Term 6 Week 9 (w/c 24/6/13)
Thank you to all who contributed last week. We hope you liked the short case format and would welcome feedback.
This week we are back to our traditional format.
What effect does old age have on morbidity and mortality in anaesthesia?
You are called to recovery as the anaesthetist on call to review a 84 year old lady who has had an incarcerated inguinal hernia repaired. She remains drowsy and is difficult to rouse.
As you make your way to recovery what are your thoughts?
You arrive to find a frail looking lady. She is breathing with a RR of 22, Her HR is 115 irregularly irregular, BP 105/46 CRT ~2s. Her GCS is E2 V2 M4. Pupils are equal and reactive to light. She received a general anaesthetic – Propofol / Atracurtium / Sevoflurane and has been given 5mg of Morphine and 20 mls of 0.25% Levo-bupivacaine for pain relief in theatre. She has been in recovery for 45 minutes.
Repeat bloods reveal Na 132 K 3.3 Ur 8.5 Cr 90 Hb 101 WBC 11.2 PLT 245
ABG pH 7.30 pO2 17.3 pCO2 6.3 HCO3 20 Lactate 2.2
Lab glucose is 4.3
What are your thoughts now?
It is difficult to perform a full neurological examination, however her tone appears normal and she has normal plantar reflexes. Her ECG is as follows:
Is there anything else that you need to consider?
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