Epidurals Lecture Notes Review

Flashcards about epidural procedures including midwife responsibilities, potential complications, and relevant anatomy and physiology.

Epidural Training

Additional training is required to care for patients with epidurals.

Epidural Pathophysiology

Understanding the pathophysiology is important for answering questions about epidurals.

Post-Registration Training

Hospitals provide orientation and learning packages with competency demonstrations.

Maternity Web Tool

A tool to play around with for understanding maternity data, though it has limitations.

Perinatal Spine

New system is being developed for broader data collection.

Epidural Rate

Epidural rate was just below 30% in 2022.

Midwife's Role in Epidural Administration

Midwives support the anaesthetist by helping with gowning, preparing the trolley, and preparing medications.

Relevant History for Epidural Review

Surgical history and neurological problems like epilepsy and multiple sclerosis.

Required Blood Tests for Epidural

Full blood count to check platelets, creatine levels, and liver enzymes.

Platelet Count Significance

Low platelets may impact the decision to have an epidural.

Epidural Contraindications

Contraindications include blood clotting disorders and existing infections.

Platelet Count Threshold

Epidural placement is cleared if above 100.

APT and PTA tests

Measure how long it takes blood to clot.

Optimal Patient Positioning for Epidural

Sitting and curving the back forward is preferred.

Epidural Mechanism

Involves numbing sensory and motor nerves.

Initial Step in Epidural Procedure

Numbs the area with local anaesthetic.

Midwife Assistance During Epidural

Help keep mum positioned, open gown packs, and set up the trolley.

Pre-Epidural Preparations

Encourage a wee and insert an IV line.

Frequency of Pulse and Blood Pressure Checks

Every five minutes for 20 minutes.

Why Epidurals Reduce Blood Pressure

It blocks sympathetic nerve fibers, leading to vasodilation.

Purpose of Checking Block Level

To ensure the block level isn't too high.

Frequency of Post-Epidural Monitoring

Hourly pulse, BP, and respiratory rate.

Immediate Actions for Blood Pressure Drop

Call for help, turn off the epidural pump, left lateral position, raise legs, and speed up IV infusion.

Target Block Height

Around nipples or T4.

Why Oxygen is Administered

To help with respiratory distress by increasing oxygen levels.

Return of Sensation and Movement After Epidural

Returning sensation and movement varies among individuals.

How long is epidural catheter kept in

Overnight at least or usually for 24 hours.

Purpose of Enoxaparin

Reduce the effects of blood clotting or the risk of it.

Low Platelets

Platelets under 80 is a concern, the anaesthetists will decide.

HELLP diagnosis sings

Elevated liver enzymes and blood pressure is a sign.

Area Checks

Making sure that the skin looks okay and that they are regaining some sensation.

Hands on Care in Post Epidural

Lift up mums legs, wriggle toes, massage feet.

Purpose of Blood Thinners

Prevent the risk of or reduce the risk of blood clots

Catheter Removal Instructions From Ray

Have them drink a lot of water, and ensure they urinate this amount of moles within this amount of hours, just to make sure that your bladder and everything's working.

Shower Trick When Removing Catheter

A nice trick thats less clean up for spilled liquid.

Purpose of Passive Descent

Helps baby descend.

Doctor Drake epidural slides

There is a bunch of slides about epidural, uh, by Doctor Drake, which I just can't stop laughing about.

Best video to review

There the great video by Juliet Walton to review.

When to have someone in the delivery room

After delivery and after the epidural has been stopped.