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Re: What do you do? From: ainsron@msn.com Wed Jan 17 22:58:11 2001 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Medical Industry Today: "Medical Industry Today for a medical industry professional Thursday, January 18, 2001" Previous message: Geffrey H. Klein, MD: "Re: Gestational Diabetes:Diagnosis" In reply to: Efrain Ramirez: "What do you do?" Next in thread: Myer S. Bornstein, MD, CPE, FACOG: "Re: What do you do?" If it is a low risk, reliable patient with good transportation/support, lives close to the hospital, I would send her home with instructions to return if the contractions become 5' apart for 1-2 hours, SROM, bleeding, increased pain, decreased fetal movement, etc. I would not necessarily tell her to see me the next day unless I suspected a problem unless the contractions continued but did not increase to those we would define as labor. I would not sedate her unless she requested something for sleep, then would opt for Vistaril, 50-100mg po, not MS - she is not in labor or prodromal labor by my definition. If she didn't have reliable transportation or supervision, I would probably keep her for several hours or overnight for observation, but would not come in to see her myself unless the L&D nurse had some concerns I needed to personally address, or if she was a "walk-in" who had not been seen previously seen by myself or those I share call with. >What do you do? > >You receive a call from LDR nurse at 1AM - 24 y/o GI P0 38 3/7 weeks - >uneventful prenatal care - contractions every 8- 10 -15 minutes for the >last 30 -45 minutes- Cx long, FT -posterior - FHR tracing - reactive. >Vital signs WNL The patient is in no distress. There is no other >obstetrician in the LDR. > >Would you: >a) Tell the nurse to discharge the patient home with the instructions >that if contractions would get stronger to return to LDR -if not -- you >will see her in the morning at your office. >b) Tell the nurse to observe the patient for 2- 3 hours - reevaluate - >if no cervical changes in spite of contractions every 10 minutes - send >her home with previous instructions - if cervical changes did occur to >call you back. >c) You admit the patient - give her Morphine SO4 (or the sedation of >your choice) - with the intent of reevaluating her in the morning - you >instruct the nurse to call you if there is any change in the patient's >status. >d) You would immediately go to the hospital and evaluate the patient. >e) None of the above - if so - what? > >-- >"Life is neither the notes nor the silence between the notes, but the music that > arises out of sound and silence felt as a living whole. Stop choosing...between > chaos and order, and live at the boundary between them, where rest and action > move together..." > -- Ronald E. Ainsworth, MD Next message: Medical Industry Today: "Medical Industry Today for a medical industry professional Thursday, January 18, 2001" Previous message: Geffrey H. Klein, MD: "Re: Gestational Diabetes:Diagnosis" In reply to: Efrain Ramirez: "What do you do?" Next in thread: Myer S. Bornstein, MD, CPE, FACOG: "Re: What do you do?"

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