Case Week 9 (w/c 28/11/11)
This week gasclass endevours to combine both anaesthesia and critical care.
You have been called by the Urology SpR. He is in the Accident & Emergency department with a 56 year old male who has been admitted 10 days following a TRUP with gross haematuria and a Hb of 6.1g/dl. The patient is hypotensive and tachycardic. The Urologist wishes to take the patient to theatre ASAP.
What is your initial plan?
7 days ago (3 days post op) he developed a Pulmonary Embolus and has been fully anti-coagulated. His INR is 5.3. His bleeding started suddenly and he has attended A&E promptly. He is a heavy smoker.
What are you going to do now? Where are you going to send him post op?
His anticoagulation is reversed, he is resuscitated and taken to theatre. He receives 6 units of PRC intra operatively. He is extubated with a plan to send him to HDU post op however he develops respiratory failure in recovery and is reintubated.
On ICU he continues to have blood in his catheter, a nose bleed and altered blood up his NG tube.
His ICU admission blood gas shows a metabolic acidosis with BXS -15. He is oliguric. He requires RRT.
What are your thoughts now? How are you going to manage him on ICU?
His RRT clots without heparin. What options do we now have?
There are no trick questions on #gasclass. It is an educational tool only so please feel free to join the conversation. Remember to include the phrase #gasclass in your response. This is referred to as a ‘hashtag’ and you can easily follow the conversation by searching for ‘#gasclass’ in your twitter client.