Term 5 Week 5 (w/c 11/02/13)
Welcome to this weeks #gasclass.
After a week in the remote environment of neuroradiology, we are heading back to the theatre suite.
You are covering the emergency theatre and have been asked to see a 38 year old man with a dental abscess.
As you head off to the ward what thoughts are going through your mind?
You arrive on the ward and see a large man who is unshaved and generally unkempt. You can still smell alcohol on his breath. He is lying on the the bed and has a large swelling on the right side of his face. He looks flushed and has a temperature of 37.7. He can open his mouth by approximately 2 finger breadths. The Max Fax surgeons inform you that he has an abscess of his Lower Right 7.
Is there anything else that you would you like to know and what is your plan?
Interesting comments and thoughts yesterday.
You speak to the surgeon who feels that the man needs to go to theatre soon as the swelling is likely to get worse. The man feels that his mouth opening is restricted by pain. His thyromental distance is 9cm and he has good neck movements. He has a WBC of 26.5 Hb 12.5 PLTS 146
Theatre can send for him in approximately 45 mins.
What is your anaesthetic plan?
Seems like its time for the first poll of the term.
The man arrives in the anaesthetic room approximately 60 minutes after you visited him on the ward. He now looks increasingly unwell, the swelling has increased slightly on the side of his face. His HR is 130 BP 100/60 Temp 38
Are you going to stick to your current plan? What is your plan B?
You opt for AFOI. As you perform the procedure you struggle distinguish any normal anatomy and accidentally burst the abscess. The patient starts to cough and begins to desaturate. He is difficult to ventilate.
What do you do now?
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