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Re: 17 minute rule put into practice. From: Braun, R. Daniel (rbraun@iupui.edu) Tue Dec 8 05:05:43 1998 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: DoctorJoe@aol.com: "Re: Hepatitis and amnio" Previous message: Braun, R. Daniel: "Re: 17 minute rule put into practice." Maybe in reply to: Thomas Ind: "17 minute rule put into practice." Next in thread: DoctorJoe@aol.com: "Re: 17 minute rule put into practice." As EL says: You have to have thought about it ahead of time and be prepared and ready to do it. Dan -----Original Message----- From: Dr Eberhard W Lisse [SMTP:el@linux.lisse.na] Sent: Tuesday, December 08, 1998 6:56 AM To: Multiple recipients of list Subject: Re: 17 minute rule put into practice. Thomas, In message <199812080931.DAA09847@talk.obgyn.net>, Thomas Ind writes: > 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 I would expect to find 1, 2, 4, and 5 already done when I arrive. Eg if the sisters worry they call me *AND* get a line up. What bloods did you take? We have 0-neg/pos only in the periphery and the Rh original lab result is on file. If the sisters think she is going to get C/S they catheterize and shave after the drip is up. > 4 - Gave Zantac That's a matter of anaesthetists' choice. > 5 - Consented her (for what it is worth) I do not speak much of the main indigineous language and none of the other 7, so the sisters do the consenting anyway. > 6 - Spoke to the anaesthetist and theatre sister If they are in house I do that too. If they are not I send the driver to fetch sister and phone the anesthetist to come in. I have seen p laces where they push a button and all related pagers go off simultaneously. > 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 That I also do if I want it done in a hurry. However in many places the theatre is next door. > 10 - Got changed and scrubbed > 11 - Waited until the anaesthetist & paediatrician were ready. Don't they have it set up permanently? In any case there is the question about draping and doping or doping and draping. When I give anesthetics I prefer doping and draping. When I am cutting I don't mind either way. Doping and draping can be done while you are scrubbing. > 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? That's exatly the point they are making: If one does it under 17 minutes the outcomes are better. Therefor one will have to have to on site, have the theatre sister, anaesthetics and peds permanently set up, have them one site (or there within 60 seconds). IV, catheter, shave and consent policies need to be adapted, infrastructural changes (theatre in the delivery suite, I have seen places where they can cut on the delivery table, they just roll the instrument tables in). el Next message: DoctorJoe@aol.com: "Re: Hepatitis and amnio" Previous message: Braun, R. Daniel: "Re: 17 minute rule put into practice." Maybe in reply to: Thomas Ind: "17 minute rule put into practice." Next in thread: DoctorJoe@aol.com: "Re: 17 minute rule put into practice."

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