Re: Admitting labs, wasTocolytics
From: art fougner, md (evsono@pipeline.com)
Tue Jun 14 10:47:03 2005
how about simply looking at a peripheral smear ... adequate platelets
will appear as ... well ... adequate platelets. as for blood counts,
whatever happened to spinning a crit?
art
At Tue, 14 Jun 2005, Garry E. Siegel, M.D. wrote:
>
>Good question.
>
>I was told by one of the anesthesiologists at one hospital that their
>guidelines say that the platelets should be checked before placement,
>yet I cannot find it in the guidelines on the American Society for
>Anesthesiologists' website. However, he said that using clinical
>judgment was OK, too, i.e. a multip presenting at 5 cm. wanting an
>epidural ASAP can be assessed by the anesthesiologist and an epidural
>placed before the platelet count (which could take long enough, 45 to 60
>minutes) such that the patient doesn't get the epidural. That said, at
>another large hospital, it is the Anesthesiology departments policy to
>virtually always get the count, although I've had a rare exception to
>that.
>
>Digressing, it seems reasonable to ask for a platelet count before
>putting a large needle near epidural veins, although why not get a
>PT/PTT, too? I suspect this is because thrombocytopenias occur with some
>frequency in L and D, mainly from PIH or gestational thrombocytopenia,
>although the latter is rarely less than 100K.
>
>Garry
>
>At Tue, 14 Jun 2005, David Rivera wrote:
>>
>>Yeah but because it's a good practice or because "we've always done it this way"?
>>
>>"Garry E. Siegel, M.D." <garrys@mindspring.com> wrote:The anesthesiologists are practicing medicine as they think best, and it
>>is quite reasonable to ask for a CBC prior to placing an epidural.
>>
>>Garry
>>
>>At Mon, 13 Jun 2005, Barbara Parker wrote:
>>>
>>>I have actually had anesthesiologists who refused to do an epidural until the CBC was on the chart. The only reason I order them on a normal low risk woman in labor is because of rules like this.
>>>Barb, CNM
>>
>>--
>>Garry E. Siegel, M.D.
>>Private Practice
>>Roswell, GA
>>
>--
>Garry E. Siegel, M.D.
>Private Practice
>Roswell, GA
>
--
art fougner, md
"If you don't know where you are going, you will wind up somewhere else."
Lawrence Peter Berra
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