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Re: ? perf at hysteroscopy From: Joanne Bulley, MD (islesannie@gmail.com) Tue Aug 28 21:30:39 2007 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: D. Ashley Hill: "Endometriosis and abnormal uterine bleeding" Previous message: Terrence.Jones@kp.org: "Re: anemia and neuro pt" Next in thread: art fougner, md: "Re: ? perf at hysteroscopy" Reply: art fougner, md: "Re: ? perf at hysteroscopy" @ cases: Mine - one of my first H/s Rollerbar / rollerball ablations. Ther was the immediate influx of fluid (immediately identified by the nurse in charge of the fluid - and I saw the bowel floating in the fluid. No recollection anymore on the level of the fluid discrepancy - but I think it was not over 1000 cc. Kept her overnight - watched the Na and she did fine. I think she later had a hyst for menorrhagia (this was pre-1995) Case I saw a patient for - as an opinion after the fact. This case has already been decided and documented so no worry if there is a lawyer lurking (also I reviewed all this info in 98 or 99 so would not swear to the nuances: Hysteroscopic myomectomies. The Gynecologist kept going and going and going. The OR notes I reviewed before walking in to see the patient shows that hours went by - and there were problems the anesthesiologist noted as the gyn was quitting - and the fluid was off by 9000 cc. Yes - nearly 10 liters. Her Serum sodium was between 105 & 109 if I recall correctly. She was in the ICU in a coma for sometime - gradually rehabilitated and after a year or two was back to her previous job (elementary teacher if I recall that correctly) The case presented here - if she didn't drop her sodium then I think you do need to figure where the fluid went. But whether that is by CT scan / US or L/S depends on the assessments by the gyns involved and the stability of the patient. Joanne At Tue, 28 Aug 2007, ainsron wrote: > >a >failed ablation. I had a perforation on the right lateral side of the >uterus, by the lower uterine segment. It went directly into the broad >ligament and dissected along the right pelvic sidewall, above the pelvic >brim, it was amazing how much fluid she received in the blink of an eye. >When >I went back to do a LAVH six weeks later, because of continued bleeding, >complicated. > >Ronald E. Ainsworth, MD, FACOG > >-----Original Message----- >FRANCES >WREN >Sent: Tuesday, August 28, 2007 7:17 AM >To: Multiple recipients of list OB-GYN-L >Subject: ? perf at hysteroscopy > >just in with a colleague who did an endo ablation..... > >did not appear to have any problems..no evidence of perf... > >the >suction. > >assuming perf... > >urine clear,so not there. > >distinctly >like diluted stuff..versus usual intraperitoneal fluid. > >Px'd with lasix and saline @150 cc hourly.....maybe should inc rate of >saline to prevent the hyponatremia from electrolyte osmosis from the >glycine????? > >any other suggestions listers????? > >frances wren > >>>----- Original Message ----- >From: evsono@pipeline.com (art fougner, md) >Date: Tuesday, August 28, 2007 5:47 am >Subject: Re: anemia and neuro pt >To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net> > >> "It ain't over 'til it's over." >> Lawrence Peter Berra, 1973 >> >> At Mon, 27 Aug 2007, Babycatchers@aol.com wrote: >> > >> <SNIP> >> >Baby is fine. So all is well that ends well for us. I >> hope she does ok >> >now. >> > >> >Vicki Smith, CNM, MSN >> >West Virginia >> > >> >Vicki Smith, CNM, MSN >> >West Virginia >> >Midwives- changing the world one baby at a time. >> > >> >http://discover.aol.com/memed/aolcom30tour >> >> -- >> art fougner, md >> "May The Wings of Liberty Never Lose a Feather." - Jack Burton >> -- Joanne Bulley, MD, FACOG Solo gyn Keene, NH USA Next message: D. Ashley Hill: "Endometriosis and abnormal uterine bleeding" Previous message: Terrence.Jones@kp.org: "Re: anemia and neuro pt" Next in thread: art fougner, md: "Re: ? perf at hysteroscopy" Reply: art fougner, md: "Re: ? perf at hysteroscopy"

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