Home > Uncategorized > Term 6 Week 8 (w/c 17/06/13)

Term 6 Week 8 (w/c 17/06/13)

June 17, 2013

Good morning everyone. Thanks for those who contributed to last weeks case. For anyone that missed the case or wants to look back at what people have said, we have created a Storify Summary Hopefully by producing these summaries we can produce something more tangible for people to take away from the discussion each week. If you have any other ideas for suggestions or improvements then get in touch.

For this week we are planning on doing something slightly different. Instead of one long case discussion we thought we might hold several short case discussions instead…

Short Case 1

You are working over night in a general hospital and are involved in the care of a patient with gastro intestinal bleeding. The patient is shocked and requires urgent upper GI endoscopy. You plan to perform the procedure under general anaesthesia. When the on-call endoscopist arrives you realise that they smell strongly of alcohol. They openly admit to having been at a party but deny drinking and they continue getting ready to perform the procedure…

How do you proceed?

Short Case 2

You are asked to see a patient who needs urgent maxillo-facial surgery. He was an in-patient in a near-by mental health hospital where he was being treated for Schizophrenia and self neglect. He has been transferred due to significant facial swelling. His nutritional state, self care and dental hygeine are poor and he has a dental abscess with swelling getting progressively worse over the past few hours. Examining him you find:

Temp 38.2

Submandibular pain and swelling

Mouth opening 1 – 2 fingers. Poor dental health with multiple pegs and loose teeth.

No stridor but complaining of some dysphagia

You explain the process of awake fibre optic intubation. But he refuses to co-operate saying he is fine and asks you to leave him alone…

How do you proceed?

Short Case 3

Your colleague tells you about a patient they saw in clinic that will be in your room tomorrow.  They are a 55yo man for elbow replacement.  His PMHx is significant for HTN, severe OSA (CPAP machine setting is 20cm H2O and he doesn’t like to use it), pulmonary hypertension (2D Echo shows RVSP 60 mmHg), COPD (50 pack-year smoking), obesity (BMI 45) and chronic pain.  He is on OxyNeo 60mg PO TID, fentanyl patch 125 ug/hr and gabapentin.

What are your main concerns for this case?  How would you perform this case?

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.

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Categories: Uncategorized
  1. June 17, 2013 at 8:26 pm

    Youve got to remove him or her from the clinical environment, haven’t you? Even if you think they are the patient’s best chance of having their bleeding treated. There’s a temptation to say ‘oh, it’ll probably go well’ but if it didn’t no-one has a leg(less) to stand on!

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