Admitting diagnosis: Egtopic pregnancy Essay

Chief Complain The longanimous presents in the emergency this morning, complaining of bring low abdominal pain sensation. HISTORY OF PRESENT ILLNESS the forbearing states that she has been having vaginal bleeding more like spotting over the past month, she denies the chance of gestation period although she states she is sexually active and using no birth control. Gynecologic account patient is graved to par 1 abortus 1. her only sister is a year old 15 year old daughter who lives in Texas that lives with her grandmother. PAST aesculapian HISTORY Positive for hepatitis BPAST SURGICAL HISTORY Pilonidal cyst removed in the away past, has plastic surgery on her ears child. SOCIAL HISTORY Married, has 1 daughter, patient works as a substitute teacher, smokes 1 pack of cigargonttes on a daily basis. Denies EtOH. Smoked marijuana last night, no iv drug abuse. ALLERGIES TetanusMEDICATION NoneREVIEW OF SYSTEMS Patient complains of lower abdominal pain for the past calendar week. Ap parently got much worse last night, and by this morning wasnt tolerable. She is also having slightly nausea and vomiting, denies hematemesis and mel She has had vaginal spotting over the past month with questionable vaginal fuel as come up. denies the frequency, urgency and hematuria and denies arthralgia. Review of systems is otherwise essentially negative. PHYSICAL EXAM Vital signs sight temperature 97 degrees. pulse 53 respirations 22. blood pressure 108/60. GENERAL Physical exam revels a well developed, well nourished 35 year old white female is the moderate amount of harm the time of the examination, HEENT are all remarkable except poor indentation. neck is soft and supple. CHEST Lungs are clear in two fields. HEART Regular rate and rhythm. ABDOMEN soft exclusively compulsive bleakness of her lower abdominal area. Fundus was not palpable. above the pubic area.Left andexal are more than tender than the right. VAGINAL The cervix is unopen. a moderate amount of motherapul ient vaginal discharge is noted. the patient wouldnt support me to perform a bimanual examination due to her pain. so the speculum was withdrawn. EXTERMITIES No clot or edema. NUEROLOGICAL-in ingenuity urea x3, no nuerologica defictest. DIAGNOSTIC Dr. on admission hemoglobin 12.8 grams, hemaocrit is 36.6%. urine analysis is essentially negative. beta hcg is prescribed wit the WBC count of 23,278 RADIOLOGY Pelvic ultrasounds shows a 7 week 4 twenty-four hours off viable ectopic pregnancy per radiologist. the patient was given Demerol 25mg and promethazine 25mg iv for the pain after her subject was obtained. she was also given Claforan 1 gram iv, I paged Dr. Gerald GYN, physician as soon as they received the ultrasound report at slightly 10 am he was not in his north Miami office.I paged the south Miami office and reached Dr. Gerards office at approximately 1015am. his office personnel advised me that he is not on call, Dr. Vonbeck is on call. I spoke with Dr. Vonbeck at approx imately 1025 am and she will be here to reside the patient to the operating room. ADMITTING DIAGNOSIS Left Ectopic 1st trimester pregnancy. The patient received and iv of lactated clones upon the arrival in the emergency room. This was normal saline while we were awaiting Dr. Vonbecks arrival. The surgical procedure was explained the patient and her husband all the risk and benefits were discussed. Then assessing in immediate surgery and informed consent was signed. no old records are available for review. Dr McClure end dictation.Rosemary Bumbak dictating aOPERATIVE REPORTPatient chance on Brenda C. SeggermanPatient ID 903321Date of Admission 03/27/2012Date of Surgery 03/27/2012Surgeon Rosemary Bumbak, MDAssistant Michael Gerard , DOAnesthesiologist General and tracheal by Dr. AvalonEstimated Blood Loss approximately 1000ml undeniable transfusion of 2 unitsof tout ensemble blood. specimen removed heap of leave fallopian thermionic valve containing the ectopic pregnancy. op erative Diagnosis unexpended electron tubectoipc pregnancyPostoperative Diagnosis1 rupture let tubal ectopic pregnancy2. Hemoperiteoneum3-pelvic adhesions surgical Procedures1-exploratory laperotomy2-partial salpingectomy3-evauation of hempopatium4-lisis of adhesionsProcedure in detail The patient was prepped and draped in the usual expression and placed under adequate general anesthesia, Pfannenstiel incision was preformed and carried through skin and subcutanous tissue, fascia and peritoneum. the paritenial cavity was entered. the hemoparituim was noted, and approximately 500 ml of blood was rapid evacuated from the pelvic cavity, as were heroic cloths, following this, the bowel was jam-packed away the pelvic area with packing lapse. A retaining retractor was introduced. The left fallopian tube was noted. A large tubalectopic pregnancy was noted effecting approximately the distal half of the fallopian tube. Following this Heaney clinch was placed and the mesosalpinx cell and another curver clamp was paced in the proximal aspect of the left fallopian tube beyond the area of ectopic pregnancy. A patial salpiingectomy was preformed. removing the portion of the left fallopian tube containing the ectopic pregnancy.Heaney clamps were replaced with sutures with 1 micro. Hemostasis was checked again and no bleeding was detected. hike evacuation of blood and blood clots was then preformed. the right fallopian tube was noted to be covered with adhesions both tubular variatand tubal uterine The adhesions were then sharply lysed freeing the right fallopian tube. Hemostasis was checked again. No bleeding was detected. Mild cirrhosis abrasion was noted was noted where the area of the ectopic pregnancy was manifestly attached to the bowel and not bleeding and was very superficial. hemostasis was checked and no bleeding was detected. The peritoneum was closed continuously was homeochinoc suture. The facsia was approximated was inntrupted withfigure of 8 stitches of m icro and the skin was approximated with staple gun. The patient tolerated the procedure well and left the operating room in satisfactory condition. All counts were correct. Blood loss was estimated at 1000ml which was replaced with 2 untis of whole blood while in recovery. Rosemary Bumpbak, MD OBGYNDIAGNOSTIC REPORTDr Donna Harrison dictationPatient let on Brenda C. SeggermanPatient ID 903321Date of Admission 3-27-2012ER Physician Alex McClure MDTransvaginal ultrasound on 3-27-14Patient History Serve left pelvic pain rule out ectopic pregnancy. Pregnancy test is positive. Findings-transabdominal mental imagery demonstrates utures with small amount of fluid deep down it Psudodecidual sign. There is a large amount of hemorrhage seen within the left adnexa. no embryo is seen. The right ovary is unremarkable Endovaginal examination was performed in searched of viable ectopic. One is seen with roof length with 1.3cm corresponding to 7 weeks and 4 days. A large amount of free fluid is seen, esooudo gestuational shift is noted within the uterus which is oblong. IMPRESSION A left sided ectopic pregnancy is found with large amount of hemorrhage is noted and extending into the cul-de-sac the hemorrhage measures 13x6x10cm. Dr. McClur and the emergency room was notified which notified the surgeon and is on her way, end of report Dr Harrison.(Contiuned)_________________________Dr. Donna HarrisonNNEFD 3/27/2012T 3/27/2012Please send a likeness of this report toRosemary Bumbak, MD OBGYNDISCHARGE SUMMARYRosemary Bumbak, MD OBGYNPatient Name Brenda C. SeggermanPatient ID 903321Date of Admission 03/27/2012Date of Discharge 03/30/2012Admitting Diagnosis ectopic pregnancySurgical procedures1-expoloratory laparotomy2-partioal salpingectomy3-evacation of hemoparitoneum4-lises of adhesionsComplication-blood loss requiring transfusion x2History This 35 year old white female Gravida 3 para 10121 had her last menstrual cycle in early January. Prior menstrual cycles had been reg ular. She reported no contraceptives but not attempting pregnancy. Patient presented to the emergency room complaining of vaginal bleeding with pain in lower pelvic area. ultrasound preformed in the emergency room showed a 13.8 cm left adnexall mass with positive cardiac activity compatible with ectopic pregnancy. Hospital Course On 3-27-2014 the patient underwent exploratory laparotomy, left partial salpingectomy, evacuation of hemoparitoneum, and lyses of adhesions. Blood loss was approx 1000ml and was replaced with transfusion of 2 units of red blood cells the blood image was noted to be ORH negative and RhoGAM was provided. The patient was discharged on post operative on day number 3 on after having a normal bowel movement she was discharged with complaints on no medications. She understood her instructions regarding follow up, wound care and limitations Rosemary Bumbak ,MD OBGYNPATHOLOGY REPORTBerry J Lzano, dictation forPATIENT NAME Brenda C. Seggerman.PATIENT ID 903321Date o f Admission 3/27/2012Surgery 3-27-2014Admitting diagnosing Ectopic pregnancySurgeon Rosemary Bumback, MD OBGYNPathological Findings 03-s-965 specimen received 3/27 specimen report 3-320 Procedure left partial salpingectomyThe patient has a ectopic pregnancy as proven by pelvic ultrasound. tissue received left fallopian tube. GROSS PATHOLOGY desc examination of designated left fallopian tube reveals a left fallopian tube measuring 6cm in length and 2.3 cm in normal width. Sectioning of the tube reveals a distending of the tube with blood clot and possible field tissue. reprehensive sections are places in 1-c for embedding MICROSCOPIC microscopical examination was preformed