Re: ? perf at hysteroscopy
From: art fougner, md (evsono@pipeline.com)
Wed Aug 29 10:58:34 2007
Thanks Joanne
yet another zero sum game.
Art
At Tue, 28 Aug 2007, Joanne Bulley, MD wrote:
>
>@ 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.
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>>>
>>> --
>>> art fougner, md
>>> "May The Wings of Liberty Never Lose a Feather." - Jack Burton
>>>
>--
>Joanne Bulley, MD, FACOG
>Solo gyn
>Keene, NH USA
>
--
art fougner, md
"May The Wings of Liberty Never Lose a Feather." - Jack Burton
