A case of APH with haemorrhagic shock presents with difficulty in breathing and falling Spo2 at the end of LSCS . Photos shows monitoring , X-ray and Venti parameters .



already all r discussed very well. .I would like to add one impt point. .BP Is 180/91 ..but pt is on shock as per the history. ..may be already PIH pt BP may be higher than this before surgery. ..pt had wide pulse pre

wide pulse pressure means septic shock. narrow pulse pressure present in cardiogenic shock. ..may b septicaemia. Ards. septic shock possible

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CXR suggestive of pulmonary edema, BP is high S/O hypertensive heart failure. kindly get 2 D echo. control BP aggressively, use lasix and nitroglycerine infusion. use pressure control mode with PEEP of 8 to 10. 14 PEEP is high. if patient continues to have tachypnea sedate patient and can use control modes of ventilation.

peripartum cardiomyopathy, amniotic fluid embolism may be rare causes but to be kept in mind.

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how come her BP is 180/91 when she came in shock? is she on some inotropes?

Dr Manish this is post resuscitation parameters at the end of surgery. In fact just after shifting to ICU

- pulmonary oedema as result of septisemeic shock - inj. Lasix 4ml IV state and w/f urine output, s.creatinie, bl. Urea - higher antibiotics ,close monitoring of vitals - it want be Amniotic fluid Embolism, as in such catastrophic events BP must fall drastically and patient can't breath , frothing and continuous coughing , without intubation patient cannot survive

amniotic embolism cousing pulmonary embolism. ..matching with all parameters and ecg tracing suggests sinus tachycardia

sir amniotic fluid embolism is misnomer it is anaphylactoid reaction of amniotic fluid

CX ray showing pulmonary oedema. At this point it ( with the clinical history) looks like PPCM. treat with diuretics, NTG drip for hypertension. get ECG , echo, thyroid function,CXR,Renal functions, electrolytes, CBC. pulmonary embolism, amniotic fluid embolism are DDs. can start with Inj heparin also, can start beta blockers/ACE inhibitors depending on investigations.

differncial diagnosis pulmonary edema trali ards dic amniotic embolism

I think if it is immediate post op it is more likely to be pulmonary edema.. ARDS will take little bit time to develop.. intra op how many fluids and blood given?

Could be over resuscitation.. Pulmonary edema picture.. high blood pressure.. how much fluid & blood products was given?

please provide whole history & clinical details. APH How many days back, how many blood products used, is bleeding stoped now. what bout sensorium. it could be TRALI if blood products used, ARDS OR Amniotic fluid embolism. important thing is t/t is same for all condition. Treat the cause, venti. support, Try to keep pt in negative balance if bp allows, CVP? Urine out put monitoring etc.

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