Term 5 Week 1 (w/c 14/01/2013)
Welcome to Term 5 and another year in the life of #Gasclass. We have picked up quite a few new followers over the holidays and we are looking forward to their contributions.
We have had a good break and are back with more case based discussions aimed at all grades of anaesthetists..
We are back at the coal face of theatres. There is a 31 year old man for an urgent Laparoscopic Appendicectomy.
What features do you mention to the patient as part of your consent for anaesthesia?
Thank you for an interesting discussion.
After discussion with our surgical colleagues, it seems that all is not quite as straightforward. The 31 year old man has had abdominal pain intermittently for a number of weeks. This carried on to become a constant pain in the Right Iliac Fossa. His White Count is 23 and an ultrasound has been performed which shows a suspicious Caecal mass.
The surgeon is fairly confident that this will all be sorted laparoscopically but unusually she finishes with ‘dont be surprised if I open him up’.
Quick outline of your anaesthetic technique. It would be good to imagine this is your Primary viva!
Thank you for an interesting discussion. As usual various plans emerged. Please find time to link a good piece of evidence if you can!
The patient is now back in recovery and is waking from his slumber. He claims that there is a large segment of one of his upper left teeth missing.
What do you do now?
Thanks for the discussions so far.
On examination of the mouth there is a gap which you really do not recollect seeing before. It sits on the upper left quadrant. There is a slight cut on the lip but no real evidence of gum trauma. However, he has hypoermobile teeth across all his incisors and has very poor dental hygiene with obvious periodontal disease.
You are convinced by the need to perform a CXR.
?Action. Please answer to whatever grade you are at considering how this kind of case presents within normal practice.
The action considered by many was to buy a bigger phone to look at the picture. However, maybe a lateral might help.
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Image from Southwest Journal of Pulmonary and Critical Care