Summary
Samenvatting Hoogrisco verloskunde: rea & anesthesie
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Samenvatting van lessen rea & anesthesie van het vak Hoogrisco verloskunde
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Hoog risico verloskundeReanimatie & anesthesie
1. Anesthesie & aanpak complicaties
1.1. Respiratoir
A+B belangrijk
a) Airway/luchtweg
Obstructie door: diep slapen, houding, tong
o Luchtweg vrijmaken
o Door middel van maneuvers BLS
Chin lift & Jaw trust & mayo canule
o Uizuigen van de mond/keel
b) Breathing
Ademhaling evalueren
o Saturatie (zakt pas na 1min slecht ademen
o Ademfrequentie
o Thoraxbeweging
Mogelijke oorzaken
o Infectie
o Vreemd voorwerp
o Allergie met oedeem & bronchospasme
o Secretie in luchtwegen: bloed/slijm (kan ook obstructie zijn)
o Effect na anesthesie
o Longproblemen: astma, COPD
Behandeling
o 02 toedienen
o Medicatie: puffer
o RX-thorax
1.2. Cardiovasculair
Diagnose: BP, hartritme, ECG
1.2.1.Hypertensie
Oorzaken:
o Pijn, stress, angst, verkeerd inname medicatie
Behandeling:
o Pijnstilling, antihypertensiva
1.2.2.Hypotensie
Oorzaken
o Hypovolemie (bloeding), vasodilatatie (epidurale), anesthesie
Behandeling
o IV vocht, transfusie, epidurale dosis verminderen, medicatie (efedrine)
, 1.2.3.Ritmestoornissen
Zeer variabel: kan nieuw zijn of van tevoren aanwezig
Kan hemodynamische weerslag hebben
o Is het onschuldig of levensbedreigend?
Behandel indien nodig
o Anti-artimica & advies cardioloog
1.2.4.Ischemie
Hartinfarct
Kliniek
o Dyspneu & pijn op borst
o Hypertensie/hypotensie/ritmestoornissen
o Nausea/braken/zweten/klam/angst
Diagnose
o ECG
o Labo: cardiale enzymen, troponine, CK-MB
Acties
o Advise cardioloog
o 02 geven & symptomatiesch behandelen
o Soms reanimatie
1.2.5.Hypovolemie
Oorzaken:
o Bloedingen: postoperatief & postpartum
o Overmatig plassen
o Langdurig onvoldoende drinken
o Overmatig braken & diarree
1.3. Gastro-intestinaal
PONV/ Post-operatieve nausea/vomiting
o Kan direct zijn of na enkele dagen
o Preventief behandelen
o Risicofactoren
Vrouw
Niet-roker
Reisziekte
Gebruik opiaten
o Aan de hand van Apfel score
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