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17 minute rule put into practice.From: Thomas Ind (ThomasInd@compuserve.com)Tue Dec 8 02:31:46 1998
I've just done a 'crash' section. I've been looking at my watch to see just how easy it was to obey this 17 minute rule in routine practice. Was called in to see a lady who at 39/40 in 2nd pregnancy had continuous severe abdo pain and a 'roller coaster' CTG. I made my initial assessment and after noting that she was 1 cm dilated and had a 'stoney hard' uterus, I made the dicision to do a C/S. At this point I looked at my watch and it was 19:23. I must have spent a good 3 - 5 minutes assessing the situation and she had already had 10 minutes of a CTG. However, to give me the benefit of the doubt we will call the decision time 19:23. With my resident and the midwifery staff I did the following; 1 - Got IV access (x2) 2 - Took bloods and arranged cross-match 3 - Catheterised and shaved 4 - Gave Zantac 5 - Consented her (for what it is worth) 6 - Spoke to the anaesthetist and theatre sister 7 - Put her on a trolley 8 - Took the trolley to theatre myself after waiting for the lift (LW on 1st floor, theatre on 2nd, all lifts on 7th floor). 9 - Wheeled her into the theatre 10 - Got changed and scrubbed 11 - Waited until the anaesthetist & paediatrician were ready. 12 - Knife to skin at 19:39. 13 - Delivery at 19:40. 14 - Abruption confirmed at C/S and happy outcome. That's 16 minutes so I just made it. I don't think I could have done it any faster. I hurried things along by playing porter as well. Furthermore, I was on labour ward (not 40 minutes away) when the call came; the anaesthetist was already in theatre; and the theatre (as always) was ready prepared. If I hadn't timed it I would have guessed that I got the baby out in 4 or 5 minutes. This 17 minute rule is a joke. I work in a unit with everything required for a quick C/S (except a theatre on LW). How can people in other units do it?
-- Thomas Ind MB BS MD MRCOG St George Hospital Kogarah Sydney Australia
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