Palmo Anest

A near miss encounter

Cases of near miss happens on and off in both public and private hospitals. Resently I met one, this time my wife is the 'victim'.

My wife when to a foreign own private hospital in penang for delivery of our new born kid. Our 1st and 2nd was delivered in public hospital, very good obs care but the nursing care as usual is NOT desirable at all. That is another story, lets go back to this encounter.

Her os was 6cm when we admitted to the labour suit, supprised to find out that they don't routinely insert a IV line patient in labour. I felt uneasy but still ok with that coz I'm confident with my IV setting skill and I know that my wife had 'good vein' easy to set a line anytime.

When the os is 8-9cm, the nurse called the obstetrician for delivery. When she came, after she assessed the cervix, it was almost full and she ask the nurse to set an IV branula. The sister oncall was there and she know me since I do locum in their A&E too, so she ask if I'd like to set the line myself. I did that, they gave me a pink (20G) branula - it has an estimated flow rate of clear fluid 61ml/min as compaired to green (18G) which allows 96ml/min in best condition.

IV line in-situ but no plan for running a drip. They proceed with delivery when the os is full and Tina has bearing down sensation. After about 50min, when the baby finally crowning, gush of fresh blood came out from the vagina, luckily with a good push and a liberal episiotomy, my baby was delivered in just a few seconds after blood started to gush out from within. Apgar 9, crying spontaneously. Thank God.

At this moment, I can feel my wife's pulse became tachy (about 150bpm), I asked if we can start a drip, the obsterician then ask the nurse to run Hartmen solution. Took a BP and it was 54/33mmHg, PR 146bpm. She ask the nurse to take another BP, still the same. I noted my wife became very pale and she complaint of dyspnea. I ask the sister to give me another branula, and put up another drip, at this time the 'good veins' already almost collapsed.

My hand abit shaky when I inserted another branula into my wife's wrist. The largest IV branula they have in Labour suit is a grenn (18G), I'm sure they dun have a 14G, ask for a 16G they don't have. The obstetrician noted the severity, ask for to put up a Haemacele and ask to draw blood for cross match.

Lowest BP recorded was 48/28mmHg. BP and pulse rate improved as we flood her with fluid to meet the looses. BP and pulse became stable after running in 2L of crystaloid and colloid when the 3rd Little going in, she is already comming back from the shock. And the placenta was delivered and episiotomy wound repaired. Uterus well contracted.

Thank God she is ok. Clinically looks like Hb 4-6g% to me. Transfused 1 pack of blood. Still dizzy when standing erect early this morning. But she is all well later in the afternoon. Can even walk to the neonates unit without support for breast feeding.

posted by LT @ 10:00 PM