another c-section nightmare

[Trisomy13]

On the schedule for this Wednesday.

Pleasant 26 yr old G2P1, weighing in around 450 lb, with PMH significant for asthma, GERD, morbid obesity, sleep apnea, recent (~month ago) bout of pneumonia. Scheduled for C-section for term IUP with a surgeon who has seen his share of large patients, planning possibly a high transverse incision (above the multiple pannus layers). Patient is currently an inpatient (here since her pneumonia left her with respiratory difficulty). Currently uses BIPAP a better portion of the day. Normally uses it at night for the OSA, but since the pneumonia and increased abdominal pressure with pregnancy finds she needs it all the time now. Lying flat is predictably difficult. She has an IJ central line for access - floor nurses couldn't find anything in the way of peripheral veins. Airway is an intimidating tiny black dot buried in soft tissue.

Fetus has been cooperative thus far. Well insulated and unable to hear the Baby Mozart cd, but behaving itself.

Any concerns? (Besides "turf to midwife for water-birthing".)

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[OB1🤙]

"turf to midwife for water-birthing"

 

[VentdependenT]

Who impregnated this total hottie?!

 

[Ferdie]

status quo up here in WI

 

[jetproppilot]

Who impregnated this total hottie?!

HAHAHAHAHAHAHAHAHAHAHAHA

Its 3 am and I just put in number 2 epidural, after finishing up C section number 6 earlier.

I needed a laugh.

Thanks, Venty.

 

[bubalus]

Who impregnated this total hottie?!

Not only who, but HOW?

 

[joshmir]

>Who impregnated this total hottie?!

a la preying mantis, she may have eaten him.

 

[VentdependenT]

HAHAHAHAHAHAHAHAHAHAHAHA

Its 3 am and I just put in number 2 epidural, after finishing up C section number 6 earlier.

I needed a laugh.

Thanks, Venty.

You know jet, there is the ACADEMIC C-SECTION here. 3.5 hour sections x2 on monday. I wanted to end it all when the last one finished at 315am.

My spinal wore off on the first one, masked her, surgeon goes to shover her intestines back in, LARYNGOSPASM. I grabbed the Sux...forget that 20mg noise in the books, I pushed the stick on her 305lb's and tubed her. That stunk but could have been much worse. LMA ready to go just in case.

Forget Single Shots here man. Gotta do CSE's from now on. So now I gotta PULL the epidural (if patchy or older than a day), do a CSE, and place another one.....sweeeeeeeeeeeeet.

 

[VentdependenT]

Not only who, but HOW?

Ahh. Its called the Hillbilly.

Get a 2x4 from out back, lift the panus with it. Tape it in place with your grandpappy's duct-tape, light some sterno, and feel the moment with your sedentary loved one.

 

[New2Midwest]

Yet another great example of the terror in OB anesthesia. Remote locations and limited resources (as well as OB residents). For anyone who thinks that CT anesthesia is the ultimate in anesthesia, those guys have it easy (a perfusionist, great access, TEE, and a surgeon who can crack a chest)-

 

[jwk]

Not only who, but HOW?

Splash technique - if I have to explain it, you really don't want to know.

 

[Voodoo]

...does she wear the BiPAP during impregnation attempts?

 

[Gern Blansten]

Not only who, but HOW?

One day in OB, a resident point blank asked this 450 lb lady with the 100 lb soaking wet husband how they accomplished the deed. I won't go into too much detail, but suffice it to say, it involved a dinner table with a removable center leaf and caring neighbors for assistance with the pannus. I wonder if those same neighbors ever accepted dinner invitations after that.

 

[VentdependenT]

One day in OB, a resident point blank asked this 450 lb lady with the 100 lb soaking wet husband how they accomplished the deed. I won't go into too much detail, but suffice it to say, it involved a dinner table with a removable center leaf and caring neighbors for assistance with the pannus. I wonder if those same neighbors ever accepted dinner invitations after that.

Ahh that move is called "The Thanksgiving Feast." Excellent choice for those with BMI's approaching or surpassing 40.

 

[cfdavid]

Who impregnated this total hottie?!

oh boy.... that's what i was thinking. vent, are you just covering for yourself!???

 

[VentdependenT]

oh boy.... that's what i was thinking. vent, are you just covering for yourself!???

Bah...I only dig chicks with at least a good Stage III sacral Decub.

 

[Trisomy13]

Bah...I only dig chicks with at least a good Stage III sacral Decub.

options

 

[FuzzyBK]

"Options" - is that code for waiting for the ostomy?

It reminds me of the family guy episode where Lois becomes fat and Peter enjoys it more. Speaking of the Hillbilly, we call it the broomstick sign where I am. Right and Left lower quadrant bruising from broomsticks propping up pannus. This probably reduces awkward conversations with the neighbors - "Hey Jim, can I borrow a cup of flour and, oh by the way, what are you and the wife doing Saturday night?"

 

[Chillio]

Well, thanks for your heartwarming stories, our heavyweights don't seem so bad anymore

 

[cchoukal]

[QUOTE we call it the broomstick sign where I am. Right and Left lower quadrant bruising from broomsticks propping up pannus. [/QUOTE]

Call me naive, but is that really true? That's disgusting.

 

[VentdependenT]

[QUOTE we call it the broomstick sign where I am. Right and Left lower quadrant bruising from broomsticks propping up pannus.

Call me naive, but is that really true? That's disgusting.[/QUOTE]

And its totally HOT

 

[Gern Blansten]

Ahh that move is called "The Thanksgiving Feast." Excellent choice for those with BMI's approaching or surpassing 40.

Is that one included in the Kamasutra? You are starting to scare me with your knowledge of these things. I knew a guy who ended up divorcing his wife after she lost ~150 lbs with gastric bypass. He liked her better when she was big.

 

[VentdependenT]

Its in a book called "Big Pushin" which is available at most liquor stores in the south.

 

[pharmer]

where ever there's a pig there's a pig f**cker

 

[serenity]

On the schedule for this Wednesday.

Pleasant 26 yr old G2P1, weighing in around 450 lb, with PMH significant for asthma, GERD, morbid obesity, sleep apnea, recent (~month ago) bout of pneumonia. Scheduled for C-section for term IUP with a surgeon who has seen his share of large patients, planning possibly a high transverse incision (above the multiple pannus layers). Patient is currently an inpatient (here since her pneumonia left her with respiratory difficulty). Currently uses BIPAP a better portion of the day. Normally uses it at night for the OSA, but since the pneumonia and increased abdominal pressure with pregnancy finds she needs it all the time now. Lying flat is predictably difficult. She has an IJ central line for access - floor nurses couldn't find anything in the way of peripheral veins. Airway is an intimidating tiny black dot buried in soft tissue.

Fetus has been cooperative thus far. Well insulated and unable to hear the Baby Mozart cd, but behaving itself.

Any concerns? (Besides "turf to midwife for water-birthing".)

Get an epidural in her somehow,yesterday we did a 370 lbs lady took 2 hours to get the epidural in,but worth it, she went for a C-section soon after.
According to my attendings,we use an 11 cm epidural needle for anyone above 350 pounds,use a longer finder needle ,keep the BiPAP on her if she goes for a C-section.
Its good to know about these patients earlier cos if they are crash C-section you are doomed.
I would do an awake fibro-optic(emergent or not emergent) in case the epidural fails ,after all ,mother's 450 pound life is more important ..Hahaha