Nurul Natasha Binti Suli,

26yo Para 1, post EMLSCS day 3 (ebl 600cc)

Ht 15cm
Wt 90kg

noted pt tachycardic since 11/5/23, HR 107-124

pt was still able to ambulate to ward
tolerating orally well
pu normal
unable to BO and not passing flatus since post op
ps 1-2
mild dizziness since 7am

Diagnosis : post EMLSCS fro poor progress and MMSL

Done Exploratomy relaparotomy

EBL 1.5L

Preoxygenation done

Vital pre induction

BP 159/95
HR 147bpm
Spo2 98% under NP5L/min

Induced with
IV Fentanyl 150mcg
IV Propofol 50mg
IV Suxamethonium 125mg

Intubated with ETT size 7.5, via CMAC anchored at 19cm

Connected to ventilator VC, peep 6, rr 18, TV 500

Intraop vitals
BP range
HR range
Spo2 100% under ventilator
etco2 36

Lines :
18G right wrist
18G left brachial
20G radial artery

Other drugs given

IV Rocuronium 30mg + 10mg + 10mg
IV Dexamethasone 8mg
IV Morphine 8mg
IV Paracetramol 1g
IV Tranexamic acid 1g
IV Granisetron 1mg

Fluids intraop
2 pint NS
2 pints Gelafundin
1 pint packed cells (350cc) + 205cc
Output
CBD : 200cc

EBL : 2L

ABG pre induction : pH 7.364/ pCO2 31.7/ pO2 101.1/ hco3 18.3/ Lac 0.9/ Hb 7.9
ABG post 1 pint PC : pH 7.366/ pCO2 31.3/ pO2 140.6/ hco3 18.1/ Lac 0.9/ Hb 8.2

Extubated well with IV Sugammadex 200mg

Plan : (d/w Dr Shaiful, Anaesthesiologist)

for PACU admission for monitoring
FM 5L/min , keep Spo2 >05%
repeat all blood investigations ; fbc, rp, coag
cxr post extubation
serum ketone at PACU
for s/c morphine 5mg QID
monitor DXT , keep DXT 6-10mmol/l
complete blood transfusion (2nd pint)

//////////////////////

Nurul Natasha Binti Suli,

26yo Para 1, post EMLSCS day 3

Ht 15cm
Wt 90kg

ANC :
1. Maternal Obesity
� 33 kg/m2
� MGTT x 2 N

2. GBS +ve
� HVS C&S @ 33w
� Completed abx

3. Persistent Proteinuria
� EOD BP N range
� Urine PCR x2 N
i. 12.9 & 14.3

day 3 Post EMLSCS for poor progress + MMSL at 23:00, 9/5/23

EBL : 600 mls

noted pt tachycardic since 11/5/23, HR 107-124

pt was still able to ambulate to ward
tolerating orally well
pu normal
unable to BO and not passing flatus since post op
ps 1-2
mild dizziness since 7am
no sob/chest pain/ palpitation

Planned for Exploratomy relaparotomy KIV hysterectomy kiv proceed

Upon review in holding bay
c/o sob, no chest pain
afebrile
palpitation +
no dizziness

OE alert, conscious, tachypneic, pale, pulse feeble

BP : 145/95mmHg
HR : 145bpm
Spo2 : 100% under NP 3L/min

lungs : clear
CVS : drnm

Airway Assesment :
MP 3
tmd >3FB
good MO
neck ROM good
no loose tooth

Spine : NAD

Plan :
for operation under GA
For high risk consent-taken from husband
PACU backup (ongoing bleeding)
IABP monitoring
GXM 3 pint to OT