Ruptured Ectopic

8/13/2019 Ruptured Ectopic

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A CASE OF RUPTURED

ECTOPIC PREGNENCY WITH

SEVERE ANAEMIA.

Dr. S

Dr. S

Dr. S


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Patients Name - Sarvesh

Age/Sex - 29 Yrs/Female

Occupation - House Wife

Address - W/O Netrapal

R/O Rapur, Atrauli, Aligarh

Date of Admission - 01/02/14 @1:20am

Casualty No - 2688/14

CADS No - 2712/14

Consultant Incharge - Prof. Imam Bano


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Complain of :-

Cessation of Menses - 1.5 months

Bleeding Per Vaginum - 3 days


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History of present illness:-

According to the patient she was apparentlywell 1.5 months back when she developed cessatio

of menses with all signs and symptoms of pregnanc

There is history of bleeding per vaginum in the form

of spotting since 3 days.

There is no history of Fever With RashesDrug Exposure

X-ray Exposure

ANC Visits


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Menstrual History:--

LMP : 26/12/13Pregnency: 5w 2d

Obstetric History :--

G4P3+0L2All Were delivered at home


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History of past illness : --

No history suggestive of TB , DM,

HTN and previous Hospitalization

Family History : --

Nothing significant


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Personal History : --

Bowel/BladderRegular

AppetiteNormal

SleepAdequate

DietNon-vegetarian

AddictionNil


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EXAMINATION General Examination:--

The patient was a middle aged female of average

built and nutrition, conscious, well oriented to time place

and person neither dyspneic nor cyanosed.


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Vitals:--

P/R 120/min, Regular , Low Volume

BP 86/60 mm of Hg

RR 20/min , regular

TemperatureAfebrile

PallorPresent (+++)

No Icterus/ Cyanosis/ Clubbing

No Lymphadenopathy

No Pedal Edema


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Systemic examination

Per Abdomen Examination :--

Umbilicus centeral

Lower abdomen was slight distended

Guarding was present

Tenderness was present in lower abdomen

Exact uterine size not made

Per Vaginum Examination-Os closed, fullness present on both fornices(more on rig

Tenderness present

Fluid in POD


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Respiratory System :--B/L Rhonchi Present

B/L Equal Air Entry

Cardiovascular System :--Precordium normal

S1 and S2 normal, no added sounds

Central Nervous System :--

Patient was conscious well oriented to time placeperson

EMV- 15/15

Pupils- B/L NSNR

All cranial nerves are intact

No motor or sensory deficit


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INVESTIGATIONS :--

Hb : 5.6 gm%

TLC : 24100 cell/m

DLC : P91L6Mx3

PLATELET COUNT : 261,000 /mm

BT : 2 min 10 sec

CT : 3 min 20 sec

Blood sugar (R) : 110 mg%


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Renal Function Test:--

Blood Urea Nitrogen(BUN): 11mg %

S. Creatinine : 0.7 mg %

Serum Electolyte :--

S. Na+ : 138mmol/L

S. K+ : 3.4mmol/L


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Pre-anaesthetic Evaluation :--

Vitals:

PR : 120/min, Regular , Normal Volume

BP : 80/60 mm of Hg

RR : 20/min , regular

Pallor : (+++)

ANAESTHESIA NOTES : -


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NPO from 4 hour

No History of :-

Cough, Dyspnea,

Chest Pain, Palpitation

Drug Allergy

Jaundice, Seizure

Any chronic illness

previous history of anaesthetic

exposure


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Respiratory System:-

B/L rhonchi, B/L Equal Air entry,

CNS:- Patient was consciousEMV 15/15

Pupils B/L NS NR

CVS:-

S1 and s2 are normalno added sound

Airway Examination :- MP I

ASA : Grade III


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Pre Anaesthesic Preparations:-

Two large bore (18G) needle placed

1 unit RL started.

250 ml voluven infused.Blood samples sent for cross-matching

Foleys catheterization done

Premedication :-

Inj. Metoclopramide 10 mg iv

Inj. Ranitidine 50 mg iv

inj. Tramadol 100 mg iv

inj. Midazolam 1.5 mg iv


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Technique:-- Under GA(RSI)

Procedure:--

Patient was Pre-Oxygeneted with 100% O2for

Cricoid pressure applied.

Induced with Inj. ketamine 90 mg iv

Relaxed with Inj Sux 50 mg iv

OTI done with CETT No. 6.5

Maintained with O2 + N2O + IPPV + Inj Vecuron


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Progress:-

Time PR BP SpO2 IVF IVD

2:20 AM 130 90 98 RL1 VOLUVEN Inj. Diclo 75 mg

2:35 AM 122 88 99

2:50 AM 118 96 97 RL2

3:05 AM 110 102 98 NS4

3:20 AM 104 100 99

3:35 AM 109 104 99 BT1

3:50 AM 110 106 98 RL3

4:05 AM 106 108 99

Urine output at the end of sur


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Intra Operative Finding:-- Left Sided Ampullary Ruptured Ectopic Found

Approximately 3 -3.5 Litre Of Hemo Peritoneum

Left Sided Salpingectomy With Right Sided Tub

Ligation was Done

Operation:--


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Postoperative Examination:-

Extubation trial not attempted

Pt shifted to ICU for further management

Vitals in ICU was

Pulse: 104/min

BP: 116/74 mm of Hg

Chest : B/L rhonchi present

CVS: S1 S2 present

CNS : Intubated and Relaxed


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2 units of PRBCs and 2 unit of FFP was transfused in

Pt was extubated in ICU at 11:30 AM ON 01/02/14 (DAY

Recovery - Adequate

Reflexes - Present

Respiration20/min, regular, adequate tidal volum

Vitals:-PR - 86/min

BP - 114/70 mm of Hg.

RR - 22 /min

ChestB/L Clear

CVS - S1 S2 present

CNS - EMV 15/15

Urine I/O -1300/300


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ABG ( at 12.00 pm ) on 01/02/14(ICU day 1)

Pt. Was on hudson 6 L/min of pH 7.41

pO2200.8 mmHg

pCO235 mmHg

HCO323 meq/l

S. Na+132 meq/l

S. K+4.6 meq/l

SpO299 %


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Patient shifted to ward on 01/02/14 @7:00 Vitals in ward

PR90/min

BP- 106/70 mmhg

SPO2-98% Patient is now improving well in the ward


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Ruptured Ectopic

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