Jevohas witness and cesarean hysterectomy

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The patient had hemoglobin of 8 and had cesarean for CPD. Intraop there was placenta increta and the obgyn manually extracted. Noted couvelair uterus and did hysterectomy.
Postoperative the hgb is 4. Vitals are relatively stable. Volume resuscitation done and pt making urine
Any one here has experience with perflurocarbon?
Any protocols that any big institution has
Tx
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She sounds like she is in "good" shape for a low hgb. Ensure adequate end organ perfusion, and let her sit in the hospital a while. I have no experience with artificial hgb products, but from what I have read they are not quite ready for prime time. That hgb should be fine for survival, she just wont be out working off that baby weight for a long time. I would be happier letting someone who is in that boat create her own PRBCs. Maybe others have awesome success stories with those products, but if all is relatively well, why test them in her?

Lowest Hgb for a surviving JW person I have personally taken care of was 1.3. She was ok with CVVH, multiple pressors, and remaining intubated for a few weeks (on our dime of course). She walked out of the unit fully intact at 3.2 after 3 weeks. Have not gotten more phone calls from a floor service/nursing than at that time, ever.
 
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Yeah, Hgb of 4 in that situation is outstanding. Just let her get better on her own. JW's have proven to us that people can get by pretty well with low Hgbs.
 
Depends on where you are, but hyperbaric chamber is another Hail Mary option if tissue hypoxia becomes evident. This pt isn't there yet.
 
Hawaiian Bruin said:
Depends on where you are, but hyperbaric chamber is another Hail Mary option if tissue hypoxia becomes evident. This pt isn't there yet.
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... Or just a nonrebreather mask, if the pt is breathing OK and currently on room air or nasal cannula. (Think of the PaO2 with a pt on 100% O2 vs 50/50...) But you're right that HBO would be the next step after that.
 
Yes mask oxygen given, pro crit, iron transfusion given, but heart rate in 140. Don't want her to go into high out put cardiac failure. Thanks for the input

Small rural setting here, don't have hyperbaric
 
Another point. Since you are in a rural setting, make sure the OB/Gyn is not the primary person making decisions for this patient. They likely need someone who knows how to take care of sick patients and to recognize when they are in trouble. If you are the one doing that, then never mind.
 
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Yes, the hospitalist, administrator, lawyers for the hospital have all been consulted in real time. The hospitalist is in charge.
 
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The other thing to do, IF tissue hypoxia develops (which I doubt it will), is intubate, crank up the FiO2, and deeply sedate. That is, decrease the oxygen demand along with fully maximizing your pO2.
 
How long does anesthesia need to follow up in sick patients? Assuming there are no anesthesia complications
24 hrs -48 hrs?
 
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norwood said:
Maybe a dumb question on my part, but how's the pain control?
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I believe no question is dumb in anesthesia. Personal bias. She came for a Regular delivery from out of town, no prenatal care. Dilated to 6 cm and now had CPD. So cannot transfer to higher level of care.
Did a spinal with duramorph. At the end of the chys, she was complaining of discomfort. Gave versed, fentanyl and ketamine. I. Had everything ready to intubation her if needed.
Hr150-160 yday.
She got some intermittent dilaudid. Not a complainer
 
inquisitiveanes said:
How long does anesthesia need to follow up in sick patients? Assuming there are no anesthesia complications
24 hrs -48 hrs?
Click to expand...
Really depends on your institution. We don't do ICU care at all. Once they leave the PACU, unless they have an epidural pump for post-op pain, they are the responsibility of the attending OB and the intensivist.
 
inquisitiveanes said:
Legally how long are anesthesiologists on the hook?
48 hrs?
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On the hook for what? Once the patient is discharged from PACU to a floor, they are back under the care of their surgeon. You can't be held responsible for what happens to them after they leave the PACU.

Now on the other hand how long they can dig through the chart and come back and sue you for something you did while they were under your care (in the preop/OR/PACU) depends on the state. But you aren't legally responsible for what somebody else does to them after they leave your care.
 
Re: perfluorocarbons, I was just at the SCA a few weeks ago and there was a talk about them. I seem to recall that they are only used in places like South Africa and Russia where the risks associated with them (renal failure, IIRC) outweighed the risks of a transfusion from a dicey blood supply. I recall that every company that has tried to get into developping them has gone bust.
 
Patient doing better
Dc from icu
Hgb-5.5
Thanks for the input.
 
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