Term 3 Week 1 (w/c 30/04/12)
Welcome to the new term of Gasclass!
We once again find ourselves in the operating theatre this week. The next patient on the emergency list has been booked for a ‘Burr hole’.
What issues come to mind as you head off to visit the patient?
As set off for the preoperative visit, you speak with the neurosurgery registrar about the case. He explains that the patient has been referred with a cerebral abscess & they are planning on doing drainage via burr hole & a brain biopsy.
Does the above information raise any additonal concerns? How do you plan on anaesthetising the patient?
You attend the preoperative visit on the ward. It is a Lady in her 50s. She has no risk factors for immune suppression or retro-viral disease. She is sleepy, GCS 14 (E3 M6 V5) and is currently in a HDU bed on the neurology unit.
While thumbing her notes you find a series of echocardiograms & find that she has been under the care of the cardiologists. She has been diagnosed with idiopathic (primary) pulmonary hypertension 3 years ago. Her main symptoms being breathlessness. Her maximum recorded mean PAP was nearly 100 mmHG. She has been started on Sildenafil with a reduction in her pressures to 40mmHG. Most recent echo shows a dilated RV with mild impairment & normal LV function. She has NYHA class III symptoms, and is breathless at 100 yards.
What is your plan now?
Transcript #gasclass – Term 3 Week 1
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