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OB: Toxicology screenFrom: Garry E. Siegel, M.D. (garrys@mindspring.com)Fri Dec 30 09:57:39 2005
Two cases: 23 YO primigravida from Syria (this may be germane) induced at 41w1d, labored and delivered uneventfully under an epidural and 30 ml. 1% plain xylocaine local/pudendal. Around 15 minutes PP, began somnolent and close to unresponsive. BP, pulse, pulse ox, physical exam all normal, epidural level at T-8 or so. CBC, metabolic panel all normal. Neurologic exam by a neurologist was non-focal, and since she really didn't get better for two hours, a CT of the head was done, and it was normal. A toxicology screen was negative, and she slowly got to normal. There was a "whisper" from one family member (there were several, including an older, "detached" husband) that she has had spells like this as a teen-ager. Next case: at 4 PM yesterday, my partner (on call for the ER) got a call from a CNM of another practice whose office was nearby, but about 10 minutes from OUR hospital (not the hospital that CNM or MD group uses, which is 20 minutes from their office) that a 35 weeker had heart tones in the 60's in the office on NST, and she was being put in an ambulance to go to the nearest hospital (that's us) ASAP. I was the closest doc and thus went to L and D where the OR/anesthesiologist/etc. was ready, and she was wheeled into the OR directly. I got there about 5 minutes after arrival (it took a couple of minutes to communicate among us and for me to get there), and FHTs were in the 140s. She was a 28 YO P0010 at 34w5d with a pregnancy complicated by migraines and Fioricet-codeine usage (she said she had seen a neurologist), smoking and lagging growth (31% percentile) on recent MFM scan. NST was non-reaactive, BPP 8/8 with no cord entanglement, normal fluid and dopplers, but the fetus was lagging at 32 weeks size. CBC and C-Met were OK, and her BPs were, too (i.e. no PIH). As she was being discharged to go home to see her MD/CNM tomorrow, her tox screen came back positive for THC, PCP, barbs, and TCAs. So. . don't forget to order a tox screen at times when things aren't right. Garry
-- Garry E. Siegel, M.D. Private Practice Roswell, GA
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