Hellp with di
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This document presents a case study of a 24-year-old woman, pregnant with twins, who came to the hospital at 34 weeks gestation with high blood pressure and other symptoms of Preeclampsia with Severe Features (HELLP Syndrome). Tests confirmed HELLP Syndrome and Diabetes Insipidus. She underwent an emergency C-section under spinal anesthesia and delivered two healthy babies. Post-operatively she had excessive urine output consistent with Diabetes Insipidus, which was successfully treated with nasal vasopressin spray. She recovered well and was discharged on post-operative day 8.
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![Twin pregnancy with HELLP
SYNDROME with DIABETES
INSIPIDUS
Case Presentation
By - Dr.Manjushree Boob
M.B.B.S.,M.D.,D.N.B.,F.I.C.M.C.H.
FELLOWSHIP LAPAROSCOPIC SURGERY
& INFERTILITY [FRANCE]
Dr. Saima Khan [D.R.C.H. Student]
Dr.Shweta Soni [D.R.C.H. Student]](https://image.slidesharecdn.com/hellpwithdi-170221115503/85/Hellp-with-di-1-320.jpg)
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The document discusses various aspects of Java memory usage and garbage collection. It describes the Java heap structure, including the young generation, old generation, and survivor spaces. It also discusses object header information, memory addressing, and the impact of architecture (32-bit vs 64-bit) and JVM vendor (Oracle vs IBM) on object sizes. The garbage collection process of marking, sweeping, and compacting is explained.
Beast TLH
The document describes a technique for simplifying total laparoscopic hysterectomy (TLH). It outlines 10 key steps: 1) patient preparation and positioning, 2) insertion of a uterine manipulator, 3) abdominal entry and trocar placement, 4) dissection of uterine attachments, 5) mobilization of the bladder and posterior dissection, 6) securing the uterine artery, 7) separating the cervix from the vagina, 8) removing the uterus and adnexal tissue, 9) suturing the vaginal vault, and 10) suturing the ports. The technique emphasizes teamwork, careful dissection using bipolar cautery and scissors, and use of a simple uterine manipulator to aid visualization during
Surgical Management of Uterine Abnormality
This document discusses the surgical management of uterine abnormalities. It begins by defining congenital genital abnormalities and Mullerian anomalies. It then provides classifications for uterine anomalies and discusses their prevalence. Various uterine anomalies are described in more detail, including their associated symptoms, prevalence, and effects on pregnancy outcomes. The document discusses diagnostic challenges and various treatment approaches for different uterine anomalies, particularly for septate uteri. It concludes that management must be individualized based on each patient's anatomy and clinical situation.
TOTAL LAPAROSCOPIC HYSTERECTOMY
This document describes a technique for performing total laparoscopic hysterectomy (TLH). The key tools used are Kleppinger bipolar forceps for coagulation and desiccation of vessels, a Purandare uterine manipulator, and a mineral water bottle cap used as a cervico-vaginal delineator. Between 2005-2008, the author performed 505 laparoscopic hysterectomies, with 362 being TLHs. The simplified TLH technique presented allows for an intrafascial hysterectomy within 40-90 minutes using simple, safe tools and with minimal complications.
Laparoscopic myomectomy
This document discusses uterine fibroids and laparoscopic myomectomy. It defines different types of fibroids and their locations in the uterus. Laparoscopic myomectomy is described as a technique for removing fibroids through small incisions instead of open surgery. While it has advantages over traditional laparotomy, laparoscopic myomectomy requires skill and experience to perform carefully without complications. Factors such as fibroid size and location can increase the difficulty of the procedure and risk of conversion to open surgery.
Total Laparoscopic Hysterectomy- Tips, Tricks & Techniques
Total Laparoscopic Hysterectomy (TLH) - the operative steps made easy with detailed explanation & Tips at various stages of surgery to master it .
Laparascopic Hysterectomy, technical aspect
The document discusses the technical aspects of performing a laparoscopic hysterectomy. It covers:
1) Preparation steps including positioning the patient, surgeon, assistants and equipment. Port placement depends on uterus size.
2) Technique including orientation and exposure, dividing ligaments, opening spaces, cutting arteries and detaching the uterus.
3) Video clips demonstrate some key steps like suturing.
4) Patient selection is similar to open hysterectomy. A supracervical technique is also described.
Vaginal Hysterectomy
In this introductory remark at workshop on vaginal hysterectomy where Dr Shirish Seth was operating faculty.
I spoke “lets promote and propagate vaginal hysterectomy which is an indigenous surgery in line with PM Modi’s mission of MAKE IN INDIA.
Vaginal hysterectomy is like Aam admi surgery which is in the best interest of patients and has best scientific evidences in its favour."
Let us not be driven by glamour,gadgets and gimmicks."
Total abdominal hysterectomy with bilateral salpingo-oophorectomy.
TAHBSO is a surgical procedure that involves removing the uterus, ovaries, and fallopian tubes through an abdominal incision. It is used to treat endometrial cancer and uterine sarcoma. An oophorectomy or salpingo-oophorectomy removes one or both ovaries and possibly the fallopian tubes to treat ovarian cancer, tumors, or complications. A hysterectomy can be performed abdominally, laparoscopically, or vaginally to remove the uterus. Complications may include infection, bleeding, pain, urinary issues, and blood clots, but are generally treatable.
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Total Laparoscopic Hysterectomy- Tips, Tricks & Techniques
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Total abdominal hysterectomy with bilateral salpingo-oophorectomy.
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APH.pptx
This clinical case presentation discusses a 37-year-old pregnant woman with antepartum haemorrhage (APH) due to central placenta previa. Her medical history and examination findings are presented. Investigations confirm central placenta previa and placenta accrete is found during her lower uterine segment caesarean section (LUCS). She receives postoperative management and care. The discussion covers definitions of APH and its causes, differences between placenta previa and abruptio placenta, risk factors, complications, prevention of APH, and use of condom catheters for haemorrhage control in Bangladesh.
Postpartum Haemorrhage : Case Illustration
A 35-year-old woman experienced postpartum hemorrhage (PPH) after delivering a 3.9kg baby at a private facility. Despite treatments including ergometrine injections and oxytocin infusion, her uterus remained atonic and she experienced massive bleeding. She was transferred to a general hospital in a moribund state and died soon after arrival. A 30-year-old woman at a district hospital also experienced PPH after a vaginal delivery. Despite treatments including ergometrine, oxytocin, and uterine massage, she continued to bleed heavily and became lethargic with low blood pressure. She was transferred to a general hospital where a cervical laceration was suture
For this homework assignment, you will continue coding for Reports 2.docx
For this homework assignment, you will continue coding for Reports 2-5, which are located on pages 182-184 of the Step-by-Step Workbook. Using Encoder Pro, create codes for information from Reports 2-5. Additionally, explain how you arrived at that code.
Report 2: Discharge Summary
Diagnoses include:
1. Chronic pelvic pain secondary to pelvic metastatic clear cell carcinoma of unknown primary location.
2. Vena Cava syndrome post placement of Hickman catheter.
3. Anemia due to chronic disease.
4. Hypertension.
HOSPITAL COURSE:
The patient is a 78 year old female whom we have been following in our clinic for hypertension and also chronic pudendal nerve pain. She had been recently diagnosed with pelvic metastatic clear cell carcinoma, which her primary location is unknown at this time. She will be discussing this further after the pathology reports are read. During her hospital stay a Hickman catheter was placed in order to have IV access for pain medication or future cancer therapy. She was also admitted for chronic pain. She did develop swelling of her arms and neck. She was brought to interventional radiology and she did have venography and the Hickman catheter was removed. Her swelling to her arms and neck have decreased greatly. She denies any shortness of breath. No choking sensation as previously noted. Her pain has been managed well with fentanyl patch at 175mcg. She has also been on IV heparin therapy for anticoagulation following the vena cava syndrome. Today, the patient has been having complaints of nausea. She did get some dexamethasone IV for her nausea, which did improve later this morning. Her blood pressure has been under good control. Her labs today include a WBC of 5.18, hemoglobin 7.8, hematocrit 23.7, protime 14.4, INR 1.5, PTT 39.6, BUN 6, sodium 139, potassium 4.2, and CO2 27.2.
DISCHARGE MEDICATIONS:
1. Will continue home medications.
2. Phenergan 12.5 1-2 tabs p.o. p.r.n. every 6 hours for nausea.
3. Lovenox 1 mg/kg subcutaneously every 24 hours.
4. Fentanyl patch 175 mcg to be changed every 3 days.
5. Epogen 40,000 units subcutaneously weekly at the Cancer Center.
REPORT 3. CLINIC CHART NOTE
HISTORY: This 16 year old female is seen today after falling off a curb and twisting her right ankle. She is normally a patient of Dr. Anderson, who is out of town this week. She states that she has pain surrounding the entire foot and ankle. Seems unable or unwilling to bear weight.(Problem focused history)
PHYSICAL EXAM: Ankle and foot examined. Foot is warm to the touch. Some swelling and bruising noted around the lateral aspect of the ankle. X-ray is negative for fracture. (problem focused examination)
IMPRESSION: Sprained right ankle. (MDM complexity straightforward)
PLAN: Elevation; ice to affected area. Weight bearing only as tolerated. Return for follow-up p.r.n.
REPORT 4: ADMIT INPATIENT
This is a 19 year old with a living-related donor kidney transplant as of last month and admitted to hospital fo ...
Case discussion
A 69-year old lady with a history of hypertension presented with two hospital admissions in 4 months for chest pain and shortness of breath. On examination, she had moderate cardiomegaly, elevated blood pressure, abdominal bruit, and retinal exudates. Investigations showed evidence of bilateral renal artery stenosis. The patient has been referred for angiography and possible angioplasty of the renal arteries.
Obesity anaesthesia
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Total spinal
This document summarizes a patient's medical history and details of a surgical procedure under anesthesia. A 45-year old male patient presented with vomiting, weight loss, abdominal pain and fatigue. He had a history of perforation and laparotomy surgery. The patient was diagnosed with CKD and diabetes. He underwent a total spinal anesthesia for a 2-hour surgery to investigate enlarged mesenteric lymph nodes. During the procedure, the patient experienced hypotension and bradycardia due to the spinal anesthesia. He was intubated and given intravenous fluids and medications to stabilize him. After the surgery, the patient was extubated and able to follow commands with normal vital signs.
Case presentation on Iatrogenic Perforation
Mr. Mosharaf Hossain, 26, presented to the hospital with abdominal pain, distension, and shortness of breath. He had undergone a colonoscopy earlier in the day. On examination, he displayed signs of peritonitis including abdominal rigidity and obliteration of liver dullness. Imaging revealed free air in the abdomen. He was diagnosed with an iatrogenic perforation from the earlier colonoscopy and underwent an emergency laparotomy. Three tears were found and repaired in the sigmoid colon. The patient recovered well post-operatively and was discharged on the 12th post-operative day.
Case presentation
The document presents a case study of a 24-year-old female patient who was found unresponsive. Initial examination found the patient to have a Glasgow Coma Scale of 10/15, tachycardia, hypertension, and signs of respiratory distress. Laboratory tests revealed metabolic acidosis, elevated white blood cell count and creatinine, and rhabdomyolysis. Ultrasound showed signs of pregnancy. The patient was treated for pre-eclampsia with magnesium sulfate and antihypertensives, intubated, and underwent termination of pregnancy. She was admitted to the ICU and later discharged in good condition.
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Malaria in pregnancy case presentation edited
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4. complex febrile fit
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Nursing Pharmacology Discussions.docx
1. The document describes several patient cases involving medication management and nursing care. Details are provided about the patients' conditions, medical histories, vital signs, lab results, treatments and nursing assessments.
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3. Lab results, provider orders and treatment plans are still pending or in progress for some of the patients.
Financial & Managerial Accounting Assignment 1 – Financial S.docx
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Tanija & Muaz case presentation.pptx
1. The patient, Poli Ahmed, presented with irregular menstruation 2-3 times per month for 4 months with severe abdominal pain and excessive bleeding.
2. On examination, she appeared ill and anemic. Abdominal and systemic examinations were otherwise normal.
3. Based on her history and examination, she received a provisional diagnosis of dysfunctional uterine bleeding due to an unknown etiology.
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Yan 2Yichao YanKara WilliamsESL 10696 April 2019 Rough.docx
Yan 2
Yichao Yan
Kara Williams
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6 April 2019
Rough Draft Analysis of Argument Essay
In the article “What Else Can I Do to Get the School Supplies My Student Need?” the author discusses that, textbook still plays an important role in today’s class. There are so many debates about weather using online text book or physical textbook in school nowadays. The author as a college teacher claims that physical textbook helps her students have better understanding of knowledges. Also, she thinks physical textbook reduced the financial burden on students. However, online source or online textbook should have more benefit then the physical textbook.
First of all, the author claims that physical textbook could helps student read and understand better of new knowledges. The resources that teachers need for their teaching are so differently. It depended on student’s grade and their teaching style. Even people nowadays assume textbooks are outdated, inefficient and biased, author still think using textbook is very important for students to know about some academic basic information, which could help students master the course better.
APPENDIX I r Reports
DIAGNOSES include:
1. Chronic pelvic pain secondary to pelvic metastatic clear cell carcinoma
of unknown PrimarY location.
2. Yeta cava sy.rdromi post placement of Hickman catheter'
3. Anemia due to chronic disease.
4. Hypertension.
HOSPITAL COURSE: The patient is a 78-year-old female whom we have
been following in our clinic ior hypertension and also chronic pudendal
nerve pain. Shie had been recently biagnosed with pelvic me,tastatic clear
cell caicinoma, which her primaiy location is unknown at this time' She
will be discussing this further after the pathology reports are, read. During
her hospital stalia Hickman catheter was placed in order to have IV access
for pain medication or future cancer therapy. She was also admitted for
chronic pain. she did develop swelling of her arms and neck. She was
broughtio interventional radiology and she did have venography and the
Hickman catheter was removed. Her swelling to her arms and neck have
decreased greatly. She denies any shortness of breath. No choking sensation
as previouily noted. Her pain has been managed well with fentanyl patch at
175 mcg. She has also been on IV heparin therapy for anticoagulation
followitig the vena cava syndrome. Today, the patient hasbeen having
complaiits of nausea. She did get some dexamethasone IV for her nausea,
which did improve later this morning. Her blood plessure has been under
good control. Her labs today include a wBC of 5.18, hemoglobin 7.8,
f,ematocrit 23.7, protime 74.4,INR 1'5, PTT 39'6, BUN 6, sodium 139'
potassium 4.2, CO2 27.2.
DISCHARGE, PLANS:
1. IV heparin is discontinued. She will be switched ovel to Lovenox
r mg/kg subcutaneously daily. The patient will have Home Health to
help her set uP these iniections.
2. She will continue with the fentanyl patch 175 mcg for the pain..
Clinicopathological conference
This document presents the case of an 11-year-old thalassemic girl who presented with drowsiness, irritability, and vomiting. Imaging revealed a large extradural hematoma that required surgical evacuation. Over the subsequent days, she was closely monitored and managed in the ICU. Her symptoms improved and she was eventually discharged with recommendations for outpatient follow up.
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Mrs. Kamrunessa Begum, a 79-year-old female, presented with respiratory distress and right lower abdominal pain. Imaging revealed pulmonary embolism and risk assessments stratified her as moderate risk. She was treated with low molecular weight heparin, antibiotics, non-invasive ventilation, anticoagulation, and physiotherapy. Her condition gradually improved and she was discharged 10 days after admission.
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This document presents a case report of an 8-month-old male child brought to the hospital with a 3-month history of persistent cough, fever, and weight loss. On examination, the child was found to be wasted and underweight. Investigations showed anemia, lymphocytosis, and a positive urine TB-LAM test. The child was diagnosed with pulmonary TB, severe acute malnutrition, and suspected HIV infection. He was admitted and started on anti-TB treatment and therapeutic feeding for malnutrition. However, the mother discharged the child against medical advice after only a few days of treatment.
Abruptio Placenta
The document provides an overview of pre-eclampsia and abruptio placenta. Pre-eclampsia is hypertension and proteinuria after 20 weeks of gestation, and can be mild or severe based on symptoms. Abruptio placenta is the premature separation of a normally implanted placenta after 20 weeks of gestation. It can cause bleeding and is associated with conditions like hypertension. The document then provides details on the patient's history, including her presenting symptoms of vaginal bleeding and abdominal pain, as well as relevant family and developmental history.
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- 4. INVESTIGATION HB-8.5gm% Bld group- AB+ve Haematocrit-30.0 MCV-100.0 MCH-28.3 TWC-8,800 S.G.O.T-70 SERUM LDH-361 KFT: serum creatinine-1.10 serum sodium-142 serum potassium 3.3 serum ionised calcium- 1.1
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- 6. After 6 hrs she had developed suttle convulsion & had a fall. Reports of PIH profile had come and was suggestive of HELLP. Immidiately shifted to OT for emergency LSCS after explaining all risk &complication to relatives.
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- 9. But as output was always more then 6liters. Nasal vasopressin spray was given and in 2 doses 4 hrs apart she responded completely. Pt was discharged on D-8 in absolute healthy condition and good suture line.