courtesy of Azad..
Did my E2 ( aka maternity call) last night. It is definitely less hectic compared to my calls in MOT HKL. Only a handful of caesarean sections to do but the day started bad. As i arrived in Selayang Hospital at 7.20am , received SMS from my colleague who was post call requiring me to be in Maternity OT straight away as my specialist just started a fetal distress case. So i missed the morning CME and breakfast.. huhuhuh..
That case was uneventful but i did not start my elective cases till about 2 pm !! As i mentioned before my morning started bad. I was not able to find the epidural space for CSE ( combined spinal epidural ).It was quite frustrating poking the poor nurse in looking for the space. My boss told me to just give a single spinal shot .. amazingly , it was a breeze.. hmm... Its either it was too early or my skill is a bit off after a long lay off from epidurals. When Dr Burn was just about to haveh is try , a call came from the labour room - patient post vaginal delivery had collapsed. Dr Burn went to see the patient..
When he came back.. there was this panic look. He's opening the 2nd OT - apparently he had to intubate the unfortunate lady as she was severely hypovolaemic. When she arrived in the OT.. my god !! She was WHITE !! gillllerr.. pallor ..and her BP was soo loww !! GOD !!! It was difficult then to insert other IV access as her veins nearly all collapsed ! It was so stormy ans blood was gushing out from her vagina.. profusely !! A quick check on her Hb status... 2.0 !! hakkss !! giller panic !!! Transfuse asal boleh jer la.. the OnG consultant was there as well and obviously she herself was panicking..shouting around.. i guess afraid of another maternal mortality which looked very likely at that time.. She was hypotensive and really really tachycardic ...
Her monitor ECG looked bad.. the T waves were thin and taller than the QRS complex. A quick check of her Pottasium level showed that it went down to 2 mmol during resuscitation before intubation !! We were busy resuscitating her with blood and blood product to the max.. asal boleh jer bagi masuk.. very very stormy. Stat ABG showed severe metabolic acidosis with hyperkalaemia.. supporting the suspicious ECG.So tu pun kena correct ah.. and the ECG became normal again...
OnG decided to proceed with hysterectomy as they could not arrest the bleeding !! ( chopped off the uterus aka womb !! ) I went.. God.. She's just 27; first baby , antenatally uneventful ; delivered normally., baby was ok... but this post partum haemorrhage certainly is risking her life to the max !! I cannot imagine how she would feel when she wakes up. Certainly a nightmare..
We managed to stabilize her..and sent her to ICU. Dr Burn was exhausted.. She lost like 5 - 6 Liters of blood on table just like that. We managed to salvage her.. but psychologically , i really don't know whether she will be allright not having her reproductive system with her anymore..
It was a sad morning seeing her family members. They were obviously glad that she was allright , but will that hold ?
I continued my cases till late evening. Only 2 LSCS at night.. and 1 cervical tear repair at about 4 am. Not bad for a pre holiday call.
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