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Myomectomy & Heparin

OBGYN Surgical Procedures

QuestionAnswer
What are the layers of the anterior abdominal wall? Skin to subcutaneous tissue, to superficial fascia, to external oblique muscle, to internal oblique muscle, to transversus abdominis muscle, to transversalis FASCIA, to preperiton adipose and alveolar tiss to peritoneum
What is the main non-anaesthetic complication in myomectomy? haemorrhage
give 2 ways in which this complication can be reduced 1. Intraoperative vasopressin into surrounding arteries 2. Preop GnRH to reduce size of fibroids 3. Blood transfusion
4 non-anaesthetic complications that occur in the first 5 days postop 1. Haemorrhage 2. Atelectasis 3. UTI/thrombophlebitis 4. Wound infection
Post op orders for next 24 hours or a pt under GA 1. Clear fluids as tolerated 2. Ambulate as tolerated 3. Maintenance IV fluids (0.9% NS D5W) 4. Medications: Analgesia , Antiemetics, Antibiotics, VTE prophylaxis
what dose of heparin would u give as VTE prophylaxis 5000 units sc `q8-12 hrs
dose of heparin in vte therapy Bolus: 80 units/kg infusion: 18 units/kg/hr
long term gynaecologic complication of myomectomy infertility
For an obstetric patient on VTE prophylaxis, what is your main concern preop? when is it safe to perform surgery without increasing the risk of hemorrhage? when is it safe to do Sx w/o increasing the risk of thromboembolism (eg, venous, arterial) after discontinuing treatment? aka Balance b/w bleed & clot
how would you preop prepare a pt on VTE prophylaxis? (wanted 4 points) Determine risk of bleeding/VTE: 1. Coag profile: bleeding, clotting time, PT, PTT 2. Discontinue heparin preoperatively 3. Reserve 4 units of crossmatched PRBCs 4. VTE prophylaxis with thromboembolic stockings
Created by: IonaDel