Home > Anaesthesia, Obstetrics > Term 7 Week 5 (w/c 04/11/13)

Term 7 Week 5 (w/c 04/11/13)

November 4, 2013

Thank you all for your contributions to an interesting case last week.

This week we are heading to the Delivery Suite.

You are working as the senior trainee on the Delivery Suite.  You have a 2nd year trainee undertaking their first Obstetric module with you.  They have heard various rumours about working on the Delivery Suite and ask you what emergencies can occur.

What do you tell them?

Thank you for your contributions yesterday. We seem to have considered maternal and obstetric emergencies but you are then asked  – what about anaesthetic emergencies?

What anaesthetic emergencies can occur?

Your discussion is interrupted by a page from a midwife asking for an epidural in a 25 year old Primigravida lady who is in labour.

As you head towards the delivery room

What else would you like to know?

You go and see the lady.  She has been admitted for induction of labour at 39/40. Her BMI is 35 and her blood pressure is 160/93. She is screaming in pain and wants you to “get rid of my pain”. The obstetricians want to start a syntocinon infusion.

Are you going to insert the epidural?  What will you tell her? Do you want any other information?

Thank you for your contributions yesterday.

As given last night: She is 4cm dilated. Her booking BP was 112/64. Temp is 37.5 and PLT 134.

You discuss epidural and decide to proceed with insertion.

As you advance your Tuohy needle, the patient moves suddenly and you notice clear fluid coming from the needle.

What are you going to do?

You decide to remove the needle and successfully resite the epidural 1 space higher.  The epidural is established and achieves adequate pain relief.

6 hours later you are called by the Obstetric SpR. The lady has failed to progress and there is now evidence of foetal distress on the CTG. They wish to undertake a class 2 LSCS.

What is your plan?

The epidural has been working well. You top up the epidural with a mixture of 2% lignocaine and 0.5% Bupivacaine. After 15 minutes you have a satisfactory block to T5. The obstetric registrar commences the LSCS and quickly delivers the baby. 10 minutes post delivery, you notice that the patient’s HR is  140 her BP is 90/40 and the suction has gone quiet. The obstetric registrar has a concerned look on her face and has asked for her consultant to attend.

What are you going to do now?

You ask for your consultant to attend but he is 20 minutes away.  The obstetric reg tells you that she is unable to get control of the bleeding. There is currently 2000ml in the suction and all the swabs are heavily bloodstained. The patients observations are HR 160 BP  BP 80/30.

What do you do next? What other options could be considered?

There are no trick questions in #Gasclass. Everyone’s contribution is welcome. Please do not forget to add the ‘hashtag’ #gasclass to every Tweet so that it is included in the conversation. To help give new contributors an opportunity to join in we would advise that you should only add one idea per tweet and not contribute until another Tweeter has joined in.

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Categories: Anaesthesia, Obstetrics
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