TEALE FENNING

Abik · Posted: Sun May 06, 2007 12:33 pm Post subject: Gynae on-call

0830 monday morning hand-over;

22yr. 6 weeks amenorrhoea, pain and bleeding. Hb 12.6. came in at 06.30hrs. ?ectopic- haem. stable

10/40 with bleeding. came in 45mins age. severe pain in shock. os closed on admission.

78 yr old post op ca. ovary. not E&D yet. IVI has tissued, time for drugs.

14/40 in acute urinary retention - not seen yet.

Elective admission for VH this am - yet to be consented. First on list of Mr. Stroppy - starts at 0830!!!

You have an SHO and a senior and two junior nurses. (who are our friends and we trust them!!!!)

wolverine · Century Club Joined: 16 Jan 2007 Posts: 394

What am I doing on the ward? Let the SHO to deal with all the problems and I'd go and consent Ms Prolapse and do the VH with Mr Stroppy!

Abik · Posted: Sun May 06, 2007 12:52 pm Post subject:

You're on call mouthy - and you've just failed, see you in 6 moths!!

Where's my next question? Are you slow at typing or thinking?!!!

Laughing

wolverine · Century Club Joined: 16 Jan 2007 Posts: 394

22yr. 6 weeks amenorrhoea, pain and bleeding. Hb 12.6. came in at 06.30hrs. ?ectopic- haem. stable
Needs assessment soon: History to asses risk for ectopic, examination to asses pain, stability, IV access, FBC, bHCG, arrange for USS, inform consultant/theatres if ectopic likely
10/40 with bleeding. came in 45mins age. severe pain in shock. os closed on admission.
Red! Rescusitate ABC, repeat speculum remove any visible products (most of the times sitting on the os), send bloods etc, arrange theatres for evac if necessary
78 yr old post op ca. ovary. not E&D yet. IVI has tissued, time for drugs
SHO or senior m/w or the phlebotomists to site a venflon
14/40 in acute urinary retention - not seen yet
Amber. Possible diagnosis incanceratetd uterus (happens with r/v uterus early in 2nd trimester when get stuck under the sacral promontory). Needs a folley's catheter to be inserted and stay in for 24-48 hours. Check urine for infection also
Elective admission for VH this am - yet to be consented. First on list of Mr. Stroppy - starts at 0830
Green. Inform her for possible delay and consent when ready or ask SHO to consent if happy.
Therefore prioritizing: First the collapsed woman. Before going there, ask the senior nurse to call theatres for delaying the elective list (so as to avoid Mr Stroppy). SHO to assist with rescusitation and then to go to the possible ectopic for clercking. Ask if a nurse could catheterise the poor woman with the retention and site a venflon to the Ca patient. Once I have saved her life I would deal with the possible ectopic and make the arrangements for USS/theatres. Then I would consent Ms Prolapse and happily go to theatres to do the VH as an award for my stressfull morning

Abik · Posted: Sun May 06, 2007 1:29 pm Post subject:

Very good - dont worry about the spelling or my eyes!

rpwalavalkar · Teale Fenning Administrator Joined: 20 Jul 2006 Posts: 966

22yr. 6 weeks amenorrhoea, pain and bleeding. Hb 12.6. came in at 06.30hrs. ?ectopic- haem. stable

confirm ectopic -- h/o, clinical, g & s, bhcg, fbc, uss,
stabilise -- iv access, fluids,
consent -- scopy sos proceed, ostomy/ectomy,
inform-- ot/boss/anaesthetist n call sho to assist,

10/40 with bleeding. came in 45mins age. severe pain in shock. os closed on admission.

stabilise -- ABC, IV access, group n xmatch 4, iv fluids, baseline bloods - fbc, bhcg,

h/o n examine -- confirm dates, p/s - assess cx, bleed n remove clots / poc's

consent n inform -- anaesthetist / ot / boss -- for evac

78 yr old post op ca. ovary. not E&D yet. IVI has tissued, time for drugs.

needs canula, get nurse to do it, once sited restart ivfluids, n recheck for vitals, urine out put

if medication is pain relief may be given PR.

14/40 in acute urinary retention - not seen yet.

needs cath,
nurse can do this -- they can also clerk the patient, rule out dehydration, send msu and get back,
though rare don't forget -- incarcerated RV ut, may need pessary a bit later to avoid repeat acute retention.

Elective admission for VH this am - yet to be consented. First on list of Mr. Stroppy - starts at 0830!!!

not really an emergency except that mr stroppy may make ur life hell Crying or Very sad

get sho to finish this stat and be available in 10 mins to clerk the ectopic.

???
_________________
Dr Miss. Raj Walavalkar MBBS MRCOG
TealeFenning Administrator
SR O&G Wessex Region