RT Book, Section
A1 Vaught, Arthur Jason
A2 Lane-Fall, Meghan B
A2 Shapiro, David S.
A2 Kaplan, Lewis J.
SR Print(0)
ID 1204537728
T1 Obstetrics
T2 After the ICU: Multidisciplinary Perspectives on Supporting Critical Illness Survivors
YR 2024
FD 2024
PB McGraw Hill
PP New York, NY
SN 9781260469257
LK accessanesthesiology.mhmedical.com/content.aspx?aid=1204537728
RD 2024/10/07
AB Patient  Care  VignetteA  33-year-old  patient  at  28  weeks  gestation  presents  to  the  emergency  department  with  a  fever,  and  back  and  flank  pain  as  well  as  symptoms  that  suggest  a  urinary  tract  infection  (UTI).  This  is  her  first  pregnancy  and  she  and  her  partner  are  quite  anxious  about  the  developing  baby.  She  has  a  history  of  obstructive  kidney  stones  that  have  required  treatment  multiple  times  over  the  last  5  years.  Her  current  symptoms  were  similar  to  symptoms  she  had  experienced  about  3  weeks  into  her  current  pregnancy  when  she  was  also  treated  for  a  UTI.  Because  she  was  pregnant,  she  was  initially  evaluated  in  Obstetrical  Triage  where  blood  and  urine  cultures  were  obtained.  Based  on  a  high  heart  rate  and  a  low  blood  pressure,  she  had  two  IV  lines  placed  and  she  was  administered  2  liters  of  intravenous  fluid.  She  was  also  started  on  pregnancy-compatible  antibiotics  to  treat  her  UTI  as  well  as  any  urinary  bacteria  that  were  in  her  bloodstream.Despite  fluid  resuscitation,  her  blood  pressure  remained  low  and  her  laboratory  profile  demonstrated  an  increasing  amount  of  acid  in  her  bloodstream  (lactic  acid,  a  lab  marker  of  poor  blood  flow  and  oxygen  delivery).  To  help  with  blood  pressure  of  both  mother  and  baby,  a  continuous  infusion  of  a  blood  pressure–raising  medication  (vasopressor  agent)  was  started.  To  assess  the  developing  baby,  fetal  heart  rate  monitoring  was  initiated.  It  demonstrated  indeterminate  tracings  that  required  ongoing  surveillance  as  they  were  neither  normal  nor  completely  reassuring.  The  patient  started  to  have  contractions  every  2  minutes,  which  were  tracked  by  the  monitor.  Given  her  low  blood  pressure  that  needed  fluid  resuscitation  and  a  vasopressor  infusion,  frequent  uterine  contractions,  and  indeterminate  fetal  heart  rate  tracings,  she  was  admitted  to  the  ICU  for  septic  shock  management.