Holy Shiit What A Case

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A TLC is a volume line if that's all u have 🙂

You can also use a 14-16 ga angiocath to place an IJ or SC. When I was a paramedic, we used a 3 1/4" angio to place CVCs in the field. As fast as a PIV to place and better for volume resusc. In a thin person, you could probably even get by with an 1 1/4" angio. You can always place a cordis over it with a guidewire when u have time.

Dre'

jetproppilot said:
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.
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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...

Sorry Jet, I should have been more clear. The question was, before/during the D&C (before the crump) were you aggressively pursuing more in the way of IV access? You mentioned that her veins were sub-par but not if you were initially happy with the 20 ga versus trying for a post-induction 2nd line. Minor point and clearly retrospective but seems like it would have helped you out down the road. Das all.
 
DrDre' said:
A TLC is a volume line if that's all u have 🙂

You can also use a 14-16 ga angiocath to place an IJ or SC. When I was a paramedic, we used a 3 1/4" angio to place CVCs in the field. As fast as a PIV to place and better for volume resusc. In a thin person, you could probably even get by with an 1 1/4" angio. You can always place a cordis over it with a guidewire when u have time.

Dre'
Click to expand...
Do you know what gauge the introducer with the catheter is on the TLC kit? I've sutured the plastic sheath off one of those into the IJ before in the ICU, to take someone for a contrast CT...
 
nutmegs said:
Sorry Jet, I should have been more clear. The question was, before/during the D&C (before the crump) were you aggressively pursuing more in the way of IV access? You mentioned that her veins were sub-par but not if you were initially happy with the 20 ga versus trying for a post-induction 2nd line. Minor point and clearly retrospective but seems like it would have helped you out down the road. Das all.
Click to expand...

I was happy with the 20" for the D&C....wasnt persuing any other IV access.

Just a freak sequence of events that I probably wont see for another 10 years....especially since it was topped off with her IV coming out. Had that not happened it wouldntve been such a big deal because we couldve quickly sedated her, which wouldda hastened the central line placement.

If I had to do it over again I'd do it the same way.....in other words I'm not gonna start placing 2 IVs on a D&C....
 
timtye78 said:
Priority:
fetus, uterus, then mother's life.
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I agree about the cordis, but in our OB suite, I would imagine a cordis is hard to scrounge up. I may go check here in a few minutes. Triple lumen is better than no lumen.
Tim, I am not sure I understand your priority list. Mine would consist only of the mother's life in this situation. You have a non viable fetus, so that's out of the picture. Saving the uterus would be nice, given the age of the patient, but that uterus is not going to produce any more kids if it's host is dead. Hopefully, I am just misunderstanding what you meant by the priority list.
Regards,
 
I think he was saying that the OB's priority list may not seem to be what you describe, but rather the order he listed.
 
nutmegs said:
Do you know what gauge the introducer with the catheter is on the TLC kit? I've sutured the plastic sheath off one of those into the IJ before in the ICU, to take someone for a contrast CT...
Click to expand...

You mean the white and blue angiocath? That's an 18G on most adult sized kits.
 
jetproppilot said:
I was happy with the 20" for the D&C....wasnt persuing any other IV access.

Just a freak sequence of events that I probably wont see for another 10 years....especially since it was topped off with her IV coming out. Had that not happened it wouldntve been such a big deal because we couldve quickly sedated her, which wouldda hastened the central line placement.

If I had to do it over again I'd do it the same way.....in other words I'm not gonna start placing 2 IVs on a D&C....
Click to expand...

I was involved in a similar case when I was a resident. Full blown DIC. Pt was bleeding like crazy when they did the D+C. I don't remember having any IV issues. The bleeding was so bad that we gave a bunch of RBC,FFP, PLt, cryo, and Factor 7. Hysterectomy crossed our minds but after factor 7 everything looked better. Everybody feels bad after a hysterectomy but they would feel worse if the pt dies.
 
jetproppilot said:

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....
Click to expand...


Cool case. But maybe taking her to the ICU (if you could keep her alive) would allow a surgical consult from a real surgeon.

When I was a resident on ICU rotation, I had a similar situation, but the patient was in the unit bleeding, getting pale, low BP and distended abdomen (after some delivery OB surgery of some sort.) I kept calling the OB guys and they came by about 4 times and kept saying, "This isn't a surgical issue."

I agree with you that sometimes you need to step up, but sometimes as a resident it is difficult to do despite your attempts to convince others. Anyway, I knew that the surgery attending was in the operating room, so I walked to the OR and asked him if he would come by and take a look at the girl (after explaining the clinical situation with him.) I know this was probably not PC asking for a surgical consult and stepping on the OB's toes but they just were not listening. Anyway, he scrubbed out of his case right away (leaving the surg resident) and came and evaluated. He then called the OB attending and said he was taking this girl to the OR immediately.
The OB staff was rather embarrassed I think.
 
pseudoknot said:
One of the above YouTube links had a related video of this emergent trach on an awake soldier during Vietnam:
http://youtube.com/watch?v=-i-3mCgsglE
Click to expand...
That video is funny, the guy they are doing the tracheostomy on didn't seem to be in distress at all and he almost smiled to the camera, it actually reminds me a little of the alien dissection movies.
 
Planktonmd said:
That video is funny, the guy they are doing the tracheostomy on didn't seem to be in distress at all and he almost smiled to the camera, it actually reminds me a little of the alien dissection movies.
Click to expand...

Yeah, it was odd. If the comment is true and it's Arthur Viera, he was pretty messed up by that point according to the excerpt from We Were Soldiers Once...And Young. Shot multiple times including the neck, hit by grenades. Maybe it was just the adrenaline?
 
numbmd said:
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.
Click to expand...

well yah, she's a g3 too. sounds like she lost the last one tho. too bad.
 
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