WILTIMS #367: 24 hour call - Wrap-up

Continued from Part 3...

20:14 - That's it folks! I'm a little sad to admit it, but my big 24 hour call turned out to actually be a 14 hour call. I know people that have done more than that on what was supposed to be a 12 hour shift. But one of the cardinal rules of medical school is, when someone tells you to leave, leave. You will not get brownie points for staying and everyone will be happier if you go sleep/eat/study and come back rejuvenated the next day.

But since this day was supposed to be a transition day to my upcoming week of night shifts, I still need to stay up as long as I can to disrupt my sleep schedule.

23:16 - Well, the Mets helped a little, but I'm pooped. Here's hoping some Netflix and bright light will keep me going!

04:30 - Nope! I did enjoy that first three and a half minutes of Batman Begins, but even sitting in an awkward position with all the lights on and sipping a soda, I nodded off immediately. I'm going to go sleep in my bed for a bit now and hopefully sleep and nap through the rest of the day. Tonight I get one more go at staying up before my night shift on Tuesday.

TIL: Whereas emergency high blood pressure levels in an adult are over 180 systolic, in pregnant women it's only 160.

There are several pharmacological interventions that doctors can use to either prolong a preterm pregnancy or to improve the outcome if the baby is born premature. Giving magnesium sulfate to a woman with signs of premature labor is neuroprotective to the fetus woman, protecting it her from seizures. Be careful though when monitoring at the fetal heart rate, because magnesium suppresses the normal heart rate variability. Steroids such as betamethasone are given to help speed along lung maturity in preterm labor. 17α-hydroxyprogesterone caproate (artificial progesterone) can be used to prolong a pregnancy, but can't be given after 36⁶ weeks^* gestation, because it will have negative effects on the delivery and recovery.

Fetal heart rate variability can fall into several descriptive categories:

absent: flatline
minimal: 1-4 beats per minute (bpm) of variability
moderate: 5-25 bpm
marked: >25 bpm

Finally, a health fetus has periodic elevations in heart rate called accelerations. before 32 weeks, you want to see two accelerations of 10 bpm over the baseline for 10 seconds each over any 20 minute period. From 32 weeks on, you want two of 15 bpm of 15 sec in 20 minutes.

*In obstetrics, weeks are denoted as n^x where n is the number of weeks and x is the number of additional days. So 26 weeks and 5 days is 26⁵ weeks.