Gp presentation Pam and Chris Harnden

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Demonstration of clear communication and collaborative, collegial working relationship between professionals.

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Gp presentation Pam and Chris Harnden

  1. 1. The case <ul><li>Miss R </li></ul><ul><li>24 yr old G3P1 </li></ul><ul><li>Previous elective C section for breech presentation </li></ul><ul><li>Rh neg </li></ul><ul><li>Minor complaints in pregnancy, spotting and RFM </li></ul><ul><li>Suffered abdominal burn following accident with full kettle of boiling water in second trimester. </li></ul><ul><li>Saw obstetrician given go ahead for VBAC </li></ul>06/07/09
  2. 2. The reason for midwives 06/07/09
  3. 3. <ul><li>At term seen c/o painful contractions 2:10 </li></ul><ul><li>Fully effaced 1cm dilated went home </li></ul><ul><li>4hrs later returned still same V/E- pethidine </li></ul><ul><li>2hrs later still unable to cope with contractions 2:10 </li></ul>06/07/09
  4. 4. I knew we were heading for…. 06/07/09
  5. 5. 06/07/09
  6. 6. Miss R`s idea of natural childbirth 06/07/09
  7. 7. Birth <ul><li>Became fully dilated </li></ul><ul><li>Pushed less than 1hour </li></ul><ul><li>Had normal birth in lithotomy </li></ul>06/07/09
  8. 8. Postnatally <ul><li>Stayed 48hrs no problems breastfeeding </li></ul><ul><li>Seen daily for next 3 days c/o some thigh numbness. ? Effects epidural ?effects of lithotomy </li></ul><ul><li>Seen at 1wk no problems but no longer exclusively breastfeeding </li></ul>06/07/09
  9. 9. <ul><li>Routine p/n visit at 2wks c/o “migraine” seen in A and E just came from GP given stronger painkillers </li></ul><ul><li>c/o some pressure at back of neck wanted to see the osteopath </li></ul>06/07/09
  10. 10. WHEN YOU HEAR HOOFBEATS BEHIND YOU, DON`T EXPECT TO SEE A ZEBRA THE MEDICAL SCIENCE OF HOUSE, MD 06/07/09
  11. 11. Chris + Pam Harnden 06/07/09
  12. 12. Chris in work mode 06/07/09
  13. 13. Chris before seeing ‘Miss R’ 06/07/09
  14. 14. I want some medicines that work for my migraine doc. 06/07/09
  15. 15. Miss R had no previous history of headaches 06/07/09
  16. 16. Initial diagnosis post epidural headache 06/07/09
  17. 17. Did this diagnosis make sense???? 06/07/09
  18. 18. Conclusion reassess diagnosis <ul><li>Headache commenced 9 days post epidural </li></ul><ul><li>Headache persisted for at least 5 days (usually settle after 3 days) </li></ul><ul><li>Headache was not positional </li></ul>06/07/09
  19. 19. How did the headache start? 06/07/09
  20. 20. Does examination back up my concerns? 06/07/09
  21. 21. ??papilloedema 06/07/09
  22. 22. <ul><li>Admit hospital </li></ul><ul><li>??Intracerebral bleed or sub arrachnoid haemorrhage </li></ul>06/07/09

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