Crash Sections

  1. Just wondering if this happens at other hospitals. I work WBN & NICU, so I don't understand all L& D ! We had a crash section the other night with mom only having a local anesthetic!!!!!:imbar I wasn't working (Thank Goodness). But I understand that anesthesia couldn't get to the meds because his key was bent. FHR had dropped to the 40's, and the baby was born 12 min. after it dropped. The baby was just transitioned with O2 hood, and ended up going to WBN the next day!

    This is the 2nd section under local in the 2 & 1/2 years that I've worked here. We do about 800 deliveries a year. does this happen anywhere else???!!!
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  2. 24 Comments

  3. by   anitame
    We were talking about this at work recently. The nurses who have been involved call it "splash and slash" c-sections. Apparently it happens every 4-5 years around here. I've never seen it and it doesn't sound pretty. The nurses that have seen it said that the moms seemed to tolerate it remarkably well, maybe due to the massive adrenaline rush/fear???? It will be interesting to hear from others who have actually been around one.
  4. by   SmilingBluEyes
    yes it has happened the places i have worked....VERY infrequently. The good thing is, they CAN give the MOM IV VERSED to aid in a kind of amnesia, so the pain she may have had (likely SUFFERED) is not remembered at all..... NO this is NOT a good situation....but then neither is the need for such an emergent surgery...it is likely to save the life of mom, baby or both....that is the only reason this would be done! Anyhow, IV Versed......That is what our anesthesists do for that unfortunate Mom when this sort of thing happens, after the baby is out. It is not something anyone WANTS to EVER see happen.
  5. by   luv l&d
    we call it splash and go, usually 6 minutes from decision to incision, and then another minute or 2 to baby. we are very lucky to have in house coverage 24/7 for nicu, anethesia, and ob deck doc (not residents, but practicing obs)
  6. by   littlemack
    "Been there and done that." I was lucky to be working at a teaching hospital at the time. A red head was bleeding profusely from an abruption and we received a call from the fire department who was transporting her to us. FHT's in the 40's. From admission to the unit to delivery it was 11 minutes. We were lucky that first the unit was not busy, had a nurse to spare, and secondly both anesthesia and both OB residents were up on the floor at the time of the initial call. Baby did well, and transitioned in level 2 nursery for about 12 hours. We were lucky!
  7. by   rdhdnrs
    Okay, what!!??? His key was bent??? I think I know this guy. Just kiddin'. Why didn't he go to the main OR and get drugs for GETA? I have never encountered a c/sec under just local and hope I never do. Yuck!!
  8. by   Nighshft
    I've been doing L&D for 24 years and have not yet witnessed a "splash and slash" under local. We have 2 anestheisia docs and a CRNA on our unit 24/7, so I guess we're luckier than many. I've seen them put a patient under general and go, and many have epidurals now, so that helps in cause of a crash.
    A BENT KEY??? geez you think he would have noticed that earlier? makes you wonder just how careful they check all their resources when they change shifts
  9. by   Mofe'ny
    Well, I also heard that he left the OR when th OB started cutting to tell the family that he couldn't put mom under due to his bent key. when the CRNA got up there from the main OR and they put mom under---- the CRNA straightened his key out and it would work!!!!!! They also charted all of this in the pt.'s chart, as well as what else was happening in the main OR's with which other doctors and that it "was a very busy night" Oh my gosh I am so glad I wasn't there!!! Rish management will have a fit over that chart don't ya think! There are about 8 incident reports filed on that case, because the OB doctor was pushing anesthesia around and throwing instruments after the section.

    By the way this mom was WALKING to the nursery to pick up the baby by the next night!!!!
    The other local section was an abruption after mom was pushing for an hour. They had called a section for CPD when they lost FHT completely and mom started hemorrhaging. I think that one was 8 minutes from loss to admission to the NICU. Baby did OK on that one too. Too scary though.
  10. by   mark_LD_RN
    have seen it once at a small hospital, pt had versed and local. anesthesia got there it time to but here under general to be closed up. hope to never see it again
  11. by   at your cervix
    OK, a little off the subject, but reminded me of this. I had a pt that came in with a birth plan that said that she didn't want to be offered any meds under any circumstance (you know the type.) We ended up having to do a c-section for ftp because she insisted on pushing at 7 cm and cervix and vagina became so swollen, could barely get fingers in to check her (after SEVERAL hours of pushing.) Then had non reassuring fht's. Well, all throughout this terrible day in labor, the pt just kept telling me that she would not take any meds (even though I never offered.) So, when it came time for the c-section, I couldn't help myself, I said, "I know that you don't want me to offer any meds, but do you want a spinal, or were you planning on using breathing techniques for your c-section?" Needless to say, she chose the spinal.
  12. by   shay
    Yes, we actually have a special kit for just such an occasion in our OR, and it has been used once. Local anesthesia for a c-section is for a last resort MEGA emergency when the anesthesiologist isn't in house and waiting means the difference between a dead baby and a live one.

    Absolutely have seen it done. It's very scary.
  13. by   carriec
    We transported a baby to our nicu once who had been a product of a small hospital without someone to do the spinal in time..did local csection due to an abruption, and baby was very sick...went into DIC and now is 3 years old and severely mentally retarded....mom did pretty well..A LOT BETTER THAN I WOULD HAVE BEEN!!
  14. by   Zhlake
    Quote from at your cervix
    OK, a little off the subject, but reminded me of this. I had a pt that came in with a birth plan that said that she didn't want to be offered any meds under any circumstance (you know the type.)
    I am just wondering what "type" exactly you are referring to? I am due in 8 days and part of my birth preference sheet is "do not offer any pain medications or anesthesia". I was just wondering what type I am.

    I work labor and delivery and have no problem with people asking to not be offered pain medications. I also fully understand that they are generally talking about a normal, healthy labor and delivery--not a major abdominal surgery.

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