0071643192.pdf

COMPLICATIONS

■ Maternal death or poor neurologic outcome
■ Neonatal death or poor neurologic outcome

INTERPRETATION OFRESULTS

■ Traditionally, Apgar scores are used in the standard newborn evaluation. A
score of 7–10 is considered normal, while 4–7 might require some resusci-
tative measures, and a baby with Apgars of 3 and below requires immedi-
ate resuscitation.

ANESTHESIA

A young woman presents with a laceration of the upper right lip after

being bitten by her dog. How would you anesthetize this wound prior to

examination, irrigation, and possible closure?

Infraorbital nerve block.

Local Anesthesia

INDICATIONS

■ Used for the majority of minor surgical procedures such as excision of skin
lesions, incision of abscesses, and suturing of wounds

CONTRAINDICATIONS

■ Local infiltration distorts the tissues that will be incised or repaired, mak-
ing it undesirable in areas requiring precise anatomic alignment (eg, some
lip repairs).
■ Epinephrine can theoretically cause ischemia and gangrene and should
be avoided in digital blocks, penis, tip of nose, or earlobe.

PROCEDURES AND SKILLS

FIGURE 19.9. Delivery of neonate with perimortem cesarean section.

(Reproduced, with permission, from Cunningham FG, Leveno KL, Bloom SL, Hauth JC, Gilstrap
LC, Wenstrom KD. Williams Obstetrics, 22nd ed. New York: McGraw-Hill, 2005:597.)

APGARscore–-invented

by Dr. Virginia Apgar

Appearance—blue/pink;

body/pink

Pulse—absent/< 100/>

100

Grimace—no response/

grimace/pulls away

Activity—none/

flexion/active

movement

Respirations—absent/

weak/strong