The case During the early hours of the morning, you get a call to get yourself immediately to room 1 in the labor and delivery suite. On arrival, you find an apparently term, obese patient in bed. She looks blue and is foaming at the mouth. She is thrashing about and impeding attempts to keep a mask on her face and to secure intravenous access. For the same reasons, you have no way of getting a blood pressure or pulse oximeter reading, but heart rate on the electrocardiogram (ECG) tracing shows sinus tachycardia at 150–160 beats per minute. You are told that the patient ate dinner, got short of breath, her water broke, and she started having contractions at home. She came to the emergency department and was sent to labor and delivery right away, and now there are no detectable fetal heart tones. Your obstetrician colleague tells you that clinic notes on the patient indicate that she is at 40 weeks' gestation and has gestational diabetes mellitus, but there is no indication that she has preeclampsia. The patient's belly is tilted to the left while the obstetrics (OB) team is desperately looking for fetal heart motion. Someone manages to get intravenous access and is told to guard it with her life. While the patient turns a darker shade of blue and is losing consciousness, despite oxygen being delivered by Ambu-bag, you attempt to suction whitish foam from the patient's mouth while she bites the Yankauer.
|Original language||English (US)|
|Title of host publication||Core Clinical Competencies in Anesthesiology|
|Subtitle of host publication||A Case-Based Approach|
|Publisher||Cambridge University Press|
|Number of pages||10|
|State||Published - Jan 1 2010|
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