Position: Supine
Time: 1-2 hours (average)
Blood Loss: Moderate (50 – 200 ml)
Post-op Pain: Moderate (3-6)
Maintenance Paralytic: Yes

Blocks: TAP

Approach – If non-emergent, proceed with GETT for ex-lap. If emergent, GETT with RSI

Blocks – TAP block if time/situation permits!

Lines – Recommend at least two 20g (or greater) IVs, for possible blood infusion. Two large-bore IV’s if emergent. If the patient is expected to have unstable BPs, get an A-line.

Uterotonics – Have oxytocin, methergine, and hemabate available. The surgeon will let you know when to give.

Emergency drugs – have emergency drugs close and/or out and ready – epinephrine, atropine, ephedrine, neosynepherine (push and/or drip), and levophed.

Fluids – Crystalloid or colloid volume replacement is usually the first route if patient is volume depleted.

PONV precautions – Zofran 4mg, Pepcid 20mg, decadron 4mg, and haldol 1-2mg given intra op is a great way to reduce PONV.

Arterial line (general considerations): Preoperatively check pulses to gauge the best side to attempt the A-line. Perform an Allen test to ensure adequate blood flow. Have the A-line equipment set up and ready in the room.

High blood loss RISK (general considerations): Though most of these cases don’t result in a high blood loss, there is a high blood loss RISK. Type and cross, CBC, and CMP should be done prior to the procedure. Consider having an A-line, blood tubing, and extra IV push-lines. Depending on the fragility of the patient, you may want to have blood in the room and available.

Ectopic Pregnancy is a pregnancy in which the fertilized egg is implanted somewhere outside the uterus. Most ectopic pregnancies occur in the fallopian tube (96%).

A ruptured ectopic pregnancy typically occurs in the fallopian tube when the growing egg runs out of room, massive bleeding occurs soon after. Pending fallopian tube rupture results in sudden lower abdominal pain and referred shoulder pain as the blood irritates the peritoneal cavity. Signs and symptoms of shock (tachycardia, hypotension, syncope, pallor) soon follow if hemorrhage continues.
Exploratory laparotomy is the first line surgical treatment. Surgical procedures typically include salpingectomy or ipsilateral oopherectomy.

These patients are typically health young women, so BP will typically remain stable until they are very volume depleted. However, be aware that they can decompensate quickly.