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Classic triad of AFE
Amniotic fluid embolism
- 1. Hypoxia
- 2. hemdynamic collapse
- 3. coagulopathy without obvious precipitated cause
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What is the primary factor that determines the diagnosis of AFE?
Speed of onset of symptoms
Right heart failure is the principle hemodynamic alteration
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Hallmark sign of Venous Air Embolism
Mill-wheel murmur over the precordium
Chest pain, dyspnea, decreased EtCO2, elevated CVP
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What are non-reassuring fetal heart rates?
< 60 or > 160
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Placenta previa definition
- Painless vaginal bleeding with the
- placenta covering all or part of the cervix
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Three types of placenta previa
- Marginal (partial)
- Complete
- Low-lying
Marginal and complete must have C-Section.
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Double set-up
- Monitors
- (2) 16 or 18 g PIVs
- Blood pump IV set primed
- 2 units blood in the room
- Bicitra
- oxygen
- skilled assistant
- sterile prep and drape
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IF the patient is bleeding and needs a C-section, what anesthetic drugs should you choose?
- Induce with ketamine (1mg/kg) and succ. (1.5mg/kg)
- Use cricoid pressure
- awake extubation
- 50% N2O and O2
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Placenta Accreta definition
placental implantations directly onto or into the myometrium giving rise to one of three conditions
Incidence increases with uterine incisions
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Placenta accrete vera
placenta implantation just onto the myometrium
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Placenta increta
placental implantation into the myometrium
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Placenta percreta
Placental implantation penetrating the myometrium thru the full thickness of the myometrium and possibly onto other abdominal contents
Methotrexate after delivery may facilitate placental involution
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Abruptio placenta
separation of normally implanted placenta after 20 weeks and before birth
Painful vaginal bleeding!!!
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How much blood can be sequestered in the uterus?
2500 mls
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Name the classifications of abruptio placenta
- Concealed
- Marginal
- Complete
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What is the major fetal risk with abruptio placneta?
Fetal hypoxia
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What is the definitive management of abruptio placenta?
Empty the uterus
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Uterine rupture most reliable sign
Fetal distress- non-reassuring heart tones with variable decels
- other S&S:
- vaginal bleeding, severe uterine or lower abd. pain, shoulder pain, severe maternal hypotesion/shock, loss of fetal heart tones
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Early decelerations
Usually begin
shows fetal head compression with descent into canal
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Deceleration
Fetal heart rates changes with contractions
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Late decelerations
fetal heart rate decreases after the contraction is over
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Variable decelerations
- Fetal heart rate decreases not correlated with contractions
- Umbilical cord compression usual culprit
- Usually not bad unless FHT <60 or >160
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Fetal bradycardia
Omnious sign
Emergency!
Left or right uterine displacement then Oxygen then fluids then ephedrine
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Postpartum hemorrhage
Defined as blood loss greater than 500ml after delivery, or as a 10% decrease in HCT from admission to the postpartum period or need to administer PRBC
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Primary postpartum hemorrhage
- occurs during first 24 hours after delivery
- more likely to result in maternal morbidity or mortality
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secondary postpartum hemorrhage
occurs between 24 hours and 6 weeks postpartum
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What can you give to relax the uterus if exploration is necessary?
- benzodiazepines
- ketamine
- inhalational anesthetics
- opioids
- 50-100 mcg NTG
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What is the main goal with uterine inversion?
Get it back inside before the cervix begins to contract
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TRALI
Transfusion related acute lung injury
- Non-cardiogenic pulmonary edema from leukocyte antibodies a few hours after transfusion
- Reactions most commonly caused by ABO incompatible blood
Fever, chills, nausea, flushing, chest and flank pain
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What can you give to get potassium back into the cells?
- Insulin/glucose
- albuterol
- bicarb
- kayexlate
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What can you give to combat the citrate in the PRBCs?
Calcium chloride
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Placenta previa has abnormal placental _________
postioning
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Placenta accreta has abnormal placental ________
implantation
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Abruptio placenta has _________ of the placenta with the uterus
interruption
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5 ratings of apgar scale
- A-appearance (skin color)
- P- pulse
- G- grimace
- A- activity
- R-respiration
Ratings at birth and 5 minutes
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