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Re: Hospital admissions for obstetric patientsFrom: Joanne Bulley, MD (islesannie@yahoo.com)Sat Oct 28 00:53:39 2006
I agree - on the OB service with the OB serving as the Executive Officer. 'Cause as others have said - all the non-Ob docs and RNs are scared off completely by that gravid uterus. All this brings to mind a patient I had as a chief resident on the OB Services. As I recall: patient in late 20's - language barrier - private patient - husband seemed to indicate that she had had some sort of heart problem at one time. She had suddenly clutched her chest - like the MI patient on a TV show. Calling a STAT cardio consult on Ob was interesting - we had to have a med student stand in teh halls to catch the guy and haul him in cause he had no idea where we were located! She had many many PVCs I basically said to the cardiologist - and the CCU nurses: either you can have us transfer her to the CCU and bring up an L&D nurse - or you can free up a CCU nurse to help with the management here in the L&D unit. No hesitation whatsoever - the CCU found a nurse to come to our area. The Cardiologist said he wouldn't treat the arrhythmia unless there were more than a certain number of extra beats in a minute. I pointed to him that there were that many on a single occiliscope screen and that was much less than a minute, so what was his criteria really going to be. He wasn't pleased that I could assess things that well! We finally agreed that the deciding factor would be evidence of adequate perfusion and oxygenation. And for that - the fetus and FHR monitor were a good way to follow. She was sired for everything. 2 IVs - one for possible IV lidocaine - one for anything we wanted to do OB wise (as in the Pit to get her delievered). Interestingly, as soon as she was delivered (we never needed to start that lidocaine), her arrhytmia resolved. Joanne
At Fri, 27 Oct 2006, Meenan, Anna L. wrote:
>
-- Joanne Bulley, MD Keene, NH, USA
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