| Blood pressure >160 systolic or >100 diastolic |
Common diagnoses - Chronic hypertension
- Preeclampsia
- Sympathomimetic medications (methylergonovine, phenylephrine, other vasopressors)
Rare but life-threatening diagnoses - Illicit substances (eg, cocaine, amphetamines)
- Endocrine disorders (pheochromocytoma, hyperthyroidism, renal artery stenosis)
- Hypoventilation with hypercarbia (eg, opiate-related, obstructive sleep apnea, respiratory muscle weakness)
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| Blood pressure <90 systolic |
Common diagnoses - Dehydration
- Supine hypotension syndrome
- Regional anesthesia side-effect
- Hypotension solely due to regional anesthesia is unusual if the cephalad anesthetic level is at T10 or below
- Hemorrhage
- Medication side-effects (beta-blockers, calcium channel blockers)
- Vasovagal reaction (in presence of bradycardia)
Rare but life-threatening diagnoses - Sepsis
- Cardiac (cardiomyopathy, right or left heart failure, myocardial ischemia, pericarditis, cardiac tamponade, arrhythmia)
- Thromboembolism (PE)
- Concealed hemorrhage (retroperitoneal hemorrhage, abruption, uterine rupture)
- Amniotic fluid embolism
- Anaphylaxis
- Diabetic ketoacidosis
- Drug toxicity (magnesium, local anesthetic)
- High spinal or epidural block
- Tension pneumothorax
- Vascular emergency (splanchnic arterial dissection, aortic dissection)
|
| Heart rate >120 bpm |
Common diagnoses - Dehydration
- Hemorrhage
- Infection
- Medication side effects (sympathomimetics, beta-2 agonists)
- Anxiety/pain/panic attack
Rare but life-threatening diagnoses - Cardiac (cardiomyopathy, right or left heart failure, myocardial ischemia, pericarditis, pericardial tamponade, tachyarrhythmia)
- Illicit drugs (eg, cocaine, amphetamines)
- Thromboembolism (PE)
- Concealed hemorrhage (retroperitoneal hemorrhage, abruption, uterine rupture)
- Amniotic fluid embolism
- Anaphylaxis
- Endocrine disorders (pheochromocytoma, hyperthyroidism/thyroid storm)
- Malignant hyperthermia
- Vascular emergency (splanchnic arterial dissection, aortic dissection)
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| Heart rate <50 |
Common diagnoses - Vasovagal reaction (in presence of hypotension)
- Medication side-effects (beta-blockers)
- Hypertension (reflex bradycardia)
Rare but life-threatening diagnoses - Heart block from cardiac disease (eg, myocardial infarction, myocarditis, or hemochromatosis)
- Hypoventilation or hypoxemia (eg, obstructive sleep apnea)
- Electrolyte disturbances (K, Na, Ca, Mg)
- Medication toxicity (magnesium)
- Stroke/increased intracranial pressure
- High spinal or epidural block
|
| Respiratory rate >30 |
Common diagnoses - Hypoxia (eg, asthma)
- Hemorrhage
- Infection (eg, sepsis, pneumonia)
- Anxiety/panic attack/exertion
Rare but life-threatening diagnoses - Cardiac (cardiomyopathy, right or left heart failure, myocardial ischemia)
- Thromboembolism (PE)
- Aspiration
- Metabolic acidosis including diabetic ketoacidosis
- Concealed hemorrhage (retroperitoneal hemorrhage, abruption, uterine rupture)
- Amniotic fluid embolism
- Stroke
|
| Respiratory rate <10 |
Common diagnoses - Medication toxicity (opioids, benzodiazepines, magnesium)
- Obstructive sleep apnea
Rare but life-threatening diagnoses - Airway obstruction
- Asthma with respiratory failure
- High spinal or epidural block
- Cerebrovascular accident
|
| Oxygen saturation <95% or increasing oxygen requirements to maintain oxygen saturation ≥95% |
Common diagnoses - Atelectasis (following anesthesia, obesity, supine position at the end of pregnancy)
- Bronchospasm (asthma)
- Hemorrhage
- Hypoventilation (obstructive sleep apnea, opiate or benzodiazepine effect)
- Infection (eg, pneumonia)
Rare but life-threatening diagnoses - Airway obstruction (asphyxia, laryngospasm)
- Pulmonary edema
- Thromboembolic disease (PE)
- Cardiac disease (cardiomyopathy, right or left heart failure, intracardiac shunt)
- Concealed hemorrhage (retroperitoneal hemorrhage, abruption, uterine rupture)
- Amniotic fluid embolism
- Anaphylaxis
- Aspiration
- Acute chest syndrome (sickle cell disease)
- Pneumothorax
- Venous air embolism
- Blood product reaction (TACO, TRALI, anaphylaxis)
|
| Maternal confusion, agitation, or unresponsiveness |
Common diagnoses - Hypoxemia
- Hemorrhage/hypotension
- Illicit substances (either intoxication or withdrawal)
- Seizure/postictal state/posterior reversible encephalopathy syndrome (PRES)
- Psychosis is a diagnosis of exclusion
Rare but life-threatening diagnoses - Diabetic ketoacidosis, hypoglycemia
- Sepsis
- Concealed hemorrhage (retroperitoneal hemorrhage, abruption, uterine rupture)
- Thromboembolic disease (PE)
- Amniotic fluid embolism
- Anesthesia complications
- Cardiomyopathy
- Cerebrovascular accident, cavernous sinus thrombosis
- Increased intracranial pressure
- Electrolyte abnormality (hypermagnesemia)
- Hyperthyroidism/thyroid storm, myxedema coma
- Medication toxicity
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| Oliguria <35 mL/hour over a two-hour period |
Common diagnoses - Severe dehydration
- Hemorrhage
- Obstructed urinary catheter
Rare but life-threatening diagnoses - Surgical complications
- Genitourinary tract injury
- Preeclampsia with severe features
- Sepsis
- Concealed hemorrhage (retroperitoneal hemorrhage, abruption, uterine rupture)
- Acute renal failure
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