Term 6 week 3 (w/c 13/05/13)
Hi and welcome to a new week on Gasclass. Last week saw a a good number of visitors amd thank you to those who contributed to what turned out to be a useful discussion.
We are starting with a slightly different perspective this week.
In what circumstances may obtaining consent for anaesthesia prove difficult?
We are keen to hear your thoughts and this is a good opportunity for new and old participants to make some suggestions.
You are asked to anaesthetise a patient on the trauma list.
He is 90 years old with dementia.
He fell last night and was brought to hospital with a fractured neck of femur. He is in pain and the surgeons are planning on fixation with dynamic hip screw.
He is able to hold a conversation but is obviously confused and has significant short term memory loss.
You use the notes to acertain his PMH which includes:
Ex smoker on inhalers
MI 6 months ago treated with angioplasty (no stent)
He lives in a nursing home and usually mobilises with a frame. He is fairly frail and weighs 49kg.
Meds include aspirin, clopidogrel, furosemide, bisoprolol, simvastatin, amoldipine.
What are the important features in planning anaesthesia for this case? You do not have to mention them all. Instead pick one and explain its significance or how you will manage it?
For some reason part of this weeks case did not upload but the next question we asked on day 3 was…
Given the above information and the discussion held on Twitter, how would you proceed with anaesthesia? (search #gasclass on twitter to see some of the suggestions made already)
Final case expansion for this week:
You choose to proceed with general anaesthesia. After carefully inducing anaesthesia that patient is intubated and ventilated and transferred to the OR for surgery to commence.
Unfortunately after 20 mins operating time the patient becomes increasingly unstable with worsening hypotension, unresponsive to fluid administration and despite escalating vasopressor use it is clear that further treatment is likely to be futile. An appropriate Do Not Attempt Resuscitation had been made in advance and all the team agree that further treatment is not in the patients interest.
Describe the appropriate next steps (e.g. management of a death in the operating room)
We will try and summarise this weeks discussion as add a Storify summary for easy reading. Get in touch if there is anything in particular you would like to see. Tune in next week
There are no trick questions in #Gasclass. Everyone’s contribution is welcome. Please do not forget to add the ‘hashtag’ #gasclass to every Tweet so that it is included in the conversation. To help give new contributors an opportunity to join in we would advise that you should only add one idea per tweet and not contribute until another Tweeter has joined in.