OBSTETRIC ANALGESIA AND ANESTHESIA
Uterine contractions and cervical dilation result in visceral pain (T10-L1).
Descent of the fetal head and pressure on the vagina and perineum result in somatic pain (pudendal nerve, S2-S4).
In the absence of a medical contraindication, maternal request is a sufficient medical indication for pain relief during labor.
Absolute contraindications to regional anesthesia (epidural, spinal, or
combination) include the following:
Descent of the fetal head and pressure on the vagina and perineum result in somatic pain (pudendal nerve, S2-S4).
In the absence of a medical contraindication, maternal request is a sufficient medical indication for pain relief during labor.
Absolute contraindications to regional anesthesia (epidural, spinal, or
combination) include the following:
- Refractory maternal hypotension
- Maternal coagulopathy
- Maternal use of a once-daily close of low-molecular-weight heparin within 12 hours
- Untreated maternal bacteremia
- Skin infection over the site of needle placement
- Increase in ICP caused by a mass lesion
Pneumococcal polysaccharide vaccine (PPSV) for Adults
Pneumococcal polysaccharide vaccine (PPSV) should be given once to all adults age > 65. it should also be given to all adults age < 65 with chronic diseases:
Chronic lung disease
Functional or anatomic asplenia
Chronic lung disease
- Asthma
- COPD
- Emphysema
- Chronic cardiovascular disease
- Diabetes mellitus
- Chronic liver disease
- Alcoholism
- Cochlear implants
- CSF leaks
- Immunocompromising diseases
Functional or anatomic asplenia
- Sickle cell
- Other hemoglobinopathies
- Splenectomy
- Acquired asplenia.
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