Concluded Case

What is the diagnosis and management

Post operative case of Caesarean section under spinal anesthesia with Bupivacaine just 6 hours back. Age-24 years primi gravida. Intractable Hypotension(60/40 mmHg) with Tachycardia cardia(150 BPM) . Use of ionotropic and crystaloid can not give satisfactory result. USG excluded haemoperitoneum. CBC excluded anemia and sepsis. Urea creatinine was absolutely normal initially. ECG- only sinus tachycardia. Echocardipgraphy- No wall motion abnormalities. What is the diagnosis and management?

Concluded answer
The patient died in Acute kidney injury. But actual diagnosis could not be concluded.
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Post spinal hypotension to be treated by rapid infusion of 3to4 pints fluid and use of vasopressors eg mephentermine . Mephentermine is a cardiac stimulant. It is used as a treatment for low blood pressure
Thank you doctor
Any h/o post-op tramadol inj?
Was there an USG done bedside before laparotomy? What were the findings then? And was the uterus contracted? Any undue bleeding pv? Just want to know this, as a part of the learning curve....
USG done/Laparotomy done- no hemopertoneum. Uterus contracted, no PPH.

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Post spinal hypotension can be ideally treated with bed rest and IV fluids. Spinal fluid leak can be treated by sealing the leak by forming a coagulam with injection of blood to the site.
What about Noradrenaline? It's very much effective in spinal Hypotension as well in Hypotension if not corrected by infusion.
After training in anesthesia I have found that during caesarean spinal hypotension is easily corrected by mephentermine .
- Hypovolemic shock - Explore immediately before irreversible damage occur - might be hemorrhage from utrine vessels
Laparotomy done-No haemoperitoneum seen.
The patient died in Acute kidney injury. But actual diagnosis could not be concluded.
It is also technically known as "blood patch", usually done by anaesthetist.