Flashcards in SEE exam Questions Deck (156)
What is placenta accreta?
adherence to the myometrium WITHOUT invasion of or passage through uterine muscle
What is placenta increta?
INVADES and is confined to the myometrium
What is placenta percreta?
INVADES and may PENETRATE the myometrium, the uterine serosa, or other pelvic structures
If mom has had a previous c-section or had uterine trauma, she is at risk for developing placenta _________.
accreta; the more c-sections the > the incidence.
Are the MRI and ultrasonography good indicators for the diagnosis of placenta accreta?
NO; they are poor
What is the MOST common indication for obstetric hysterectomy?
placenta accreta; most cases require cesarean or post partum hysterectomy without delay
What is the key anesthetic consideration for intra-op management during a case involving placenta abnormalities?
When is the APGAR scoring performed?
at 1 minute and again at 5 minutes
An APGAR of _______ is considered normal.
An APGAR of _______ is considered moderate distress or impairment.
An APGAR of _______ is considered to indicate need for immediate resuscitation.
How many parameters does the APGAR score include?
What are the 5 parameters for APGAR scores?
HR, respiratory effort, muscle tone, reflex irritability (nasal catheter, suctioning, etc), and color
How do you score an infant's APGAR?
Either give 0, 1, or 2 on each parameter.
HR: none is 0; 100 is 2
resp effort: none is 0; irregular or shallow is 1; robust or crying is 2
muscle tone: none is 0; some flexion is 1; active movement is 2
reflex irritability: no response is 0; grimace is 1; active coughing or sneezing is 2
color: cyanotic is 0; acrocyanotic (trunk pink, ext blue) is 1; pink is 2
When is hyperreflexia seen?
in 85% of spinal cord injury patients with lesions above T5; occurs when the hypothalamus and brainstem can no longer modulate segmental spinal sympathetic nerves and thereby inhibit their output--> acute phase has diminished sympathetic activity--> sympathetic activity returning to viable cord below the lesion is isolated from upper inhibitory control
What are signs of hyperreflexia?
paroxysmal HTN, bradycardia, and cardiac dysrhythmias in response to stimulation below the level of transection (bladder cath, childbirth)
Is hyperreflexia seen immediately after injury?
No, it is not seen until the spinal shock phase has passed (usually after 2 to 3 weeks of spinal cord injury)
How do you treat autonomic hyperreflexia?
remove stimulus, deepen anesthesia, and administer direct acting vasodilators (Na nitroprusside is reliable/rapid/titratable, but continuous monitoring of cyanide toxicity; Nifedipine can be sublingual/quick onset/relatively short duration, but unreliable and delayed absorption; BEST is NICARDIPINE which is primary arterial dilator, whereas Na Nitroprusside is veno and arterial); bradycardia is treated with atropine or glyco
What happens to untreated autonomic hyperreflexia?
HTN crisis may progress to seizures, intracranial hemorrhage, or MI
What spinal lesions are usually associated with autonomic hyperreflexia?
lesions above T5 tend to be associated with AH because the majority of spinal sympathetic efferents arise below this level; below T10 are NOT associated with AH
What are some side effects seen after fasciculations caused by succinylcholine administration?
myalgia, myoglobinemia (RARE), elevated intragastric pressure, elevated ICP
When should a burn patient not receive a dose of succinylcholine?
after 24 hours following the burn
Why does fasciculation occur after administration of succinylcholine?
b\c is it a depolarizing muscle blocker; AcH-like drug binds with the nicotinic receptor at skeletal muscle nerve endings and causing depolarization
How many cervical vertebrae are there?
How many thoracic vertebrae are there?
How many lumbar vertebrae are there?
How many sacral vertebrae are there?
How many coccygeal vertebrae are there?
What is P50 and what is the normal #?
P50 is the partial pressure of oxygen at which Hgb is 50% saturated by oxygen; normal is 26-27mmHg