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most common cause of shock in
Hypovolemic: dehydration, diabetes, heat illness, hemorrhage,
peds
burns
- NS or LR
hypovolemic shock treatment - 20ml/kg body weight
- no more than 60ml/kg, unless ongoing loss is severe
- no response, PRBC transfusion
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Distributive shock - increased vascular capacitance w/ normal circulating vol
- crystalloid
- pressors may required if perfusion doesn/t normalize after
Distributive shock tx
delivery of 2-3 10ml/kg boluses of crystalloid
- ICU
Septic shock is the most common form
systemic inflammatory response syndrome (SIRS)
causes of Distributive shock
toxic shock syndrome (TSS)
anaphylaxis
- bolus of crystalloid
Cardiogenic shock tx - pressors and possibly afterload reducers
- ICU
abnormal cardiac rhythm, distended neck veins, rales, abd hrt
S/S Cardiogenic shock sounds, friction rub, narrow pulse pressure, hepatomegaly
- cxr may show cardiomegaly & pulmonary edema
physical obstruction of blood circulation and inadequate blood
Obstructive shock oxygenation
Gonorrhea infection during
ophthalmic injury, preterm labor, premature rupture of
pregnancy
membranes and intrapartum/postpartum infection.
Drug of choice to treat Ceftriaxone 125 mg IM or 1 gm IV qday for disseminated disease.
Gonorrhea during pregnancy Patients with a PCN allergy are treated with 2gm IM dose of
spectinomycin.
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, Azithromycin 1gm. An alternate treatment is Amoxicillin 500mg TID
Drug of choice to treat for 7 days. 2-3 weeks after completion of treatment a "test of
Chlamydia during pregnancy cure" is performed. High risk populations are tested again at
35-37 weeks EGA.
Drug of choice to treat Acyclovir 400 mg BID or Valacyclovir 1000 mg daily
Herpes Simplex Virus during
pregnancy
appropriately treat the mother, reduce viral load and minimize
The goal of antiretroviral perinatal HIV transmission
treatment, AZT, in HIV positive
mothers
When maternal viral load is >1000 copies/ml
When is a C-section
recommended for HIV positive
mothers
Metronidazole is 95% effective, single dose of 2 gm OR 500 mg
Drug of choice to treat BID for 7 days OR 250 mg TID for 7 days
Trichomonas during pregnancy
Sx of Trichomoniasis itching, burning, foamy green, malodorous discharge.
Drug of choice to treat
topical miconazole, terconazole, clotrimazole or butoconazole
uncomplicated Candidiasis
are given for 3-7 days
during pregnancy
Drug of choice to treat
A single dose of Fluconazole 150 mg
refractory Candidiasis during
pregnancy
Bacterial Vaginosis
A polymicrobial vaginal infection
associated with preterm labor,
preterm premature rupture
of membranes,
chorioamnionitis and
endometritis. every 4 weeks from 0 to 32 weeks
every 2 weeks from 32 to 36 weeks
Frequency of subsequent
weekly after 36 weeks
prenatal visits "the standard
schedule: in uncomplicated
patients is: maternal weight
uterine fundal height
maternal BP
Measurements taken at urinalysis by dipstick
each prenatal visit include: FHTs
25-33 pounds (11.5 - 16 kg)
What is considered to be
appropriate weight gain during a
singleton pregnancy
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