Holy Shiit What A Case

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
jetproppilot

jetproppilot

Turboprop Driver
Verified Member
15+ Year Member
Joined
Mar 12, 2005
Messages
5,863
Reaction score
143
Members don't see this ad.
I was the OB doc today.
Lady comes in...22 weeks pregnant in labor....doesnt look good. We arent initially involved.

Lady delivers fetus....it obviously dies.....problem is she's still bleeding like a stuck pig.

To the OR for a D&C.

We do that.

To OB recovery. I leave the (talented) CRNA with the patient since I've got other things to tend to.

Lemme add this girl is 24, G3, obese, no veins, 20" IV which got us through the D&C.

30 minutes later I get a call from Joann the CRNA.

"Dr Jet, this lady looks bad. BP 70-over-palp. She's all over the place and blood is pouring out of her vagina. Oh, and she pulled her IV out."

Jet: "I'll be right there."

I arrive. The chick is clammy, disoriented, combative, bleeding, no IV. No way she'll be still enough for central line placement.

As an aside, trying to gather critical care level help in the OB unit is like trying to herd cats.

We had a happy ending to this potentially lethal situation....but lets start at the beginning....

you've got a patient thats bleeding to death thats obese with no IV and no potential for starting one.

You've got one talented CRNA, and a buncha useless L&D nurses at your disposal.

Patient is all over the stretcher.

If she doesnt get PRBCS soon shes gonna need a dirt pillow.

OH......OB/GYN shows up and wants to transfer patient to the ICU.

OB/GYN says: "I scraped everything. If I scrape more I'll perf her uterus."

Walk me through how a critical care physician saves this lady's life, ladies and gentlemen.
 
- iv access
- airway control
- probably requires some sort of sedation....IM ketamine + IM pressors


- medical versus surgical bleeding???

Surgical bleeding....up to the people who wields scalpels...

Medical bleeding:
- undiagnosed coagulopthy..

- I wouild give empirir ddavp + methergine while labs are cooking while considering some blood component therapy.
 
interosseous access an option for you Jet?
 
Tell those whiney and slow L&D nurses to quit gossiping and grab a limb to hold the patient down. Tell your CRNA to fetch a introducer, while you prep the groin.....fem introducer!

Figure out coagulopathy v surgical bleeding.

I agree methergine/hemabate, ABG, volume, and transfuse PRBC's while you wait on the objective data.


Either way I would let her relax in the unit.
 
Dart her with IM ketamine and ephedrine 50mg and methergine. OB nurses to hold her still while crna maintains airway/intubates if pt is there yet. I thought of the interosseus but I've never personally placed one in an adult and wouldn't want to try to figure it out in this situation but I would do it if it was the only option.

I'd probably place a IJ while crna held mask over airway since I can do this in no time. Femoral will take me just a little longer unless the pulse is good which isn't the case in this hypotensive obese pt. May even place a quick EJ 16-14g if visible.

Start running FFP/PRBC/Plt and recombinate factor 7. Off to the OR for hysterectomy.
 
jetproppilot said:
I was the OB doc today.
Lady comes in...22 weeks pregnant in labor....doesnt look good. We arent initially involved.

Lady delivers fetus....it obviously dies.....problem is she's still bleeding like a stuck pig.

To the OR for a D&C.

We do that.

To OB recovery. I leave the (talented) CRNA with the patient since I've got other things to tend to.

Lemme add this girl is 24, G3, obese, no veins, 20" IV which got us through the D&C.

30 minutes later I get a call from Joann the CRNA.

"Dr Jet, this lady looks bad. BP 70-over-palp. She's all over the place and blood is pouring out of her vagina. Oh, and she pulled her IV out."

Jet: "I'll be right there."

I arrive. The chick is clammy, disoriented, combative, bleeding, no IV. No way she'll be still enough for central line placement.

As an aside, trying to gather critical care level help in the OB unit is like trying to herd cats.

We had a happy ending to this potentially lethal situation....but lets start at the beginning....

you've got a patient thats bleeding to death thats obese with no IV and no potential for starting one.

You've got one talented CRNA, and a buncha useless L&D nurses at your disposal.

Patient is all over the stretcher.

If she doesnt get PRBCS soon shes gonna need a dirt pillow.

OH......OB/GYN shows up and wants to transfer patient to the ICU.

OB/GYN says: "I scraped everything. If I scrape more I'll perf her uterus."

Walk me through how a critical care physician saves this lady's life, ladies and gentlemen.
Click to expand...

Pardon my ignorance but I will take a shot:

1) non-IV Sedation
2) ABCDE algorithm - AIRWAY!
3) Oxytocin injection to contract the uterus?
4) substernal IO access?
5) Rush to the OR for Surgical Intervention?
6) r/o coagulopathy
 
lfesiam said:
Pardon my ignorance but I will take a shot:

1) non-IV Sedation
2) ABCDE algorithm - AIRWAY!
3) Oxytocin injection to contract the uterus?
4) substernal IO access?
5) Rush to the OR for Surgical Intervention?
6) r/o coagulopathy
Click to expand...

Have you ever done one? I haven't even heard of it.
 
You guys are good!!! Like Will Smith said in Bad Boys: "THATS HOW YOU DRIVE!! I'M TELLIN' YA...THATS HOW YOU DRIVE!!!!

Less than deft OB/GYN involved, which is a strike against us. She wants to go to the ICU. I think we need to go to the OR.....I don't know if its accreta, retained products, etc, but I don't see a medical solution to the problem.

Mil and Noy, I took your advice.

Told JoAnn the CRNA to fetch the 200mg/mL ketamine, which she did.

Darted the chick in the deltoid with 200mg ketamine.

Few minutes later she's sedated.

Right sided IJ triple lumen placed CDAZY FAST.

Then 100mg IV ketamine just for kicks, followed by 100mg sux....

8.0 ETT in....

instructed useless L&D RNs to check all blood products arriving....

started pouring PRBCs into 16" port of TLC.....

then had a COME TO JESUS talk with OB/GYN atending....

JET: "Dude," (a chick OB/GYN but I consider "DUDE" applicable to anyone).."We're bleeding out here. If we go to the ICU she's gonna die."

Yeah, that sounds melodramatic. But I knew that was the truth. And it was.

OB/GYN says "lets go to the back."

We get her on the table.

They open her belly and start fiddling with the anterior portion of the uterus.

I'm getting pissed, since I have a finger on her carotid artery and can feel the faintness of it.

The surgical intervention is outta my league, but I know the 2 OB/GYNs operating are at the bottom of the bell curve.

I feel an obligation to this patient.

Jet: "ARE YOU TWO GAINING CONTROL OF THE BLEEDING? WE'RE POURING IN BLOOD AND HER BLOOD PRESSURE STILL SUCKS!!! ARE YOU AT THE UTERINE ARTERIES YET?

I'm WAY overstepping my boundaries here. I'm not a surgeon. But I recognize these two clowns are trying to save the uterus.....instead of sacrificing it and saving the chicks life.......

Jet: "LISTEN DUDES......WE'RE STRUGGLING UP HERE TO KEEP HER ALIVE.....YOU EITHER ARREST THE BLEEDING OR SHE'S GONNA DIE!!!"

I wish I was exaggerating...but thats how the banter went.....and thats what it took to get the "doctors" to GO AHEAD and sacrifice the uterus....what the fuk? was I missing something? Why were they so fixated on preserving the organ with the chicks life teetering? I guess they didnt appreciate how dire the situation was....it was my job to let them know....

I'm posting this to let my budding colleagues out there that sometimes you have to STEP UP TO THE MIKE WITH MICATIN.....

I mean NOONE was interested in taking the reigns with this case....lets just go to the ICU so we can get her outta the OB unit....

FUK THAT!!!

She wouldda died.

Uterine arteries clamped.

Subsequent removal of organ.

Many units of blood products later, chick is in ICU....intubated, but waking up.

Thats whats cool about this job, colleagues.

Every once in a while you get a case where ALL IS AWRY and everyone around you is running around in circles, accomplishing nothing.

Allowing you to STEP UP TO THE MIKE WITH MICATIN...

and make a difference.

JoAnn the CRNA and I made a difference today.

We saved that lady's life.

FUKKIN A. I'M FEELIN' GOOD ABOUT MY CONTRIBUTION TODAY.
 
You're absolutely right, dude. Sometimes you have to show some sac. The are more concerned with saving the uterus, you have to remind them they have to be concerned with saving a life. Forest and trees.
 
Noyac said:
Start running FFP/PRBC/Plt and recombinate factor 7. Off to the OR for hysterectomy.
Click to expand...

Agree, but are you saying you would go ahead and give the Factor 7 upfront or would you wait until you had tried the other products first? Obviously, this is clearly a life-threatening scenario so you couldn't be faulted for Factor 7 but it seems like we are taught that it truly is a last line of defense because of the potential for complications, though death is obviously worse than a Factor 7 complication.
 
Noyac said:
Have you ever done one? I haven't even heard of it.
Click to expand...

never done one. heard of it below:

ED fast system, pretty new,......http://emergencycare.wordpress.com/2007/03/03/intraosseous-route-the-fast-system/

fast.jpg


th_applied.jpg
 
Arch Guillotti said:
Agree, but are you saying you would go ahead and give the Factor 7 upfront or would you wait until you had tried the other products first? Obviously, this is clearly a life-threatening scenario so you couldn't be faulted for Factor 7 but it seems like we are taught that it truly is a last line of defense because of the potential for complications, though death is obviously worse than a Factor 7 complication.
Click to expand...

I don't know if its a coagulopathy or post delivery bleeding like retained product, accreta, etc. I'm giving factor 7.

But she probably would do fine without it if curative therapy is instituted, ie: hysterectomy.
 
Most of the time dem OBGYN's don't think like surgeons and if they can't get control of the bleeding you might have to remind dem to place a cross clamp on the aorta (I guess they know were it is?) befor eyour pt kicks the bucket
 
very nice case. i think thats pretty much the way it has to be done.

im guessing it was atony vs. a DIC picture. ive seen trasylol given in DIC 2/2 amniotic embolus with a similar operative picture.

after an exsanguination i had a few weeks ago, im considering factor VII for everyone, but this lady seems to be a pretty good candidate.
 
I hope I do not get a case like that while I am responsible for OB today.

I appreciate the comments about the labor and delivery environment. It is nice to know that I am not the only one who has to swim upstream
 
jetproppilot said:
I was the OB doc today.
Lady comes in...22 weeks pregnant in labor....doesnt look good. We arent initially involved.

Lady delivers fetus....it obviously dies.....problem is she's still bleeding like a stuck pig.

To the OR for a D&C.
Click to expand...

This one hits too close to home for me.
This happened to my wife a couple years ago.
 
This may seem like a stupid question... But why was she so combative and disoriented in the first place? Was that from the shock or from previous medication? I'm assuming in from decreased perfusion and blood volume...
 
treasurefull2 said:
This may seem like a stupid question... But why was she so combative and disoriented in the first place? Was that from the shock or from previous medication? I'm assuming in from decreased perfusion and blood volume...
Click to expand...

Not a stupid question.

Probably a combination of both....recovering from GA from the D&C, and the fight-or-flight stuff she was most definitely feeling as a result of her ensuing hypovolemic shock.

She kept wanting to sit up.....despite pleas from everyone for her to be still.....she wasnt listening, and was fighting our attempts to lay her down.

Nothin a little ketamine wont cure....
 
nice job - but why a tlc? Ours are 20 cm long and the 16 g port is like an 18-20 g piv. I would go for the biggest cordis I could find (9fr).
 
this reminds me of a case I had during residency....
It was actually the OB residents ski day so only OB attendings to cover the unit...

Get a call about a lady over on antepartum (aka anti-partum) who has been sitting there for about a month with her previa (not thought to be an acreta or anything). She's bleeding... it's always a game with those patients who sit on antepartum whether to maintain IV access (burn through all her veins or save them). I run over and she's not just bleeding; she is gushing.. and they dont have any vitals on her I manage to dart a 16G IV into her, tell the LD nurses to call an OB bleeding emergency, and we bring her back to the OR. There are about 12 L/D nurses there, with the sole purpose of trying to get the baby on the monitor (they dont even know how to put the arm rest on the table). Chug some bicitra, 1st BP 70s, scrub up her belly, and off to sleep. I manage to snag an a-line somehow and drop another 16G into her. I'm calling for blood and the attending open up her belly... **** in a handbasket and blood everywhere... and i've got barely any BP. I'm yelling for blood and the circulating nurse asks if I want the O neg. I yell at her what the hell do you think an OB bleeding emergency entails.... I'm pouring the clear stuff into her to try to get her BP up (with no avail). In the meantime, i am running the vec/O2 anesthetic but fortunately someone had slammed on a BIs and it was reading 7 the entire time. The Heme fellow finally shows up with 8 Units of O neg after about 15 mins and apologizes out of breath that apparently the blood bank hospital assitants were off at lunch. I tell her thanks for the blood, go get me more. turns out she has a percreta and her placenta was invading the bladder- and bleeding like stink. Two OB attendings are yelling to call for a gyn onc attending. They say page everyone, call the damn chairman's office if you have to. Finally, a GYN onc attending shows up, gets control of the situation, and cuts out the uterus.

But the best remark I get is when I finally get a BP higher than 70 and I hear from the other end of the table: we're getting a lot of bleeding her, can you get her BP down.

Final tally- 16 Units of blood, 12 L of the clear stuff and a patient who in my mind lost 15 L of blood of so... took her down to the ICU and she was extubated teh next day. Fortunately her brain tolerated the extended time of low flow and she didnt take much of a hit (though she didnt start with a full deck either)
 
Great thread, great save.

jetproppilot said:
You guys are good!!! Like Will Smith said in Bad Boys: "THATS HOW YOU DRIVE!! I'M TELLIN' YA...THATS HOW YOU DRIVE!!!!

Less than deft OB/GYN involved, which is a strike against us. She wants to go to the ICU. I think we need to go to the OR.....I don't know if its accreta, retained products, etc, but I don't see a medical solution to the problem.

Mil and Noy, I took your advice.

Told JoAnn the CRNA to fetch the 200mg/mL ketamine, which she did.

Darted the chick in the deltoid with 200mg ketamine.

Few minutes later she's sedated.

Right sided IJ triple lumen placed CDAZY FAST.

Then 100mg IV ketamine just for kicks, followed by 100mg sux....

8.0 ETT in....

instructed useless L&D RNs to check all blood products arriving....

started pouring PRBCs into 16" port of TLC.....

then had a COME TO JESUS talk with OB/GYN atending....

JET: "Dude," (a chick OB/GYN but I consider "DUDE" applicable to anyone).."We're bleeding out here. If we go to the ICU she's gonna die."

Yeah, that sounds melodramatic. But I knew that was the truth. And it was.

OB/GYN says "lets go to the back."

We get her on the table.

They open her belly and start fiddling with the anterior portion of the uterus.

I'm getting pissed, since I have a finger on her carotid artery and can feel the faintness of it.

The surgical intervention is outta my league, but I know the 2 OB/GYNs operating are at the bottom of the bell curve.

I feel an obligation to this patient.

Jet: "ARE YOU TWO GAINING CONTROL OF THE BLEEDING? WE'RE POURING IN BLOOD AND HER BLOOD PRESSURE STILL SUCKS!!! ARE YOU AT THE UTERINE ARTERIES YET?

I'm WAY overstepping my boundaries here. I'm not a surgeon. But I recognize these two clowns are trying to save the uterus.....instead of sacrificing it and saving the chicks life.......

Jet: "LISTEN DUDES......WE'RE STRUGGLING UP HERE TO KEEP HER ALIVE.....YOU EITHER ARREST THE BLEEDING OR SHE'S GONNA DIE!!!"

I wish I was exaggerating...but thats how the banter went.....and thats what it took to get the "doctors" to GO AHEAD and sacrifice the uterus....what the fuk? was I missing something? Why were they so fixated on preserving the organ with the chicks life teetering? I guess they didnt appreciate how dire the situation was....it was my job to let them know....

I'm posting this to let my budding colleagues out there that sometimes you have to STEP UP TO THE MIKE WITH MICATIN.....

I mean NOONE was interested in taking the reigns with this case....lets just go to the ICU so we can get her outta the OB unit....

FUK THAT!!!

She wouldda died.

Uterine arteries clamped.

Subsequent removal of organ.

Many units of blood products later, chick is in ICU....intubated, but waking up.

Thats whats cool about this job, colleagues.

Every once in a while you get a case where ALL IS AWRY and everyone around you is running around in circles, accomplishing nothing.

Allowing you to STEP UP TO THE MIKE WITH MICATIN...

and make a difference.

JoAnn the CRNA and I made a difference today.

We saved that lady's life.

FUKKIN A. I'M FEELIN' GOOD ABOUT MY CONTRIBUTION TODAY.
Click to expand...
 
thank you for this cool case jet . do you mind telling us what the OB/GYN's take on the whole thing was after it was all over? fasto
 
damn...that just made my day. KEEP EM COMING! I cant wait till i start residency. just have to get thru my intern year 😳
 
Nice work Jet and Joanne.

Excellent lesson. If your brain has something to add to the care of the patient then use it! In this case Jet did everything right on his end. The OBGYN's were focused on saving the uterus because of the pt's age. Pt still goen down.

Speak up yall.

I've had a recent intraop on-call conversation with the Gyn when she just wasn't totally sure she had bleeding controlled and was actually thinking about closing because she couldn't locate the oozer and it was like 4 am or something. I was like "look man, do you wanna be able to sleep tonight? You think you're gonna be able to sleep if you don't get some help in here to get your back?" Gen-Surg showed up a few minutes later and together they got everything under control.

Jet you saved this chicks life and yourself a big fat law suit. Seriously. It could have been easy to listen to the OBGYN and dumped this chick off in the unit where they would have coded her and done a bedside X-Lap. People get swayed in times like this. They don't think clearly.

Anyhoots,

I couldn't do an inteross line. I would have no idea where to even get one let alone know if its placed right (your gonna be squeezing in the fluid against tons of resistance even if its in the right spot).

I woulda ketamine/ephedrine darted her and shoved an IV in her neck. CRNA to tube. Time for OR, blood, some of that IM hemabate stuff and more Pit in the bag. This is Uterine atony/Rupture/inversion until proven otherwise. And it takes a knife to prove it.

Strong work you beast.
 
Very nice case. High "pucker" factor.

While Gyn-Onc and the guys who do high risk OBS are pretty strong, you have to be careful on the guys who only do bread and butter OBS. In our system, GYN-OBS is the only surgical residency that does not write the POS (Principles of Surgery) exam during their training and it shows. Resuscitation and emergency preparedness is generally lacking.

Why is there always more panic and shouting and banging of equipment during a stat C/S when compared to a trauma case where a guy has blown his face off or has sliced his neck from ear to ear, or ....

One funny example of this was when I was just walking to the cafeteria when I hear a Code Blue called for the OBS floor. Well the only thing uglier than a code in radiology is a code in OBS so I thought I would poke my head in.

As I jog through the door I ask for the story and get that the pt is post-partum day 1, went to the bathroom and then looked in the bowl, saw alot of blood and passed out. OBS staff and resident in room not doing anything. Patient is now conscious and crying in bed. BP machine and O2 sat standing lonely and unused in the corner. NS bag attached to 18g iv in wrist is closed. What is the active resuscitation going on? Patient is sitting up in bed, legs are being held apart and a foley is being placed "To measure urine output". WTF? I walk over, lay the bed head down, asking the patient the usual questions as I open the IV wide open and hook up the BP machine while feeling the pulse. Normal BP, normal pulse, pt gives clear vasovagal hx and I walk out of the room shaking my head at the first "STAT - foley placement" I have ever seen.

As an aside to those in training. When you get called to a stat C/S for fetal distress and the patient is brought flying into the OR always ask "What is the fetal HR now?". Not that it was 60 bpm 3 min ago but what is it NOW? Often it is back to normal once that contraction has passed and while the baby does need to come out you can tell everyone to decrease the amount of noise in the room, slam in your slick 45 second spinal and get the show on the road. Don't let their panic push you into a stat GA for that 400 pounder when the FHR has normalized and you have time for a spinal.
 
fastosprintini said:
thank you for this cool case jet . do you mind telling us what the OB/GYN's take on the whole thing was after it was all over? fasto
Click to expand...

Sorry, I didnt talk with her afterwards, Fasto. She's kinda hard to talk to, and I was beat....so just left. I think in addition to this nightmare I did 6 or 7 epidurals and a cuppla C sections so I was ready to get the flock outta dodge.
 
jetproppilot said:
We saved that lady's life.

FUKKIN A. I'M FEELIN' GOOD ABOUT MY CONTRIBUTION TODAY.
Click to expand...


👍

Sounds like your OBGYNs rotated through HPL at one point in their training, where the chief of OB said to my face one day, "You know Trin, us OBGYNs are considered capable of doing three things in the belly: taking out the uterus, cutting the left ureter, and cutting the right ureter."
 
He does have that Singletary look in his eyes. Could you imagine that guy coming head on with his eyes locked on you like that?
 
Boxers are awesome dogs.

And I love getting to learn from others' experiences like this.
 
Hi, I'm the MMQB. I'm just curious, with her "bleeding like a stuck pig" even before going back for the D&C, what else did you try to do while you had her nice and still to secure IV access above that 20ga?
 
Just curious but there were a few things that came to mind prior to the OB/Gyns needing to do a hyster and that could have been done during the DC. I would think that the proper sequence as an OB/Gyn goes something like this: (1) pack uterus with surgical towels and leave them in, (2) hypogastric artery ligation, (3) last resort was a hyster.
Hypogastric artery ligation is uterus preserving and can stop bleeding, it apparently isn't a technique that is used much anymore because of the risk in disecting out the artery (damage to ureters, OB docs not knowing their anatomy etc).

Was this amniotic fluid embolus with DIC?
 
W222 said:
Just curious but there were a few things that came to mind prior to the OB/Gyns needing to do a hyster and that could have been done during the DC. I would think that the proper sequence as an OB/Gyn goes something like this: (1) pack uterus with surgical towels and leave them in, (2) hypogastric artery ligation, (3) last resort was a hyster.
Hypogastric artery ligation is uterus preserving and can stop bleeding, it apparently isn't a technique that is used much anymore because of the risk in disecting out the artery (damage to ureters, OB docs not knowing their anatomy etc).

Was this amniotic fluid embolus with DIC?
Click to expand...

The pt is bleeding to death. How many ob/gyns do you know that can quickly identify the uterine artery? I'm sure there are some, I just don't think I know any? And once the uterine artery is ligated, what happens to the uterus?

Pack the uterus? Well maybe but that wouldn't be my first choice.

AFE? She's bleeding from the vagina and Jet didn't mention the other signs of AFE so probably not likely. If DIC, it is from blood loss or retained products or something like that most likely.
 
I agree the urgency of the situation would be an indication for a hysterectomy. It sounded like the blood pressure was not stable despite aggresive fluid resuscitation and pressors (at least ephedrine). The uterus does have a collateral blood supply to my recollection from the uterine and hypogastric (I think) arteries so occluding blood supply from one or the other may slow down the bleeding but wont neccesarily stop it or cut off the entire blood supply of the uterus. I think the that there was a study showing a good pregnancy rate following uterine artery emobolization although I would have to look up the article again.
 
Noyac said:
The pt is bleeding to death. How many ob/gyns do you know that can quickly identify the uterine artery? I'm sure there are some, I just don't think I know any? And once the uterine artery is ligated, what happens to the uterus?

Pack the uterus? Well maybe but that wouldn't be my first choice.

AFE? She's bleeding from the vagina and Jet didn't mention the other signs of AFE so probably not likely. If DIC, it is from blood loss or retained products or something like that most likely.
Click to expand...

I realize that on the second go around time was an issue, but I was suggesting that these things be done on the first OR session. Also, if the hypogastrics are ligated then the uterus can stay in and the patient's fertility can actually be preserved. Granted, this patient was tanking.
 
I asked my wife, who will be done with residency in about 2 months, what she would do.

She said she'd go back to the OR and take out the uterus in this unstable patient. Too late to do anything else.

If the patient is stable then it goes like this: jack up uterine tone, shove a balloon in the uterus, get her off to IR and have em do some kind of embolization.
 
Back in the OR tomorrow.

Will try and look da chick up and see if I can find out what the etiology was that started her problem, since I don't know.
 
nutmegs said:
Hi, I'm the MMQB. I'm just curious, with her "bleeding like a stuck pig" even before going back for the D&C, what else did you try to do while you had her nice and still to secure IV access above that 20ga?
Click to expand...

HUH?

I did what I stated, Slim.

There was nothing else to do that wouldda resolved the problem, short of me quickly reading the Time Life Series To OB/GYN Emergencies and opening up da chicks belly myself. Or maybe JoAnn couldda opened and ligated.
 
jetproppilot said:
HUH?

I did what I stated, Slim.

There was nothing else to do that wouldda resolved the problem, short of me quickly reading the Time Life Series To OB/GYN Emergencies and opening up da chicks belly myself. Or maybe JoAnn couldda opened and ligated.
Click to expand...

You did the right thing. The OB did the right thing. You saved this woman's life. Period. There's only so much blood you can give. I'm becoming more and more anti-blood-unless-absolutely-necessary the more I practice and learn. I hear Vent's wife's point, but I agree she sounds unstable and probably would've bled out if/while you were trying to embolize.

-copro
 
Good job, and obviously outcome was excellent. To echo another poster, I agree a cordis would have been better. Where I've been trained, a TLC is not considered a volume line. Was there a reason, you threw in a TLC vs cordis? Other than that, nice case.

It does seem that the OB's algorithm goes something like this-

Priority:
fetus, uterus, then mother's life.
 
timtye78 said:
Good job, and obviously outcome was excellent. To echo another poster, I agree a cordis would have been better. Where I've been trained, a TLC is not considered a volume line. Was there a reason, you threw in a TLC vs cordis? Other than that, nice case.

It does seem that the OB's algorithm goes something like this-

Priority:
fetus, uterus, then mother's life.
Click to expand...

Thats good critisism (how do you spell critisism?).

To be honest, the TLC is what I saw so I grabbed it.

Unsure whether or not we have cordis's in OB....but thats a good thing to bring up.
 
You must log in or register to reply here.

Similar threads

W
Case discussion: why acidosis?
Replies
46
Views
3K
narcotics999
N
V
CRNA introduced herself as “anesthesiologist” before case
Replies
23
Views
4K
coffeebythelake
coffeebythelake
M
Case logs
Replies
7
Views
3K
Ashers
Ashers
O
What happens after 10-year cycle?
Replies
4
Views
1K
Dantrolene FC
D
V
Critical AS case
Replies
41
Views
5K
Radetzky
R
Top