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Call poison control.  Check urine toxicology for co-ingestions esp. salicylates , acetaminophen. Get an EKG. Pay special attention to QRS, QTc, PR Beware QRS on EKG> 0.10 sec; VT, VF, myocardial depression can ensure (Q on T phenomenon) Evaluate if ICU admi...

Call Poison control ABCs, vital signs, Tele monitor Diagnosis EKG, CXR, head CT if suspect cerebral hemorrhage.  Labs: Urine toxicology, CBC, electrolytes, glucose, CPK, UA for myoglobin, lactic acid, Troponin, Pregnancy test. Management For tachyarrhy...

Effects CNS - sedation and respiratory depression, seizures w/ meperidine, propoxyphene and dextromethorphan (Esp. in renal insult) Pulmonary - acute noncardiogenic pulmonary edema Diagnosis H&P (pinpoint pupils, CNS and resp. depression) Response to nalo...

Symptoms depend on CO level (carboxyhemoglobin) CO: 20-40%: Dizziness, headache, weakness, disturbed judgement, decreased visual acuity CO: 40-60%: Tachycardia, tachypnea, ataxia, syncope, seizures CO: >60%: Coma, death Diagnosis To get CO level, get ABG ...

The first visit of prenatal care typically occurs in the first trimester. The frequency of follow up is based on the individual needs and assessment of risks.  In General, this is what we follow: Risk assessment and patient education is initiated at the firs...

Initial Visit or First trimester visit: Prenatal Panel: CBC, GC/Chlamydia, HIV, Rubella, RPR, HBsAg, UA, Urine culture, Blood type, Rh (D), Antibody First trimester screening between 10 weeks to 13 6/7 weeks of pregnancy Pap smear at 21 y.o and older, if in...

Step 1: Document First day of the last normal menstrual period then use Nigel's rule or use uptodate EDD calculator to estimate EDD If pregnancy resulted from assisted reproductive technology (ART), the ART-derived gestational age should be used to assign t...

These are ways used to establish fetal well being: Fetal movement count Non-stress test Contraction stress test Amniotic fluid index BPP Fetal survey for anatomy and growth Umbilical artery doppler velocimetry These test are used to follow: GDM IUGR ...

Definition Sonographic EFW <10th percentile Etiology Maternal factor: Behavioral (smoking, substance use, decrease nutritional intake), Medical (Diabetes, HTN, renal insufficiency, autoimmune), extreme of maternal age Fetal factor: Chromosomal or genetic c...

Contraindications: Gestational age <24 weeks Interpretation: >32 weeksReactive NST: two fetal heart rate accelerations within a 20-minute interval, peaking at least 15 beats per minute above the base line and lasting 15 seconds  <32 weeks Reassuring for g...

The contraction stress test is interpreted by the presence or absence of late fetal heart rate decelerations. Negative: No late or significant variable decelerations. Positive: Late decelerations following 50 percent or more of contractions (even if th...

Scoring: The non stress test (2), fetal breathing movement (2), Fetal tone (2), Fetal movement (2), amiotic fluid (2) Eight to ten is usually considered normal. Six is considered equivocal (uncertain). Four or less is considered abnormal. To ge...

BASELINE FHR The normal FHR range is between 120 and 160 beats per minute (bpm). The baseline rate is interpreted as changed if the alteration persists for more than 15 minutes. FHR VARIABILITY Prematurity decreases variability therefore, there is little ra...

Lab values in Pregnancy

The Bishop score may be used to rate the readiness of the cervix for labor.  Scores ≤ 5 suggest an unfavorable cervix, and that induction may be necessary for successful vaginal delivery. Scores 6-7 do not definitively predict whether or not induction will b...

Definition 3 or more consecutive preg losses before 20wk gest or after 2 consecutive losses, esp if age >35 y.o Evaluation Determine actual gestational age at time of miscarriage rather than time of onset sx Ask about hx of thrombosis or prev fetal death, ...

Definition Nausea and vomiting in pregnancy that significant enough to cause dehydration, metabolic alkalosis, ketonuria, weight loss (>5%), hypokalemia Risk Factors Multi gestation, Family history or personal hx in prior pregnancy Labs CBC, lytes, UA, TS...

Definition Chronic HTN: SBP greater equal to 140 or DBP greater equal to 90 prior to 20 weeks or persisting longer than 12w post partum Gestational HTN: SBP greater equal to 140 or DBP greater equal to 90 after 20 weeks with or without proteinuria Pre-eclam...

Appropriate candidates Hx 1-2 C-section via low transverse hysterotomy.  Inappropriate candidates Previous classical or T-incision, prior uterine rupture, extensive transfundal uterine surgery (ex: myomectomy), and patient with any contraindication to vagin...

Review gestational dating AFI/BPP and NST at 41 weeks and repeat once to twice a week Consider membrane stripping at 39 weeks Consider induction at 41 weeks and cervical ripening agents