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Hello, I am hoping for some advice or suggestions of improvement. I’m still learning to balance medicolegal and clinical decision.
I’m doing my first vacay coverage locum stint at a rural county hospital. They don’t have MRI on weekends. I did a laboring epidural on a healthy, bmi25 , G1 without any kind of issues. Went quickly and easy. Worked great for 7hours, including through 3 hours of active pushing (no instruments). During pushing, she started feeling paresthesias and weakness in her right thigh with hip flexion which persisted with epidural off.
I didn’t find out until next morning when I came in for a scheduled c-section. On exam, she had numbness on that right leg and calf anteriomedially, and profound quad and some hip flexor and adductor weakness. Afebrile, no back pain or any other symptoms, already urinating on own, no Bm yet. WBC elevated at 19, but elevation could be typical post delivery and in setting of no fever, pain, and time line, I thought abscess less likely. Seemed mostly a femoral nerve involvement, but I hadn’t encountered her degree of motor loss before, so got a CT since MRI wasn’t available. My thought was if anything looked funky, I’d transfer her to the nearest place with mri and neurology/surgery.
My question is:
1. Would you have gotten any imaging in the first place?
2. Was the CT the right way to go? (Vs transferring her for mri). I could not find much on line, other than it was the modality of choice until mri came along. (The radiologist report was stone cold negative, no epidural hematoma or abnormal fluid collection.)
3. Would you still get an mri when it becomes available?
Thank you!
I’m doing my first vacay coverage locum stint at a rural county hospital. They don’t have MRI on weekends. I did a laboring epidural on a healthy, bmi25 , G1 without any kind of issues. Went quickly and easy. Worked great for 7hours, including through 3 hours of active pushing (no instruments). During pushing, she started feeling paresthesias and weakness in her right thigh with hip flexion which persisted with epidural off.
I didn’t find out until next morning when I came in for a scheduled c-section. On exam, she had numbness on that right leg and calf anteriomedially, and profound quad and some hip flexor and adductor weakness. Afebrile, no back pain or any other symptoms, already urinating on own, no Bm yet. WBC elevated at 19, but elevation could be typical post delivery and in setting of no fever, pain, and time line, I thought abscess less likely. Seemed mostly a femoral nerve involvement, but I hadn’t encountered her degree of motor loss before, so got a CT since MRI wasn’t available. My thought was if anything looked funky, I’d transfer her to the nearest place with mri and neurology/surgery.
My question is:
1. Would you have gotten any imaging in the first place?
2. Was the CT the right way to go? (Vs transferring her for mri). I could not find much on line, other than it was the modality of choice until mri came along. (The radiologist report was stone cold negative, no epidural hematoma or abnormal fluid collection.)
3. Would you still get an mri when it becomes available?
Thank you!
