Tag: erik erichsen

ANESTHESIA

Posted on by The Rebel Surgeon in ANESTHESIA

SPINAL

  • All obstetrical procedures can be performed in spinal anesthesia
  • Preferred method for C/S
    • Unless patient is in chock

KETAMINE

  • When spinal anesthesia fails
  • When spinal anesthesia is contraindicated
    • Shock due to
      • Sepsis
      • Hemorrhage
  • Combine with
    • atropine
    • valium
  • Recommended doses:
    • 1-5 mg/kg  IV  
    • 5-10 mg/kg IM
    • 1-2 mg/kg at rate of 0.5 mg/kg/min as infusion
      • solution of 1 mg/ml in Normal Saline or Glucose

PUDENDAL BLOCK / SACRAL ANESTHESIA

  • Forceps Delivery
  • Episiotomy

LOCAL INFILTRATION ANESTHESIA

  • Episiotomy
  • Symphysiotomy
  • C/S

GENERAL INTUBATION ANESTHESIA

  • Uterine Rupture
  • C/S in Eclampsia.

BLOOD TRANSFUSION

Posted on by The Rebel Surgeon in BLOOD TRANSFUSION

In lack of laboratory equipment for typing and crossmatching:

  • Take small samples of blood from recipient and donor
  • Centrifuge blood samples
  • Place a drop of serum from recipient on a white surface
  • Place a drop of red blood cells (the sediment) from donor beside
  • Mix the two drops
  • Read the result.
  • Does it clump together or not?
  • NOT COMPATIBLE
  • COMPATIBLE

If blood transfusion set is not available:

  • Place recipient on floor
  • Place donor on a stretcher
  • Connect donor and recipient with an i.v. line
  • Enhance blood flow with venous stasis by a tourniquet on the donor’s arm
  • Stop transfusion when recipient and donor have same pink mucosal linings (equilibrium has been acchieved)

In lack of electric centrifuge:

Buy a handheld

Or make your own with a testtube and piece of string

Selfmade centrifuge

CESAREAN SECTIO (C/S)

Posted on by The Rebel Surgeon in CESAREAN SECTIO C/S

Surgical technique

  • Low transverse incision through the skin
  • Small transverse incision strictly in the midline throuigh the subcutaneous tissue and fascia
  • Split the fascia by sliding a pair of slightly opened scissors transversely to the right and left.
  • That will spare the subcutaneous vessels avoiding unnecessary bleeding
  • Stretch the wound manually in a vertical direction
  • Open the peritoneum bluntly with your fingers
  • Stretch the wound further by manual traction in a transverse direction
  • Place a retractor distally in the wound
  • Apply downward traction to the retractor by assistant
  • Small transverse incision in the upper part of the lower segment of the uterus
  • Maintain a safe distance away from the bladder.
  • The more the lower segment is stretched, the higher the incision should be
  • 3 to 5 fingers above the bladder.
  • Do not incise the bladder peritoneum and push down the bladder to make the incision low in the lower segment as described in many textbooks. That’s a recipe for troublesome vaginal tears.
  • Stretch the uterine incision manually in a transverse direction
  • Apply fundal pressure by assistant
  • Lift out the presenting part with
    • One hand
    • Sellheim’s Obstetrical Lever
    • One blade of pair of ordinary obstetrical forceps  
  • Deliver the baby
  • Clamp and cut the umbilical cord
  • Lift out uterus from the abdominal cavity
  • Squeeze out placenta by fundal pressure
  • Or remove it by hand from the uterine cavity
  • Close the incision in the lower segment with a continuous inverting suture from one corner of the incision to the other.
  • Use resorbable suture such as Chromic Catgut or Polyglycolic Acid.
  • One layer is enough.
  • Remove blood from the abdominal cavity
  •  Return uterus into the abdomen
  • Close the fascia with a continuous suture
  • Close the skin
  • Sellheim’s obstetrical lever
Cesarean Sectio

CHALLENGES WITH CESAREAN SECTIO

FULL BLADDER

Empty bladder by suprapubic puncture

Full Bladder in C/S

DEEPLY IMPACTED HEAD

There are two options:

  1. Have an assistant push the head from below with a hand in vagina
Pushing Impacted Head from Below

2) Perform internal version and extraction on a foot through the uterine incision

C/S with Internal Version

LATERAL TEARS OF THE UTERINE INCISION

  • Close the wound with two continuous sutures
  • Start suturing separately in each corner
  • Tie the sutures together in the midline

BLEEDING FROM UTERINE ARTERY

  • Clamp the artery above and below the bleeding point
  • Apply suture-ligation
Bleeding from Uterine Artery

MYOMA

  • Make the uterine incision in a convenient place
  • Avoid the myoma(s) in the incision
  • Do not try to shell out or remove the myoma(s)
  • It may cause torrential and fatal bleeding.
Myoma in C/S

HIV POSITIVE PATIENT:

  • Use protection
  • Give prophylactic medication before surgery

ABDOMINAL PACK

  • Be sure to remove all abdominal packs before wound closure
  • Suspect retained pack in septic complications
  • Intra abdominal sepsis
  • Leave wound open
  • DON’T DO IT AGAIN !
    • Keep counting