Term 3 week 5 (w/c 28/05/12)
This week it’s a daylight case. It’s 18:30 in the evening. The Cardiology registrar is on the phone asking for your attendance for a cardioversion.
We will start with the question what one feature crosses your mind?
Please take turns and only put one feature per tweet. This will encourage our new followers and make it easier for junior and non anaesthetic colleagues.
Thanks for all the contributions yesterday.
The cardiology registrar has provided you with bait of history via the CCU sister. The patient requiring cardioversion is 27 years old. He has a narrow complex tachycardia of acute onset. He has dystrophia myotonica. The blood pressure is 85 systolic and the rate is 190 ish. There is some urgency to this.
Before you get to CCU what are you thinking about now?
You have now arrived in CCU.
The 27 year old man has the characteristic signs of dystrophia myotonica. He has frontal balding and early cataracts. One might observe that these are the least of his worries.
Currently he is complaining of chest pain, sweaty and hypotensive, having become acutely unwell approximately 55 minutes ago. He had just finished a full hospital meal and began to feel faint. He was admitted to the hospital with shortness of breath yesterday.
The cardiology registrar has given adenosine three times with no effect and now feels that the next stage is cardioversion. The patient is fully conscious and feeling very frightened.
Have you got a clear plan A?……. More info tomorrow.
The final piece of the jigsaw is going to make it very complicated. The patient is overweight as he has not really led a particularly fit and healthy lifestyle. The cardiology registrar had placed little more than a perilous 22g intravenous catheter on the anterior surface of the wrist prior to attempting a central venous access. Despite the use of ultrasound and his familiarity with subclavian approach he only managed to aspirate a syringe full of air from the chest. He tells you this as you make your anaesthetic plan.
Have you got a final anaesthetic plan? This is the end of the story.
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.