Obsgynaecritcare

004 Life-threatening bronchospasm – safe mechanical ventilation

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Synopsis

(*This is a fictional case) Your patient has just had a very difficult instrumental delivery in theatre after a prolonged obstructed labour. Unfortunately now her uterus won't contract despite oxytocin and ergometrine and she is bleeding pretty briskly. You clean her deltoid with an alco-chlorhex wipe, inject 250mcg (1 ampoule) of carboprost i.m. and cross your fingers that this will do the job. You lean over the drapes, talk to the obstetric team and start rubbing her uterus while they repair the episiotomy. Suddenly you hear a raspy wheezing sound from the head of the bed - you immediately jerk your head around and glance at your patients face - she looks terrified. Bronchospasm! She has pursed lips and is struggling to breathe, her sats probe says 75% and you suddenly wish you had signed up to do dermatology back in your intern year..... Your assistant runs around trying to find a nebuliser and salbutamol and over the next 4 minutes she becomes unresponsive, her breathing becomes progressively worse and