Re: 'There is no gold standard for decision-to-incision time' ???
From: Gordon Goldman (obgyndoc@swbell.net)
Mon Oct 8 20:48:50 2007
Why wait for epidural dose? Why not 'crash' and intubate? Why
scrub? 10 seconds could be the difference.
Having been a 'battlefield surgeon' in a past life, I have a
different perspective. If you have a heartbeat, run like hell and
anesthesia be damned. I have had the unfortunate experience of
having had to do some cases with succinyl (sp?) choline alone. She
will get over the pain, the baby may not.
--
Gordon M. Goldman, M.D., FACOG
Private Practice, St. Louis, Mo.
On Oct 8, 2007, at 8:04 PM, Andrew Folley wrote:
> Let me get this straight. We are racing back for an emergency stat
> C-section due to non reassuring tracing with an internal electrode.
> Baby having severe variables past 20 minutes and thenbaby just
> started a prolonged deceleration heading downwards from 100 to 90
> to 80 etc. Decison made for stat c-section. Clock is running.
>
> We get back in the OR and hook up the monitor and the heart rate is
> 50s and steady. She gets her epidural dosed and is being prepped
> and the doctor does a 10 second "scrub". the internal is in place
> and suddenly drops to zero. The baby may very well indeed be dead.
> Who is in favor of froglegging her and inserting another electrode
> just in case the first one is not picking up? Who on the list is in
> favor of having one of the nurses listen for the heart rate with a
> doppler on the abdomen? Who opts for a quick US scan?? Or who
> says "Give me the scapel and get out of my way and I will have a
> baby dead or alive for you in less than 60 seconds?????? Sign me
> up for the latter option,.
>
> Respectfully yours Dr. Bard A. Parker
>
> Date: Mon, 8 Oct 2007 04:23:30 -0500
> From: rd.braun@gmail.com
> To: ob-gyn-l@dns.obgyn.net
> Subject: Re: 'There is no gold standard for decision-to-incision
> time' ???
>
> Nor would I, but it wiuld probably be the right thing.
> Dan
>
> On 10/7/07, Raymond Stephen <stephen.raymond@dhhs.tas.gov.au > wrote:
> In my view, there is rarely an indication to section for a dead
> baby, BUT informing a mother on the table that her baby is dead and
> you are not going to proceed with the Caesar after all, is not a
> situation I would relish!
>
> Steve
>
> From: ob-gyn-l@obgyn.net [mailto: ob-gyn-l@obgyn.net] On Behalf Of
> R. Daniel Braun
> Sent: Monday, 8 October 2007 10:39 AM
>
> To: Multiple recipients of list OB-GYN-L
> Subject: Re: 'There is no gold standard for decision-to-incision
> time' ???
>
> If your indication for the section is fetal distress, certainly.
> You no longer have that indication. Or do you section people for a
> dead baby?
>
> Dan
>
> On 10/7/07, Raymond Stephen < stephen.raymond@dhhs.tas.gov.au> wrote:
> So if you find there are no fetal heart sounds as the last person
> arrives, what do you do then? Stand down the team and allow to
> deliver vaginally?
>
> Steve
>
> From: ob-gyn-l@obgyn.net [mailto: ob-gyn-l@obgyn.net] On Behalf Of
> R. Daniel Braun
> Sent: Sunday, 7 October 2007 12:11 PM
> To: Multiple recipients of list OB-GYN-L
> Subject: Re: 'There is no gold standard for decision-to-incision
> time' ???
>
> Question relating to the case presented. How long from last
> listening for FHT's and incision? It is easy to stand around in the
> OR waiting for that last member of the team to arrive and then just
> make the incision when they get there. One should always know
> whether or not there is a heart beat before making the incision.
> IMHO.
> With a one and 5 minute apgar of "0", I find it hard to believe
> that there were ht. tones present in the last 3-5 minutes befor the
> incision.
>
> Dan
> On 10/6/07, Efrain Ramirez <eramirezt@coqui.net> wrote:
> There is no gold standard for decision-to-incision time
> Don't accommodate plaintiff's attorneys who have reinvented an
> intended
> guideline as a requirement!
>
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> --
> R. Daniel Braun, MD FACOG(L) CMT
> Professor Emeritus
> Dept. of Obstetrics and Gynecology
> Indiana U. School of Medicine
>
> R. Daniel Braun
>
> "Science without Religion is LAME; Religion without Science
> is BLIND"
> Einstein 1941
>
> CONFIDENTIALITY NOTICE AND DISCLAIMER
> The information in this transmission may be confidential and/or
> protected by legal professional privilege, and is intended only for
> the person or persons to whom it is addressed. If you are not such
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> based on instructions in relation to, and is provided to the
> addressee in connection with, the matter mentioned above.
> Responsibility is not accepted for reliance upon it by any other
> person or for any other purpose.
>
> --
> R. Daniel Braun, MD FACOG(L) CMT
> Professor Emeritus
> Dept. of Obstetrics and Gynecology
> Indiana U. School of Medicine
>
> R. Daniel Braun
>
> "Science without Religion is LAME; Religion without Science
> is BLIND"
> Einstein 1941
>
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