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by what % is the FRC reduced in pregnancy?
20%
diaphragm is dislace cephalad about 4 cm
small airway closure is possible
In the pregnant pt, the inspiratory capacity, total lung capcity and vital capacity are:
unchanged due to compensatory increases in thoracic anteroposterior diameter
the pregnagnt pt has a respiratroy acidosis or alkalosis?
alkalosis (paCO2 = 30mmHg); but excretion of bicarb keeps pH normal
Would you anticipate the PaO2 to be higher in the pregnant or nonpregnant pt?
pregnant
TV increases by ____% and RR increases by ____%
this causes an overall increase in alveolar ventialtion by ___%
TV:40%
RR: 15%
Alv. Vent: 70%
uptake of inhaled anesthetics is enhanced
pregnant women will desat quickly.  Why?
Decreased FRC
If the mother is hyperventilating, is the fetus at risk?  Why?
yes. because hypocarbia causes uterine vasoconstriction, causing a decrease in placental perfusion
O2 consumption increases by _____% during pregnancy
20%
there is a ____ increase in blood volume and how does this affect BP?
35%, but BP is not increased due to decreased peripheral vascular resistance
at what point is cardiac output the greatest in the pregnant pt?
after delivery
CO to the uterine vascularture is _____m;/min
700
A healthy patrurient can tolerate up to _____ml blood loss
1500
maternal BP should be kept >____mm Hg during regional block to assure uterine blood flow
90-95
list the coagulation factors that re increased in pregnancy:
I, VII, VIII, IX, X, XII
list the coagulation factors that re decreased in pregnancy
XI, XIII
increased level of circulating progesterone can do what to the GI system in pregant women?
  • decrease motilit: prolonged emptying
  • decreased lower esophageal sphincter tone
pregnant women are prone to Mendelson's syndrome.  why?
pregnant women are prone to gastric reflux (increased gastric pressure)
Mendelson syndrome: chemical pheumonitis from aspiration during anesthesia
why are pregnant women considered full stomachs?
  • Prolonged gastric emptying time
  • decreased lower esophageal sphincter tone
  • increased secretion of gastric acid: ↑ gastric pressure
  • pylorus is pushed upward and backward causing increased emptying time
  • gastroesophageal angle is changed so reflux is increased
how much is MAC reduced in a pregnant pt?
15-40%
*remember: rate of induction is increased
HOw many microscopic tissue layers are found in the placental membrane
Three:
  • Fetal trophoplasts
  • fetal connective tissue
  • endothelium of the fetal capillaries
when doe th esecond stage of labor occur and what dermatones must be blocked for pain relief?
from end of first stage until delivery is completed
pudendal nerves (S2-4) innervate the perineum, so T10-S4 dermatones need to be blocked
Pian during the first stage of labor is at what dermatones?
pain is mostly due to contractions and cervical dilation: initially T11-12 and then progresses to T10 to L1
what is the most commonly used IV pain med in labor
Demerol (meperidine)
what 2 IV narcotics given for labor pain will not have cause a cummulative respiratory depression
Nalbuphine
Butorphanol
-both are partial agonists
can NSAIDS be used for labor pain?
not recommended b/c can suppress uterine contractions and promote colosure of fetal ductus arteriosus
painless vaginal bleeding during second or third trimester is symptom of?
placenta previa (placenta lies over cervical os)
Is regional anesthesia appropriate for pt undergoing a C section with placenta previa?
yes, if fluid resuscitation is complete
make sure you know how much blood pt has lost due to vaginal bleeding; coagulopathy is common and may need blood component therapy
what is the classic prsentation for placental abruption?
painful vaginal bleeding
placental abruption is when the placenta separates from the _______ before delivery of the fetus
deciduas basalis
what is the definitive treatemnt for placental abruption?
delivery of the fetus
can pt be given an epidural for a csection if they have placental abruption?
if there are any concerns iwth volume of coagulation, then no epidural
(pt can be hemmorhaging)
most of the bleeding in placental abruption is from the
exposed decidual vessels
what is the most common indication for obstetrical hysterectomy?
placenta accreta
this level of block needed to be secured for a c-section
T4
Neonatal depression at birth is not caused by which of the followng: maternal HTN, trauma, drugs, prematurity
Maternal hypertension
most common cause of neonatal depression during labor?
intrauterine asphyxia
what is the etiology of variable decelerations during labor?
cord compression
how do you know if fetal asphyxia is present durign labor?
variable decels that:
FHR<60bpm
Decels last >60 seconds
pattern persists for 30 minutes
what are the following lab values ass. with DIC:
plt
Thrombin time
prothrombin time
PTT
fibrin degradation products
plt: <50,000
Thrombine: >100 sec
PT: >100sec
PTT: >100 sec
Fibrin degraddation prod: >200
red blood cell fragemntation is present
what type of FHR declerations signals uteroplacental insufficiency and fetal compromise?
Late Decels: there is a ↓ in arterial oxygen tension at chemoreceptors or the SA node
start 10-30 second after the contraction
are severe if FHR decreases by more than 45 bpm
when mg sulfate is used to treat preeclempsia, what si the goal plasma level?
4-8 (normla is 1.5-2)
at what Mg level will ECG change be seen (prolonged PQ and widened QRS)
5-10
SA and AV node will be blocked at what MG level and when will cardiac arrest occur?
15, resp. arrest will also occur at this level
cardiac arrest: 25
list the factors that can cause decrease uterine blood flow
  • supine postition
  • hemorrhave/hypovolemia
  • drug-induced hypotension
  • hypotension during sympathetic blcokade
  • vena cava compression
  • uterine contracitons
  • drug-induced uterine hypertonus (oxytocin, locals)
  • skeletal muscle hypertonus (Sz, valsalva)
  • catecholamines (stress)
  • vasopressin
  • vsopressors, epinephrine, local anesthetics (high conc.)
Pain pathway during:
first, second and third stage of labor
First: visceral afferent fibers accompanying sympathetic nerves and enter SC at T10-L1
Second: pain travels via the pudendal nerves and enter SC at S2-4
what drug used for IV labor pain relief is associated with fetal depression at doses >1mg/kg?
Ketamine
dose is 10-15 mg IV
Large doses can also cause hypertonic uterine contractions
why would IV Fentanyl not be a drug of choice for labor pain?
maternal respiratory depression can outlast the analgesia
dose is 50-100 mcg
what is the max dose for IV Demerol
100 mg
usual dose is 10-25 mg IV
25-50 mg IM
why would IV phenergan not be drug of choice for labor pain
pain at injcetion site
dose 50-100 mg IM
what 2 drugs can be used in conjunction when given IM or IV for labor pain?
demerol and phenergan (promethazine)
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