Caeserian section

[CHIFAMBA]

a 23yr old admitted for elective LSCS she is asthmatic, has an Hb of 11.3, platelet count of 179, on exam i noticed she has septic sores on the back from the second lumbar down to the buttocks, i am in Africa, vitals are ranging normal i have only thiopentone as an induction agent

what should i do

[Esme12, ASN, BSN, RN]

Is this a homework assignment? We are happy to help but we need to know what you think first.

[wtbcrna, MSN, DNP, CRNA]

a 23yr old admitted for elective LSCS she is asthmatic, has an Hb of 11.3, platelet count of 179, on exam i noticed she has septic sores on the back from the second lumbar down to the buttocks, i am in Africa, vitals are ranging normal i have only thiopentone as an induction agent

what should i do

Sores on the back where you would normally do your spinal are a relative contraindication for a spinal. Depending on the spread of the sores you could consider doing a spinal at L1. Thiopental for asthmatic patients is another relative contraindication. You could still use thiopental but you would need lessen the chances that it would trigger an asthmatic attack such as using an albuterol nebulizer treatment prior to induction.

Now if this is homework/clinical assignment you should be able to know the relative contraindications versus absolute contraindications for doing a spinal and for using Thiopental. Then you need to be able to defend your decision based on the clinical scenario.

[ruler of kolob]

I would go with an RSI GA..The asthma/TPH concern is a MUCH smaller factor than possibly introducing pathogens sub dural....If I were in Africa.. I would work VERY hard for an H1B.