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Re: GYN: Pelvic Mass (long--good case) From: Gail Waldby, MD (gwaldby@main.basec.net) Mon Mar 30 05:55:11 1998 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: William J Faulkner: "Re: anovulation" Previous message: Mark Perloe, M.D.: "Re: anovulation" Maybe in reply to: Garry E. Siegel, M.D.: "GYN: Pelvic Mass (long--good case)" Next in thread: William J Faulkner: "Re: GYN: Pelvic Mass (long--good case)" I missed the original post so this may not be applicable, but 2 concepts which have become popular in the general surgical critical care and trauma surgery communities in the past few years are: Damage control: Doing the minimum that will get the patient through the current op, allow you to hemodynamically stabilize them and then bring them back another day when they are more stable for any additional needed surgery Abdominal compartment syndrome: Many critically ill surgical patients develop elevated intra-abdominal pressures which are directly detrimental mostly by causing caval compression but also causing direct compression of the intestines and their blood supply--this leads to ARDS, multiple organ dysfunction, etc.--to diagnose this, measure bladder pressures (through the Foley, with it clamped and by instilling 50 cc liquid, then measure the pressure with a pressure transducer), if above 25 cm H20 (convert from the mm Hg you just measured), open the abdomen and cover it with any of the following: so called Bogota bag (gas sterilized 3 L IV or irrigation solution bag), Vicryl or Dexon mesh, parachute silk). Quite often, ARDS, renal failure, etc. improve when you open the abdomen. You could ask your critical care or trauma general surgeon for more info. Gail Waldby, MD Huron Clinic SD Calvin J. Siegers, MD FACOG wrote: > 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 Next message: William J Faulkner: "Re: anovulation" Previous message: Mark Perloe, M.D.: "Re: anovulation" Maybe in reply to: Garry E. Siegel, M.D.: "GYN: Pelvic Mass (long--good case)" Next in thread: William J Faulkner: "Re: GYN: Pelvic Mass (long--good case)"

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