentation can be judged by degrees of neck flexion. Name 3 kinds of cephalic presentation?
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1. Brow
2. vertex 3. face |
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The alignment of maternal spine to fetal spine is:
A. presentation B. lie C. position |
B
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What term describes the relationship of a specific bony part to the mom's pelvis?
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position
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In vertex position, what part is down?
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occiput
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facial presentations have what position?
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Mentum
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Breech presentations have what position?
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sacrum
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Shoulder presentations have what position?
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acromion
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Name 3 reasons Occiput presentations are important:
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1. put more pressure on sacral nerve
2. can prolong labor and increase discomfort 3. watch for shoulder dystocia |
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3 anesthetic considerations for Occiput posterior position?
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1. Add lipid sol opioids (fentanyl) to local
2. regional tech. should NOT paralyze perineal muscles 3. want T10-L1block |
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Name 3 types of breech presentation.
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1. complete
2. incomplete 3. frank |
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Which type of breech presentation is most common?
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frank
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Which type of breech presentation is most associated with cord prolapse?
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incomplete
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For an elective CS d/t breech presentation, what techniques can be used?
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GA or RA
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For vag delivery of breech presentation, what techniques can be used?
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epidural analgesia
(remember dont want to parlayze perineal muscles) |
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which method of delivery has the lowest risk of adverse outcomes in breech presentations?
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planned CS
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Which method of delivery has higher risk of poor outcomes for breech presentation babies: CS or vag?
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vag
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Name 2 anesthetic emergencies to consider when faced with breech presentation?
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1. fetal head entrapment ( before 32 weeks)
2. uterine hypertonus |
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RSI with 2-3 MAC IA will produce uterine relaxation in how long?
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2-3 min
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For emergent uterine relaxation, what drug can be used?
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NTG50-100 mcg at a time
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For external version of breech presentation, more pain = (more or less) success?
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less
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Chances for external version success is better if:
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presenting part not in pelvis, normal amt amniotic fluid, fetal back not posterior, pt not obese, or pt ruptured or dilated
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7 potential fetal hazards with multiple gestations
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1. preterm delivery
2. congenital abnormalities 3. polyhydramnios 4. cord prolaspe 5. cord entanglement 6. IUGR 7. malpresentation |
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Maternal risks with multiple gestation pregnancies?
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1. PROM
2. PTL 3. prolonged labor 4. abruption 5. operative delivery 6. uterine atony |
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Anesthetic consideration for mult gestation pregnancies/vag delivery
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1. Vigilance!!!!
2. LUD important-at ^ risk aortocavl compression 3. Need large bore IV Need to be in OR so can CS emergently |
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Name 3 maternal factors contributing to the ^ CS rate:
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1. increasing # of nullip moms
2. ^ obestiy 3. increasing maternal age |
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Name 5 obstetric factors contributing to ^ CS rate:
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1. more inductions
2. fewer vag breech deliveries 3. less forceps use 4. fewer TOLACs 5. ^ availability in undeveloped countries |
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Name 3 fetal factors contributing to ^ CS rate:
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1. more macrsomia
2. more multiple gestations 3. EXIT procedures |
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Name 4 practice envirnment factors contributing to ^ CS rate:
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1. malpractice concerns
2. FHR monitoring 3. convenience 4. concern for pelvic floor injury |
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Name 4 fetal reasons for CS?
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1. macrosomia
2. malpresentation 3. cord prolapse with bradycardia 4. nonreassuring fetal status |
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6 maternal reasons for CS?
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1. dystocia
2. precclampsia 3. active herpes 4. chorioamnionitis 5. hemorrhage 6. cardiac or pulm dz |
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Reasons for EMERGENT CS?
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1. uterine rupture
2. mom in danger 3. severe PIH 4. severe fetal distress |
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T or F: cord prolapse is an indication for emergent CS.
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F: only if baby is bradycardic
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T or F: severe PIH with normal plt count is emergency indication for CS.
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F: only if plt count low
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Which of the following are indication for GA with CS?
A. pt refusal to cooperate with neuraxial B. failure of neuraxial C. need urgent, not time for neuraxial |
all are
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Which has higher risk for death: vag or CS?
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CS
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optimal uterine incision to delivery time is?
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<90 sec
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a uterine incision to delivery time of 90-180 sec means?
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neonate compromised
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Lower APGARS, and fetal acidosis are seen with uterine incision to delivery times of how much?
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>180 sec
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Which is more effective for denitrogenation: 4 deep breaths over 30 sec or 8 DB in one minute?
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8 DB over 1 min
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Why is dextrose not used in parturients?
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Can cause fetal hypoglycemia
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Correct time to give Bicitra?
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< 30 min prior
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ranitidine is given to GA CS pt for?
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lower acidity/raise pH of gastric secretions
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reglan is given to GA/CS pts to?
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increase LES tone and ^ gastric motility
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ATB can be administered o GA CS pt when? Choose all that apply
A. before incision B. intraop C. after cord clamping D. When I feel like it |
A, C
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Thipental in preg: dose, peak, Cross placenta?
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4 mg/kg, readily crosses. Peaks 1-2 min
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Ketamine in preg
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1mg/kg, crosses placenta, but no bad effects, no resp depression
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Etomidate in preg
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.2-.3 mg/kg, ^ n&V, can potentiate seizures, watch for adrenal insufficiency, depresses cortisol prod in babies
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Midazolam in preg
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crosses placenta, causes neonate depression, .3 mg/kg induction dose, limited use
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Sux in preg
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1-1.5 mg/kg, agent of choice, intubating conditions in 45 sec. small amts cross placenta
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What drug can prolong sux blockade?
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Reglan
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Alternate agent for RSI in preg moms?
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Roc-.6-1.2 mg/kg
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Which NMB should be avoided in HELLP syndrome?
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Vec Liver metab)
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Which of the following ar ereasons for failed intubation in preg moms?
A. airway edema B. obesity C. large breasts |
All are
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LES tone is (increased or decreased) during preg?
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decreased
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Which of the following contribute to increase intragastric pressure?
A. sux fasciculations B. uterus pushing up C. lithotomy position D. obesity |
All are correct
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Drugs used during labor that can ^ N&V include:
A. Mg B. tocolytics C. ergots D. prostaglandins |
All are correct
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Hallmark sign of aspiration:
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hypoxia on room air
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Two conditions that can cause fetal hypoxia
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1. hypotension
2. maternal hyperventialtion |
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Why is LUD important?
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prevents aortocaval compression
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The higher the MAC, the ( more or less) uterine tone?
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less
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Most common cause of maternal mortality in CS with GA?
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failed intubation or aspiration
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How much circoid pressure?
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10 N before asleep
30 N after asleep |
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Reglan effects are antagonized by:
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atropine
opioids |
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Does reglan cross placenta barrier?
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yes
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Best time for cardiac surgery in preg mom?
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2nd trimester
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Moms with transplanted hearts will respond to atropine: T or F?
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False (denervated heart)
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What kind of drugs will produce chronotropic and inotropic effects in transplanted hearts?
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direct acting sympathomimetics ( isuprel)
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What is recommended anesthesia technique for mom with tranplanted heart?
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epidural
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methergine can do what to coronary vessels?
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cause spasm
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preferred pressor in cardiac /preg pt?
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neo
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vasopressors ( epi, vasopressin, dopa) do what to uterine blood flow?
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decrease it
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CO increases by how much during preg?
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40-50%
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pregnancy causes decrease in what HD parameters?
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PVR, SVR
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Time of greatest change in CO related to preg/labor/delivery?
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Postpartum ( goes up 75% more thatn predelivery)
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Management goals for AI in preg mom?
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no aortocaval compression, normal to slightly ^ HR, prevent ^ SVR, avoid myocardial depression
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Which anesthetic technique recommended for AI mom?
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epidural
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Pts with PPH shouldn't receive neuraxial anesthesia. Why?
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Cant tol decrease in SVR d/t sympathectomy
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pts with Marfans syndrome can have
A. dural ectasia B. Cspine instability C. increased risk of Ao dissection D. pulm stenosis |
A, B, C
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L-R shunt causes?
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high pulm low
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Can pts with Eisenmengers syndrome tol preg?
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no-counseled to term
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Why is preg bad for pts with L-R shunt?
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can't tol drop in SVR-this increases hunt
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Most common cardiac condition you will deal with in preg pts?
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MVP
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leading cause of neonatal mortality?
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Preterm labor
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Threshhold of viability is?
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22-24 weeks
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period of greatest vulnerability in fetal development?
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15-56 days
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Is any anesthetic agent a proven teratogen?
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No
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Neostigmine should be given with which anticholinergic during pregnancy?
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Atropine ( no fetal bradycardia, crosses placenta)
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What effect does maternal hyperventialtion have on baby?
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vasoconstriction of umbilical vessels
shift fetal O2dissoc. curve left |
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Epi and levo do what to uterine blood flow?
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decrease it
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maternal hypotension does what to UBF?
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decreasesit
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Tx for maternal hypotension: Neo or ephedrine?
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ephedrine
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Most common non OB surgeries in preg pts?
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appy/chole
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Laparoscopy can do what to UBF?
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decrease it d/t ^ intraabdominal pressure
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When should anesthetist start mainaining LUD?
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18-20 wks
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Why are steroids given to moms in preterm labor?
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speeds fetal lung maturity
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Example of prostaglandin synthetase inhibitor used for tocolysis?
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indocin
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MOA of terbutaline?
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beta adrenergic agent taht hits beta 1 and 2 ( only 2 results in uterine relaxation, 1 causes tachycardia)
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MOA of procardia as tocolytic?
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prevents release of Ca from sarcoplasmic reticulum-no calcium, less muscle contraction
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What is the main goal of tocolysis?
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get 2-7 days more intrauterine time-time to get mom steroided up and to a facility that can care for preterm infant
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anesthetic technique of choice for preterm vag delivery?
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continuous epidural infusion
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Does mom need to be fully dilated to deliver preterm baby?
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No- 6-7 cm may be enough for small baby
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Why should CS deliv be avoided for preterm delivery?
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anesthetic further depress already compromised baby
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PPTL spinal dose:
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lido 75 mg with fent 10-25 mcgs
OR bupiv 7.5 mg with fent 10-25 mcgs |
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PPTL epidural dose:
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(after negative test does)
3% choroprocaine with fent 50-100 mcgs |
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If using GA for PPTL, is an LMA appropriate?
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NO! always intubate-aspiration risk still there
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Spinal level needed for PPTL?
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T4 ( tugging on peritoneum)
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Laparoscopy disadvantages: 2 major?
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1. fetal acidosis from absorption of CO2, trauma from trocar
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Leading cause of maternal death?
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hemorrhage
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Major maternal risks during preg?
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difficult intubation, aspiration
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Is Nitrous teratogenic?
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maybe in animals...
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4 MAJOR things to avoid in aneshtetic management of moms:
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1. hyperventilation
2. hypoxemia 3. hypotension 4. acidosis |
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Preterm babies: high risk of which complictions?
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acidosis, ICH
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Terbutaline can cuase which o fhte following?
A. pulm edema B. hypotension C. hyperglycemia D. hypokalemia |
All are correct
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How long does need for reduced MAC last after delivery? (important if doing PPTL)
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12-36 hours
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When does reflux risk return to normal after delivery?
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second PP day
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