Academic OB/GYN

I am happy to announce a new partnership with a great new sponsor, TrueLearn. TrueLearn is a web based platform for learning material to improve performance on standardized medical exams, with platforms for specific specialties as well as general medical boards.  In OB/GYN TrueLearn offers question banks for CREOGS, ABOG boards, as well as general OB/GYN question banks.  In each case, the online questions exactly simulate the computer environment you will see when you actually take the test as well.

TrueLearn also allows you to track your performance over time, as well as compare you performance to other doctors and students preparing for the same exam, both on a global level and specific to each question.  It’s a great too that will no doubt be of tremendous use to the thousands of students and physicians who take OB/GYN related exams each year.

Each month, we will be doing TrueLearn Question of the Month, both on the blog and on the soon to relaunch Academic OB/GYN Podcast.

Academic OB/GYN readers and listeners can also get a 10% discount on the product by using the promo code “ACADEMICOBGYN” when they order.

This month’s question, from the CREOG Test Bank:

A 24 year old G4P2012 Jehova’s Witness and is undergoing emergent cesarean hysterectomy secondary to hemorrhage.  She clearly stated prior to the procedure her refusal of foreign blood products.  Despite receiving 2 liters of lactated ringers, her pulse has increased to 155 bpm and blood pressure is 60/40 mmHg.  The cell saver is unavailable and she is losing consciousness.  Which of the following is the MOST appropriate infusion for this patient to receive?

• Colloid
• Crystalloid
• Fresh Frozen Plasma
• Packed red blood cells
• Platelets

Answer: Colloid

Explanation:

Colloid is volume expander.  It is an intravascular transfusion which provides increased osmolarity in the intravascular spaces providing oncotic pressures in the vasculature.  Although ideally patients should receive blood products if possible and in a 1:1:1 ratio of platelets to packed red blood cells to plasma in a massive transfusion protocol, this patient has refused this.  Because the patient described has a very elevated pulse and low blood pressure, the patient is likely volume deplete and will soon enter hypovolemic shock.  Despite the need for oxygenation, this patient is best treated with a volume expander as it will provide the best opportunity for her to survive the surgery.

Volume expanders include dextran, glycogen, starches, or even lactated ringers or normal saline.  However, lactated ringers did not work well for this patient and appear to be showing no improvement.

Preferences for Jehova’s Witness patients is a frequently tested topic.  It is important to note that the full blood products are unacceptable in Jehova’s Witness.  However, partial products are a decision left to the individual and the patients should be informed of this.  Also, hemostatic agents are acceptable.  Because FFP, PRBC, and platelets are blood products, the patient cannot have them if she refused to have them.

Answer B: Crystalloid, although an option, is generally not a good volume expander and travels easily to the extravascular space

Answers C & D & E: This is a blood product and the patient has refused blood products

Bottom Line: Colloid may be used as a volume expander if a patient refuses blood products.  

This question was answered correctly by 56% of TruLearn learners.

Stay tuned for more questions from TrueLearn, and check it out at http://www.truelearn.com/obgyn/!  If you want to try TrueLearn, make sure to use promo code “ACADEMICOBGYN” to get 10% off!