Table 1: Investigations of the patient during the course of
hospital stay
- NVD= Normal vaginal delivery
- 1st DOR= 1st day of readmission
i.e. 5 days after normal vaginal delivery
- 2nd DOR= 2nd day of readmission
- 3rd DOR= 3rd day of readmission
[MANAGEMENT]The patient was swiftly transferred to the Intensive Care Unit (ICU)
under the supervision of an anesthesiologist for further management. She
was given supplemental oxygen through a face mask at a high flow rate of
10 liters per minute to ensure her blood oxygen levels stayed above
92%. To alleviate pulmonary congestion and breathing difficulties, she
received intravenous diuretics: a 40 mg dose of furosemide initially,
followed by another 40 mg dose after 10 minutes, and then 20 mg twice
daily. Additionally, she was administered intravenous GTN (glyceryl
trinitrate), starting with a 100 mcg bolus dose followed by a continuous
infusion of 5 mcg per minute to manage her blood pressure, decrease
heart load, and enhance oxygen levels.
Broad spectrum antibiotics (Piperacillin 4 gm + Tazobactam 0.5 gm) was
also started, along with a prophylactic dose of Enoxaparin (40 units)
injected subcutaneously. Hydrocortisone (100 mg three times daily) was
administered intravenously, and nebulization with a mixture of
Salbutamol, Ipratropium, and Normal saline (in a ratio of 1:1:2) was
done three times daily. IV Morphine (2 mg) was available as needed for
pain relief. Close monitoring of vital signs, fluid intake and urinary
output were initiated, and fluid intake was restricted to prevent
further fluid overload. The patient’s response to treatment was
carefully tracked through repeated arterial blood gas analyses and chest
X-rays. Over the following 48 hours, the patient’s respiratory symptoms
and oxygen levels gradually improved.