--
Richard Chudacoff, MD, FACOG
-----Original Message-----
From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Dr
Eberhard Lisse
Sent: Thursday, April 27, 2006 12:54 AM
To: Multiple recipients of list OB-GYN-L
Subject: Re: Subject: Section on demand
My Standing Orders:
D0 (elective, ie 08:00 cases):
Nil Per Os
Close Observation
Plasmalyte B (ie Ringer's) 1L 8 hrly ivi with 20 IU Oxytocin in each
Metoclopramid 10 mg 6-8 hrly ivi/imi if required
Morphine 10 mg or Pethidine 100 mg ivi/imi if required
tomorrow: 08:00 Sips of Water, Catheter out
10:00 Drip down
12:00 Free Fluids
17:00 Full Diet
(if Spinal: 24 hour bed rest, then/otherwise...)
..mobilize aggressively as tolerated
1 Amp Anti-D imi if mother Rhesus negative (and infant Rhesus positive)
D1
Mypradol 1 tab 8 hrly if required (or a NSAID of doctor's choice)
D2
get ready
D3
Discharge.
In out of hour cases, we vary the hours.
I could discharge earlier, but the Medical Aid funds do not complain
(they even permit a further day most of the time without written
motivation), and the patients prefer to stay. Occasionally one wants to
leave on day 2 and that's not a problem if the infrastructure and
support is there.
And, by the way, there is no such diagnosis as: STATUS (post C/S) :-)-O
greetings, el
on 4/26/06 10:04 PM Richard Chudacoff, MD said the following:
> You are out of date. Here is a sample of my c-section orders. In fact,
> the new hospital I joined now has incorporated them into their standard
> post op orders. I find these orders give patients the autonomy to make
> decisions that most patients loose when admitted to the hospital. Also,
> they make far less work for the nursing staff. Most of my 7AM sections
> eat dinner the night of surgery. Most of my repeat c-sections leave the
> hospital 36 hours post-op because the want to leave.
>
> --
>
> 1. DIAGNOSIS: STATUS-POST C-SECTION
>
> 2. VITAL SIGNS PER ROUTINE PACU AND POST-PARTUM UNIT
>
> 3. ACTIVITY:
>
> o BED REST
>
> o OUT OF BED TO CHAIR BY 10 HOURS POST-OP
>
> o THEN AMBULATE AS TOLERATED
>
> o *CALL MD IF UNABLE TO GET OOB*
>
> 4. IF BREAST FEEDING, MASSE CREAM AND BREAST PUMP PRN
>
> 5. DIET:
>
> . NPO
>
> . *WHEN OUT OF BED TO CHAIR:* ADVANCE TO ICE CHIPS
>
> . *WHEN AMBULATING* *TO NURSES STATION:* ADVANCE TO COFFEE, TEA
> OR COKE
>
> . ADVANCE AS TOLERATED IF TOLERATES COFFEE, TEA OR COKE
>
> 6. IV: D5LR @ _ _ cc/ hr WITH 20 U
> PITOCIN IN FIRST BAG, D/C WHEN TOLERATING PO AND AMBULATING
>
> 7. FOLEY TO GRAVITY. STRICT I/O WHILE FOLEY IN PLACE. CALL MD IF
> URINE OUTPUT IS LESS THAN 60 cc/2 hours. *REMOVE FOLEY WHEN PATIENT
> AMBULATING*
>
> 8. LABS: Hgb/Hct @ 6 AM PP DAY #1
>
> 9. MEDICATIONS:
>
> 1. TORADOL _ _ IV Q 6 HOURS, D/C WHEN
> TOLERATING PO
>
> 2. DEMEROL _ _ mg IV Q 4 HOURS PRN, D/C
> WHEN TOLERATING PO
>
> 3. MORPHINE SULFATE _ _ mg IV Q
> 4 HOURS PRN, D/C WHEN TOLERATING PO
>
> 4. PHENERGAN _ _ mg IV Q 4 HOURS PRN D/C WHEN
> TOLERATING PO
>
> 5. MOTRIN _ _ mg PO Q 6 HOUR FOR 24
> HOURS, WHEN TOLERATING PO
>
> 6. TYLENOL #3 _ _ PO Q 4 HOURS PRN WHEN
> TOLERATING PO
>
> 7. LORTAB _ _ mg PO Q 4 HOURS PRN
> WHEN TOLERATING PO, IF ALLERGIC TO CODEINE
>
> 8. TYLENOL _ _ mg PO Q 4 HOURS PRN WHEN
> TOLERATING PO
>
> 9. DARVOCET N100_ _PO Q 4 HOURS PRN
> WHEN TOLERATING PO
>
> 10. MYLICON _ _ MG PO Q AC/HS PRN WHEN
> TOLERATING PO
>
> 11. MYLANTA _ _CC PO Q AC/HS PRN WHEN
> TOLERATING PO
>
> 12.
>
> 13.
>
> 10. RHOGAM 300 ug IM IF MOTHER IS Rh NEGATIVE AND BABY IS Rh POSITIVE
>
> 11. OKAY TO SHOWER ONCE DRESSING IS REMOVED
>
> Richard Chudacoff, MD, FACOG
