Pt is a 34. y.o. G1P1 status post c-section for failure to progress. Received an uneventful spinal anesthetic and c-section proceeded uneventfully. EBL approximately 700cc with 500 hespan and 1500 LR given intraop. Other medications given included pitocin, ancef, and zofran. 15 minutes after sign out of patient to L&D nurse, anesthesia was called for HR 187.

1) What is the differential?
2) How do you evaluate tachycardia post op?
3) What are the treatments?

Severe Post-Operative Vomiting

   91 yo F scheduled for R hip hemiarthroplasty after mechanical fall.  PMH includes HTN, CAD s/p MI (1993, with angioplasty), CVA 2002 (no residual deficits), hiatal hernia, and dementia.  No symptoms of GERD at all.  Lives in nursing home and ambulates with walker.  Denies any chest pain or dyspnea when walking around nursing home.  Baseline mental status oriented x 1-2 with very poor short-term memory.  Outpatient meds – Plavix, Lipitor, Plendil, Mvit, ACEI.  Since being inpatient – Metoprolol 75 BID, Lipitor, Morphine, Lovenox.  Labs WNL, INR 1.0, Hct 37.6.

Preop vitals:  T 98.2, P 69, BP 118/62, R 20, SpO2 94% RA, Ht 66 in, Wt 75 kg.  Airway Class II, 5cm HMD, mildly limited neck extension, upper/lower dentures.  On AM of surgery, pt oriented x 1 (person) and does not remember why she is having surgery.  Consent obtained from DPOA.  Per report, NPO since midnight.

In OR, routine monitors placed, pre-oxygenation x 5 min, A-line placed prior to induction.  IV induction with Lidocaine 60mg, Fentanyl 50mcg, Propofol 100mg.  Muscle relaxation with Vecuronium 7mg.  When TOF=0, intubated atraumatically.  Surgery proceeded uneventfully with stable hemodynamics.   At end of case, muscle relaxation adequately reversed (4/4 twitches and sustained tetany) and end-tidal Iso 0.02.  Fully awake, spontaneously ventilating, following commands, and just before extubation, patient began to vomit large amount brown material.  Zofran given, oropharynx suctioned, continued profusely vomiting...... 

what is going on!?