Home > Acute medicine, Anaesthesia, Critical Care > Term 3 week 4 (w/c 21/05/12)

Term 3 week 4 (w/c 21/05/12)

Good morning class

It is 0200 hours and the surgical registrar contacts you. There is a patient in the emergency department with compartment syndrome of both his lower limbs. He is planning on performing bilateral fasciotomies.

What issues come to mind regarding anaesthesia for this patient? To encourage participation, please list one issue and allow someone else to answer before submitting another answer.

You see the patient in the emergency department. He claimed to have been out on a heavy drinking session and has consumed an estimated 60 units of alcohol in the proceeding 48 hours combined with a mixture of recreational drugs. When he woke from a stupor he was unable to walk and phoned the ambulance.

Clinically he looks dehydrated, he is drowsy and has tight tender calves and absent foot pulses.

The surgical registrar wants to go to theatre immediately.

What information (from the history or investigations) do you want before you agree to take him to theatre? We will add the requested information later

You continue your assessment of the patient.
– no significant PMH
– no allergy
– no alarming features in the airway.
– He hasn’t eaten for over 24 hours and has drank no fluids in over 6 hours
– He has been catheterised and is oligouric

HR 130 min. GCS 14/15.

Hb 20.3 wcc 14.7 plts 560
Urea 25.9 Cr 237 k+ 7.2
CK 199,200

The surgical registrar still demands to go to theatre ASAP

What are you going to do now?

There are no trick questions in #gasclass. It is an educational tool only. Everyone’s opinion is as valid as the next person. Follow the conversation by using (or searching for) the hashtag #gasclass on twitter. We welcome input from all specialities and you can send us a direct message if you would prefer to remain anonymous.

@gasclass

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