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Per Meriter recommendations: Due to a nationwide shortage of hydromorphone, the recommendations for alternatives after review of available options for labor analgesia include:
IV morphine 2-4 mg q3h prn
IM morphine 5-10 mg q3h prn
IV fentanyl 50-100 q 1h prn
American College of Obstetricians and Gynecologists' Committee on Practice Bulletins—Obstetrics. ACOG Practice Bulletin No. 209: Obstetric Analgesia and Anesthesia. Obstet Gynecol. 2019 Mar;133(3):e208-e225
Calling for an epidural
Calling for an epidural
Meriter: Resident may call anesthesia for epidural when pt is ready. OB does not need to be made aware of the epidural placement but it is wise to be aware of how busy they are before calling anesthesia.
Per policy An OB provider or trainee must evaluate the patient prior to epidural placement. If the trainee performs the evaluation, the trainee must verbally discuss the evaluation with the OB provider. the purpose of this is to determine whether fetal status is appropriate for placmeent of neuraxial block. . . . Prior to epidural placement the OB Provider must have admitted the patient and placed at note in the patient chart. Exception to this is if the patient presents in OB Triage requesting an epidural and the OB provider is on their way to the hospital.
How to page anesthesia:
(Preferred) Vocera (call 7-8000 or 417-8000) and ask for "Anesthesia Resident"
Be prepared with pt room number and sign out stats (see Resident Information page for reminder)
They primarily want to know about bleeding risk and comorbidities
OR
Call HUC (#7-6307 or 417-6307) or have paging transfer to "4N Reception"
Ask them to page anesthesia resident for:
Family Medicine Resident, Epidural, Pt Room #
Give call back number
St Mary's: Attending should call anesthesia for epidural when patient is ready (Full St Mary's Policy)
Policy states Patients followed by Family Medicine: Evaluated in OB triage by the OB triage nurse and/or resident. Determined to be in active labor. Family medicine attending determines the patient is appropriate for epidural placement. Per St. Mary’s Hospital Bylaws an H&P should be completed prior to a procedure. This can be placed by the resident and co-signed by the attending physician.
Attending will place a standardized note [.OBEPIDURAL] in the chart documenting: A. The patient is in active labor. B. The fetal heart tracing has been reviewed and is reassuring. C. The attending physician is requesting an epidural.
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