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A large case From: R. Daniel Braun, M.D. (rbraun@iunet.iupui.edu) Wed Mar 4 08:28:46 1998 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Patrick S. Pevoto: "Diabetes Screening" Previous message: Richard Chudacoff, MD: "Re: OB:Pregnancy and Device Intra Uterine" Comments or suggestions please. 25 y/o G1 P0 LMP 8-1-97 (according to her mother) is brought to shock room in ER. Over 90 minutes earlier, the paramedics had arrived at this woman's house only to find this large (500 pound, 227 Kg) woman convulsing. IV access was obtained and valium given to control seizures. Due to patients size a BP could not be obtained(Cuff would not go around forearm) and it took over an hour to get her on stretcher and into ambulance. Patient had 3 additional seizures prior to arrival in ER. Once art line was placed original BP is 300/180. Patient is determined to be pregnant. US is difficult. Several BPD's are obtained which are compatible with 32 weeks, but other measurements just not obtainable and the BPD was considered to be of poor quality at best. 30.5 weeks by LMP. Cx 3 cm with Vtx at -2 AROM performed and FSE and IUPC applied. Contractions are every 4-5 minutes, no baseline variability (NONE) late decelerations (drop of 30 BPM with each contrx). Patient had reportedly vomited during her seizures. Endotracheal intubation carried out and pieces of "Big Mac" are obtained from her trachea. Tracheal toilet carried out and patient started on antibiotics. Esmolal drip started and cannot get Diastolic below 150. Labetalol drip started and better response with diastolic down to 100. Late decels are getting worse. Management ????? Swan line placed. CVP 14, PCWP 18, PA 48/28, SVR 929, C.O. 12 Urine output 5 cc over last hour. 100 mg Lasix given with 50 cc response in next hour. Comments and management!! More later. The above spot is where we were at noon yesterday. -- R. Daniel Braun, MD A human being should be able to change a diaper, plan an invasion, butcher a hog, con a ship, design a building, write a sonnet, balance accounts, build a wall, set a bone, comfort the dying, take orders, give orders, cooperate, act alone, solve equations, analyze a new problem, pitch manure, program a computer, cook a tasty meal, fight efficiently, and die gallantly. Specialization is for insects. Lazarus Long. Next message: Patrick S. Pevoto: "Diabetes Screening" Previous message: Richard Chudacoff, MD: "Re: OB:Pregnancy and Device Intra Uterine"

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