Tuesday, August 17, 2010

Problems in a Csection

Problem 1 - former nurse with a transverse lie (baby sleeping sideways in mom's belly) in labor
How to solve problem 1 - needs a Csection
Problem 2 - pt has a fibroid in her uterus (a benign muscular growth)
How to solve problem 2 - ultrasound to see position of baby and location of fibroid, thankful the baby's back is up and won't require a classical incision
Problem 3 - due to fibroid the Csection will be more difficult and it is 0630 and I am a Family Practice doctor who doesn't have any formal training in high-risk Csections or surgery
How to solve problem 3 - see Jim and briefly discuss with him, recommends get good help - wake up Becky to see if will help, find Jim in OT waiting for us
Problem 4 - while gowning up for the surgery, a handle of the OT faucet breaks off the wall leaving a hole in the wall and hot water pouring on the floor
How to solve problem 4 - have someone try and put the handle back in the wall, call Marsha to call maintenance, rescrub/gown
Problem 5 - the spinal didn't fully set up
How to solve problem 5 - use lidocaine as needed, start incision lower, only cut up if necessary, give other meds as preparing to take baby out
Problem 6 - the suction machine was broken in the process of trying to get it to work
How to solve problem 6 - jerry rig it to get through the case
Problem 7 - can't feel fibroid when get to uterus
How to solve problem 7 - reconfirm with Jim, who is standing by, where to make the incision
Problem 8 - the uterine incision went right through the fibroid, blood is filling up in her belly, I can't get into the uterus itself nor find any part of the baby
How to solve problem 8 - pray, ask Jim to quickly gown and help out, hold pressure
Problem 9 - the uterine incision went right through the fibroid, about 2 inches in and no baby yet
How to solve problem 9 - pray as Jim just keeps going and going and going until he finally gets inside the uterine cavity
Problem 10 - the baby is breech and the fibroid is making the extraction very difficult
How to solve problem 10 - pray and keep going, retractors, bandage scissors, more prayer
Problem 11 - baby somewhat depressed after delivery
How to solve problem 11 - Becky breaks scrub and helps out baby catcher
Problem 12 - there is a huge fibroid in her uterus, making the closure difficult
How to solve problem 12 - keep sewing, layer by layer, until the bleeding stops
Problem 13 - she and/or next baby may not survive another Csection
How to solve problem 13 - send Becky to talk to husband about a BTL, he gives consent, and do the tubal
Problem 14 - the uterus is still bleeding
How to solve problem 14 - pressure, more stitches, surgicel
Problems 1-14 - by God's grace were solved and we had a healthy mom and baby at the end
Problem 15 - the work day is just beginning
How to solve problem 15 - thanking God for what He has just done and asking for strength to keep going