Thursday, October 27, 2011

#64 Operative Reports #1

If I keep this up, I’ll never be able to take boards with these cases:

Cesarean Section, 10/25/11

The patient presented at “8 months” with vaginal hemorrhaging and the baby was determined to be alive with the fetal doppler. The patient verbally consented for a cesarean section for the indication of placental abruption. She was transferred from the delivery room to the operating room by having her hobble along with blood dripping down her leg.

Once on the table a spinal was attempted, but failed. I instructed anesthesia to please try again because lidocaine with ketamine makes it hard to separate the abdominal muscles. Anesthesia was indeed able to obtain spinal anesthesia. We prepped, scrubbed, and draped. (During scrubbing the water went off, so someone was sent to turn on the pump to fill up the tanks. We continued scrubbing).

Before incision, the patient’s heart stopped and she stopped breathing (yes, she died). (What? I didn’t even know there was a problem, Simeon. How long has the monitor not been picking up an O2 sat or heart rate. I did notice it was quiet, but I thought she just wasn’t hooked up yet.) Anesthesia started mask breathing for her. First assist and lead surgeon traded off chest compressions. Another nurse in the room ran to get Mr Dr Netteburg from rounds.

Her heart started up again. Anesthesia continued bagging. High spinal suspected.

Mr Dr Netteburg entered the room, but by this time things had somewhat normalized. Mr Dr Netteburg checked her pupils.

“Dear, her pupils are fixed and dilated.”

A Pfannensteil incision was made. This was sharply dissected down to the uterus. The baby was delivered in cephalic position. The cord was clamped and cut. The APGARs were...well, he was crying some, so that’s good, right? The baby boy was passed off to the awaiting NICU team (or, um, ER doctor) for possible resuscitative measures.

The uterus was closed in 2 layers with 0-chromic. Irrigation was done. Fascia was closed in continuous fashion with 0-vicryl. Skin was closed with 3-0 vicryl using interrupted suturing because EVERYTHING gets infected here it seems.

So, this was pretty much an uncomplicated surgery except that she died and came back to life.

Baby was sent outside to the awaiting family to wrap up in a non-sterile brightly colored African cloth.

Mother received artificial respirations long enough that the spinal wore off. As I was shining the bright lights in her eyes, she eventually started blinking and pushing me away with her hands. So, her fixed pupils improved, and I don’t even know what caused them.

Mother was transferred to maternity where the family was awaiting. Strict instructions were given to family members that if she stopped breathing, look for a nurse (which sometimes can be hard to find).

I learned I was supposed to give epinephrine for a high spinal apparently.

Mother and baby are doing very well now. The mother knows I will kill her if she gives her baby water. (And it’s not the first time she will have died, she does know that too.)

Yeah! I definitely can’t turn this operative report in. Although it IS the first one I’ve written in over a year. (At least one that’s been over 3 sentences long.)

olen and danae

Olen phone: +235 62 16 04 93
Danae phone: +235 62 17 04 80

Olen et Danae Netteburg
Hopital Adventiste de Bere
52 Boite Postale
Kelo, Tchad

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