CHAPTER 5 EXERCISES: MEDICATIONS, PAIN MANAGEMENT, AND MANAGING EMERGENCIES

EXERCISE 5.1

Purpose: To review management of side effects and complications from medications used to manage pain and anxiety. How would you manage the following case scenarios of people undergoing uterine aspiration?

1. A person states that last year they had an allergic reaction to the local anesthetic that the dentist used

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2. A person chooses to have IV sedation for pain management. You administer midazolam 1 mg IV and fentanyl 100 mcg IV. As you dilate the cervix and begin aspiration, the patient falls asleep and is not arousable to chin tilt and repeated stimulation, and their oxygen saturation falls from 99% to 88%

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3. A person at 5 weeks by LMP has a history of alcohol and heroin use, and states that they last used heroin yesterday. The person requests IV sedation. Venous access is limited, but you are able to insert an IV and administer midazolam 1 mg and fentanyl 100 mcg. You insert the speculum, and the person pulls away stating “I can feel everything.”
   1. What can be done before this point to improve the chance of success?
   2. How would you treat this person’s pain?
   3. How would this change if the person were taking buprenorphine (Suboxone)?
   4. How would this change if the person disclosed using heroin today?

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4. Consider the consent process for each of the following people. What factors contribute to informed consent? What questions would you ask or what information would help you to make a decision in each case?
   1. A person at 5 weeks who appears nervous. When you enter the room you can smell marijuana.
   2. A person at 12 weeks is on methadone for opioid use disorder. They have been on the same dose for 8 years, and last took their medication this morning.

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EXERCISE 5.2

Purpose: To become familiar with other medications used with uterine aspiration. Please answer the following questions.

1. In which of the following situations is administration of RhIG (Rhogam) suggested in a person ≥ 12 weeks gestation?
   1. Patient with a positive anti-D antibody titer.
   2. Rh-negative person who received RhIG 4 weeks ago during evaluation for threatened abortion.
   3. Rh-negative person 4 days post-abortion who did not receive RhIG at the uterine aspiration visit.

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2. While person complains of nausea and “feeling faint” while completing a uterine aspiration procedure using local cervical anesthesia and ibuprofen only. They are pale and sweaty, and their blood pressure is 90/50 with a pulse of 48.
   1. What is your differential diagnosis?
   2. How might you prevent this reaction?
   3. How would you manage this patient?

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