Re: 17 minute rule put into practice.
From: Efrain Ramirez MD (eramirez@icepr.com)
Tue Dec 8 03:35:56 1998
Exactly...
At Tue, 8 Dec 1998, Thomas Ind wrote:
>
>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
>
>For every complex problem there is a simple solution...and it's wrong. (H L Mencken).
>
--
Efrain Ramirez MD FACOG
