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Re: My case list...TAH in 18yrFrom: Myer S. Bornstein (mborn@massmed.org)Fri May 29 05:24:49 1998
To Shiraz and Geoff, Bin there! done that! God Bless! Now who has the third case Myer
>-----Original Message----- I had to do a TAH ain a 18 yr.old 5 nights ago.A case from hell. Delivered by family physician at 1900h.I was called to dsee the patient because of persistent bleeding. 1930h.I was in the room.The patient was pale.Her systolic was 70.and the doctor suspected a cervical tear.Oxytocin was running. My exam reveled no tear .The uterus was flaccid.I performed a manual exploration,bimanual compression,gave her ergot and intramyometrial haemabate.Uterus still not contracting. 2015h Arranged for OR.I did eua d/c.Gave her more haemabate and ergot.By now had 2 units of blood in.She had a coaugulopathy and low platelets.I called my partner for moral support.We tried to pack her but she bled past the pack.Now 4 units of blood in.8 units of cryop.and 2 units of plasma. 2100h.Discussed with family.Mum in law a nurse in our hospital.Exploratory laparotomy.2 more amps of 250ug.of IV haemabate.The uterus was a limp and just would not contract. 2200h.Uterine artery ligation and patient still pouring blood. Anaerthetists were sweating. 23h00.Decison for TAh.Uneventful hysterectomy. Postop she did well.Had total of 8 units of blood.and has been discharged home. I was exhausted the whole week [emotionally as well].Got a thank you note from family. I wonder what a home delivery would be like in situations like this. -- Dr.Shiraz Suleman MBCHB.FCOG.FRCS(C) Consultant OB Prince Albert Canada suleman@sk.sympatico.ca 306-7642039
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