Dr. Albert Dean: Okay, so I spoke with Dr. Upton earlier tonight. He says Ms. Keys is a 27-year-old primigravida at 41 weeks.
Her cervix is 1 centimeter, 25% effaced, and minus 3. Her first blood pressure in the clinic today was 141/88, but the repeat was normal.
He wants to induce labor with Misoprostol intravaginally. I think he wants 100 micrograms.
Dr. Jim Pham: Actually, Dr. Dean, I see the orders say 25 micrograms of Misoprostol intravaginally.
Dr. Dean: Right, it is 25 micrograms.
Dr. Dean: Good catch, Dr. Pham. There are no other complications that I'm aware of, but I'll review her obstetric record and check back with the team.
Dr. Dean: We'll need to keep an eye on her blood pressures. She could be developing preeclampsia.
Dr. Dean: Janet, who's coming in for you?
Jean Casey, RN: I'm handing Ms. Keys' care off to Dana Collins. I'll make sure to mention your concerns for her potential to develop pre-eclampsia.
Dana Collins, RN: Hi, Janet. How're things looking tonight?
Jean: Hi, Dana. I'm late to pick up my kids at the sitter's, so I need to make this quick.
Drs. Dean, Pham, and I just had team huddle on Ms. Keys. She's a 27-year-old primigravida who's had an uneventful pregnancy.
She's just been admitted for induction at 41 weeks with an unfavorable cervix.
Poor thing has been waiting for a bed since early afternoon and just got admitted.
Dana: That long, huh?
Jean: Yeah. She's stable right now. Dr. Upton's the attending. Drs. Dean and Pham are on-service for her tonight.
The plan's to induce by 25 micrograms of Misoprostol intravaginally.
Oh, and there's something you need to be aware of: her blood pressure was elevated in the clinic, but they're high normal here. We just need to keep an eye on her.
Nurse: We're doing a stat section in room 15, and I need your help moving the patient to the OR.
Dana: Okay, I'll be right there. I'll keep an eye on the pressures. Looks like I've got to run.
Dana: Dr. Pham, can you please come here now? She's having some seriously painful contractions, and I'm concerned about some late decelerations on the fetal heart rate tracing.
Dr. Pham: She's at 6, Dr. Dean. Do you think we should call Dr. Upton?
Dr. Dean: It's early yet. I think we can manage this without him.
Dana: Dr. Dean, I'm concerned about Ms. Keys. I'm uncomfortable watching these late decelerations. The baby's heart rate is in the 60s. I just don't think it's safe to continue labor.
Dr. Dean: Okay, Dana. Let's page Dr. Upton.
Dr. Upton: Okay, she currently only has intermittent late decelerations, and these have improved with her position changes and supplemental oxygen.
We'll monitor her until she's fully dilated, and allow her to push. If there's any evidence of fetal distress or persistent late decelerations, we should be prepared to go to c-section.
Dr. Grant Newman: I've alerted the OR to be prepared in case we need to use it.
Dr. Upton: Great. I'll discuss this plan with Ms. Keys when we're done here.
Dr. Upton: What are her vitals right now?
Dana: Normal. Just checked 15 minutes ago.
Dr. Dean: She's had no late decelerations since you were called.
Dr. Upton: Let's continue to monitor her. I need to know when she's complete and pushing so we can keep a close eye on her second stage. Any questions?
Dr. Upton: Okay, folks, we're going to do a c-section because of persistent late decelerations, which have temporarily improved.
Dr. Upton: Ms. Keys is a 27-year-old primagravida at 41 weeks. Grant, do you have anything to add?
Dr. Newman: No additional anesthesia risks. I'm loading her right now with 10 cc of 2% lidocaine. She's almost ready for surgical incision.
Dr. Upton: Lynn, is peds on standby?
Lynn Thomas, RN: Peds has been called. They are on the way. I've alerted Linda, the charge nurse tonight. Can we do our surgical time out now?
Dr. Upton: Go for it.
Lynn: We have Michelle Keys, ID 45623901. She's consented for a cesarean due to a non-reassuring fetal heart rate tracing.
Dr. Upton: Lynn, we do have a Michelle Keys, ID 45623901, for c-section.
Mrs. Keys, as a part of our safety check, please tell me why you are here .
Michelle Keys: I'm here for a c-section.
Dr. Newman: Thank you, Ms. Keys. We're going to take good care of you.
Dr. Upton: Great job, everyone. Can we discuss how things went with Ms. Keys: what we did well and what can we do better next time?
Dr. Newman: It was helpful for me to be brought in early. That allowed me to use a regional instead of a general anesthesia.
Dr. Upton: You're right, Grant. Lynn, what did you think?
Lynn: It was great that Dr. Dean help put the Foley in place while I did the count with Alicia.
Dr. Upton: Albert, this was a great example of task assistance. How was our communication today?