ABG - PH
7.35-7.45 mm HG
ABG - PaCO2 range
35-45 mm HG
ABG - PA02
80-100mm HG
ABG - BE
-2 - 3 MeQ/L
CBC: Hemoglobin (Hgb) -... [Show More] what is the normal range?
Normal Value: 14-17.5 G /DL
CBC: Hemoglobin (Hgb) - what do high and low values indicate?
High value = smoking?
Low value = anemia or blood loss?
CBC: Hematocrit - what is the normal range?
Normal value = 41-50%
CBC: Hematocrit - what do high and low values indicate?
High value = dehydrated?
Low value = anemia or blood loss?
CBC: WBC - what is the normal range?
Normal value = 4500-11000
CBC: WBC - what do high and low values indicate?
High value = infection, anemia, steroid use
Low value = viral infection or immunodeficiency
CBC: RBC - what is the normal range?
Normal value = 3.9-5.5 million mm3
CBC: RBC - what do high and low values indicate?
High value = polycythemia or high altitude
Low value = cancer or bone marrow suppression
Coags: PT - what does it measure & how long?
Coumadin anticoagulation
10-13 second
Coags: PT - what do high values indicate?
High values can indicate liver cirrohsis, vitamin K deficiency or DIC
Coags: INR
International normalized ratio. Normal INR = 1.0.
Coags: aPTT - what does it measure & how long?
Measures Heparin
25-40 second
OB: What are some physiological changes which occur in pregnancy?
-Blood volume increases 40%
-Plasma increases, showing false anemia on labs
-BP decreases in 2nd trimester, but returns to normal
-Cardiac output increases, up to 50%
-HR increases 10-15 bpm
-SBP increases
-Body becomes more insulin resistant
-Uterus enlarges 20x
OB: Physical assessment of pregnant patient
Palpate / Check vitals / Check FHT / Ask GP-PAL
OB: What is GP-PAL
Gravida, Para, Preterms, Abortion, Living children
OB: Tx for distressed fetus?
100% O2 via NRB on mother; place in LLR; give fluids for hypotension and perform external vaginal exam
OB: Vaginal bleeding - caused by?
Ovarian cysts, spotting, fetal loss, ectopic pregnancy or uterine rupture
OB: Vaginal bleeding - TX?
O2/IV/Monitor
Manage blood loss
Blood products
Tx for shock
Monitor FHT
OB: Gestational hypertension - TX?
Treat with:
-Beta Blockers like Labetalol
-Arterial vasodilators like Hydrolozine
-Consider seizure prophylaxis like 4G Mag over 20 min
OB: Pre-eclampsia - S/S & TX?
S/S = HTN with edema, neuro changes and clonus
TX = -Beta Blockers like Labetalol
-Arterial vasodilators like Hydrolozine
-Consider seizure prophylaxis like 4G Mag over 20 min
(Delivery is only option to stop condition)
OB: Pre-eclampsia - severe S/S?
BP >160/100
Pulmonary edema
Platelets under 100k
Headache/ vision changes
RUQ pain
Proteins in urine
OB: Eclampsia - S/S & TX?
S/S - HTN with seizures
TX - Magnesium -4G bolus over 2 minutes; 2G Mag bolus if already administered. Consider Midazolam (2-5mg IM) if seizure continues
OB: Placenta Previa - S/S?
Painless, bright red bleeding
No significant findings on abdomen exam
OB: Abruptio Placentae - S/S & TX?
Caused by Trauma, HTN, ETOH/drugs
S/S = tearing, abdominal pain, vaginal bleeding. In severe cases, hemorrhagic shock and rigid abdomen
TX = 100% O2 NRB, 2 IV's with volume replacement. Consider 4G Mag or steroid
OB: Uterine Rupture - S/S and TX?
S/S = sharp pain, hypovolemic chock, distention and possible bleeding
TX = LLR, 100% O2, IV's and 4G Mag bolus
OB: Prolapsed cord - TX
Knees to chest, don't push, 100% O2, Keep cord moist, consider manual displacement if needed. Consider Nitro infusion of 2ug/min or 4G Mag bolus
OB: Name the delivery presentations
Cephalic, vertex - normal presentation
Cephalic, face - head down, posterior, head not flexed
Complete breech - feet first, indian style
Incomplete breech - one foot presenting
Transverse - (non deliverable) Butt first or sideways
OB: Vitals at birth?
RR - 30-60
HR - 100-160
SBP - 50-70
BGC - over 70
OB: Post delivery hemmorhage - caused by?
Tissue
Trauma
Tone
Thrombin
OB: Amniotic Fluid Embolism - S/S and TX?
S/S = HX, trauma, coughing, AMS, Coughing, chest pain, restlessness, CVA symptoms, hypoxic
TX = Aggressive airway management with PEEP, Manage ABC's, Fluid replacement, consider Epi or SoluMedrol
OB: Magnesium
SMOOTH MUSCLE RELAXANT
-Neuro protection for baby
-seizure prophylaxis
Dose - 4G in 100ml D5W over 15 minutes, followed by 2G/hr infusion.
OB: Nifedipine
UTERINE SMOOTH MUSCLE RELAXANT
Dose - 10mg PO
*May cause hypotension
OB: Terbutaline
SMOOTH MUSCLE RELAXANT /STOPS CONTRACTIONS/ VASODIALATOR
Dose - 0.25mg IM
OB: Indomethacin
NSAID
Dose - 25-50mg PO
*Contraindicated in 3rd trimester
OB: Labetalol
Beta blocker / smooth muscle relaxant / antihypertensive
Dose - 20-40mg (300mg max)
OB: Betamethasone
Steroid
Dose - 12mg IM x2, 24 hours apart
OB: Dexamethasone
Steroid
Dose - 6mg IM x4, 12 hours apart
Contraindicated for preterm infants
OB: Oxtocin
10-20U added to 1000ml NS/ LR.
OB: Hemabate
Tx for PPH
Dose - 250mcg IM q 15 min
Vasopressor - used to treat ?
hypotension / increase MAP / cause vasodialation
Vasopressor - Vasopressin
Dose - 0.01U-0.06U/min
Vascocontrictor
Contraindicated for: hypertension
Vasopressor: Levophed
*gold standard for septic shock
VASOCONSTRICTOR
Dose - 1-5mcg/min mixed with D5W
RSI - What are the 7 P's?
Preparation
Preoxygenation
Pretreatment
Paralysis
Protection
Placement
Post intubation management
RSI Pharmacology - Sedative agent Etomidate
Dose - 0.3mg/kg (typical dose for pts over 70kgs is 20mg)
Onset - 10-15 seconds
Duration - 10 minutes
*Use caution in septic patients
RSI Pharmacology - Sedative agent Propofol
Dose - 5mg/kg
Onset - 10 minutes
Duration 5-8 minutes
Contraindicated for egg and egg product allergies
RSI Pharmacology - Paralytic agent Succinylcholine
Dose - 2mg/kg
Onset - 45 seconds
Duration - 10 minutes
*Use caution in crush patients and long code patients
Contraindicated for muscle disorders, hx of malignant hypothermia, hyperkalemia, ocular inuries
RSI Pharmacology - Paralytic agent Rocuronium
Dose - 1mg/kg
Onset - 1 minute
Duration - 40 minutes
*Need to consider post intubation sedation; Prop running at 5-70mcg/kg/min
Inotropes - used to treat?
CHF
Intrope: Digoxin
Dose - 1-2ng/ml
Indication: L sided heart failure, SV arrhythmias, AFib
Inotrope: Dopamine
SVR INCREASER THROUGH VASOCONSTRICTION
Dose - 3-5mcg/kg/ml
Indication: bradycardia, cardiogenic shock, decompensated CHF
Contraindicated for hypovolemic shock
Chronotrope: Atropine (+)
Dose - 0.5mg IV q 5
Indication: brady
Chronotrope: Adenosine (-)
Dose - 6mg, 12 mg follow up dose
Indication: SVT
Chornotrope: Amiodarone
Dose - 150mg IV over 10 minutes in 50ml bag of D5W
Beta blockers: treat?
Puts the breaks on the heart. Slows all aspects of heart function
Beta blocker: Metropolol
Dose - 5mg q 5
Indicated: HTN, CHF, angina, MI, Tachy
RSI - Ketamine
Dose - 1-2mg/kg
Onset - 30 seconds
Duration - 10 minutes
Beta blocker: Labetalol
Dose - 0.25mg/kg initial dose
Indicated: HTN
Inotrope: Dobutamine
Dose - 2-20mcg/kg/min
Indicated - decompensated CHF (cardiogenic shock)
Warfarin (Eliquis)
Indicated for: DIC, trauma, DVT, sepsis, fibrolynics
Dose - 2-10mg
Lovenox
Indicated for: MI, angina, thrombolynic therapy
Dose: 30mg IV bolus, then 1mg/kg SC.
Vent: A/C
Assist control - vent delivers full breath when patient attempts to breathe
Vent: SIMV
When patient breathes, vent only gives what they try to take (not full amount)
BIPAP
2 different pressures
- ventilates patient with COPD to get rid of increased CO2 and also oxygenate
- Emphysema, Chronic bronchitis are also indicated for this
LEMON
Used to determine difficult airways
L-Look externally
E-Evaluate 332
M-Mallampati
O-Obstruction/obesity
N-Next mobility
MOANS
Used to determine bag compliance
M-Mask seal good?
O-obstruction/obesity
A-Age over 50
N-No teeth
S-Stiff lungs
RODS
Difficult IGel Airway
R-Restricted mouth opening
O-Obstruction/obesity
D-Distorted airway
S-Stiff lungs
SMART
Difficult cric airway
S-Stiff neck
M-Mass
A-Access/anatomy
R-Radiation
T-Tumor
Surgical Airway Contraindications
Under 10 years
Cannot identify landmarks
Tumor
Severely damaged trachea
Coagulapathy
Lack of experience
Size tube for Cric
Shiley #6, or 6.0 ETT
What are S/S of ICP?
Cushing's Triad - Bradycardia, Widening Pulse Pressure (increased Systolic and decreased Diastolic), Cheyenne Stoke's Resp.
Seizures
AMS
Posturing
Hypovolemic Shock
Loss of blood or volume
Causes:
blood loss, 3rd degree burns, excessive V/D, acute pancreatitis, DKA
S/S: Decreased CO, Increased SVR, cyanosis and hypoxia
Hypovolemic Shock TX
Fluid replacement - LR or blood
Albumin
Keep warm
Cardiogenic Shock
Pump problem
Causes:
Myocarditis, MI TX, Congenital heart defects, arrhythmias, valve issues
S/S: Low BP, Low CO, High SVR, tachy
Cardiogenic Shock TX
Treat underlying cause
02
Small amounts of fluid
Vasopressors
Obstructive Shock
Caused by tension pneumothorax, pericardial tamponade, PE
S/S: Hypotension, hypoxia
Obstructive Shock TX
02, Vasopressors, fluids [Show Less]
