Re: 'There is no gold standard for decision-to-incision time' ???
From: R. Daniel Braun (rd.braun@gmail.com)
Tue Oct 9 07:16:08 2007
Amen!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
Dan
On 10/8/07, Gordon Goldman <obgyndoc@swbell.net> wrote:
>
> 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 a person, you are
> warned that any disclosure, copying or dissemination of the information is
> unauthorised. If you have received the transmission in error, please
> immediately contact this office by telephone, fax or email, to inform us of
> the error and to enable arrangements to be made for the destruction of the
> transmission, or its return at our cost. No liability is accepted for any
> unauthorised use of the information contained in this transmission. If the
> transmission contains advice, the advice is 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
>
> ------------------------------
> Peek-a-boo FREE Tricks & Treats for You! Get 'em!<http://www.reallivemoms.com?ocid=TXT_TAGHM&loc=us>
> ------------------------------
>
> ------------------------------
>
--
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
