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Re: My case list...From: Jane Helwig, MD (jane@seasonedsystems.com)Sat May 30 10:18:22 1998
At Thu, 28 May 1998, Geffrey H. Klein, MD wrote:
> ... She developed hypotension and tachycardia... Geff, glad it was your case and not mine. I hate audible blood loss. I have a related question for the members of the list. Last week I scoped a patient with a huge (as big as the uterus) unruptured ectopic after BTL, beta 40,000. I was using a blunt probe to figure out the anatomy when it ruptured with massive bleeding. Opening her previous midline incision was tough because of the blood welling up through the trocar sites. There was 1000 cc in the suction container in less than 5 minutes. While opening, her BP went to 44/23 (and several similar readings) and she became tachycardic in the 130s. A clamp on the IP solved the bleeding problem (turned out to be a paraovarian ectopic implanted in endometriosis) and after an LSO (ureter identified first) she did well. Now to my question. We have all seen pts with stable BPs, no tachycardia, with 1000cc hemoperitoneum. But with the same amount of *rapid* blood loss, we see hemodynamic instability. Once bleeding has been relatively controlled, do hypotension and tachycardia mandate a more aggressive approach? Or can we safely wait while tanking up the patient with IV fluids, etc? Guess this is the same "decisive action" vs. "methodical" issue, but I would like to hear more about handling it. My anesthesiologist was most alarmed by this case, called for blood and gave it although bleeding had been stopped 5 minutes into the case. Any comments? And since I too am going to Chicago, feel free to question "in the spirit of the boards". Thanks. Jane
-- Jane Helwig, MD Private practice Nassawadox, VA
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