By Guy I. Benrubi MD
Revised and up-to-date for its Fourth variation, this useful, transportable, and reasonable instruction manual is designed for speedy reference within the workplace or emergency room. It makes a speciality of analysis and therapy of universal emergencies in lady sufferers and lines a number of therapy algorithms, bulleted lists, and tables, plus plentiful illustrations together with ultrasound. assurance addresses all emergent stipulations and non-emergent difficulties, reminiscent of sexually transmitted illnesses, that often found in emergency departments. This variation has been up to date to deal with present demanding situations resembling problems coming up from clinical and surgical abortion, scientific and mental difficulties bobbing up from sexual attack and different gynecologic traumas, and emergent stipulations as a result of chemical-biological warfare.
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Extra info for Handbook of Obstetric and Gynecologic Emergencies
Determining the fetal gestational age is critical, since often during a tonic–clonic seizure, the fetus will experience an episode of bradycardia. Th is bradycardia may represent the hypoxic maternal state or, worse yet, fetal compromise due to a placental abruption. If it is the former, the fetus will often regain a normal FHR within 15 minutes after the seizure. If it is an abruption, palpating the uterus will confi rm tetanic contractions, and some women may experience vaginal bleeding. The gestational age will determine whether the surgeon needs to proceed with an emergency cesarean delivery or whether it is unnecessary to perform a major surgery and administer anesthetics to an unstable mother.
Calcium gluconate 1 g IV (1 ampule) may be administered to reverse magnesium toxicity. If the patient has a history of epilepsy, she should be treated with the parenteral form of the medication she has been taking. If the etiology of the seizures is uncertain, phenytoin may be used for acute treatment. The usual loading dose is 10 to 15 mg/kg prepregnancy weight, given intravenously over an hour. The infusion is started at a rate of up to 50 mg per minute to a total dose of 20 mg/kg. Phosphenytoin may also be administered, in place of phenytoin, at a rate of 150 mg per minute in cases of status epilepticus.
Indd 19 12/18/2009 11:10:32 AM 20 Part I Obstetric following the convulsion. Breathing and circulation need to be assessed after the convulsion ceases. During the seizure, it is necessary to prevent self-injury and uterine (fetal) trauma. After the seizure, the airway should be cleared and the patient should be suctioned to reduce the risk of aspiration of secretions or vomitus. She should also be watched carefully to prevent bodily injury, lacerations, and fractures (85,88). If seizures persist, the airway must be protected, possibly requiring intubation.
Handbook of Obstetric and Gynecologic Emergencies by Guy I. Benrubi MD