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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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