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Re: GYN: Pelvic Mass (long--good case)From: Calvin J. Siegers, MD FACOG (csiegers@hayburn.com)Mon Mar 30 03:43:08 1998
At Sun, 29 Mar 1998, Garry E. Siegel, M.D. wrote: > >At Sun, 29 Mar 1998, Calvin J. Siegers, MD FACOG wrote: >> >>At Sat, 28 Mar 1998, Garry E. Siegel, M.D. wrote: >>> Garry, Go with what your "gut" is telling you on this case: you're getting no help from ID (any coliform-anaerobe combo works) or heme/onc(she needed whole blood then and probably now) or radiology(can they tell you ARDS v cardiogenic shock?) or your partner (YOU knew what to do when you were looking right at it). Does her wedge pressure R/O cardiogenic shock? if so, she has ARDS and be VERY careful with maintenace fluids and vent setting--real delicate remaining alveoli. What is her hgb and how much blood has she gotten? No one cares as much about this patient as you do, no one knows as much about her disease as you do, so please do not stand down to your expert consultants.... Recommendation: do NOT take this women back to the OR unless she has a huge new abscess or hematoma(which still would be better managed by CT drainage) because if you do she will not survive. Cal
-- Calvin J. Siegers, MD FACOG...private practice, 20 yr veteran, Holland, MI
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