Scenario
Mr Sam Speedy is a 35 year old patient who was involved in motor vehicle
accident. He was wearing a seat belt and driving at high speed when he lost
control of the car and hit a tree. His level of consciousness was normal at the
scene of the accident but it has declined slightly while in transit to the hospital.
Upon arrival Sam has received 2 L of Normal Saline.
Sam’s family history is insignificant, and the only concern with regards to his
medical history is his allergy to Penicillin. The patient admits to smoking a pack a
day and drinking socially with the guys every weekend. He is currently not taking
any medication except for a stress relieving medication bought at the health
shop.
On admission the hospital, Sam is found lying on a backboard with a cervical
collar in place. His vital signs were recorded as follows:
BP 90/60
HR 120 bpm
SaO2 95% (on oxygen)
LOC GCS 14
After a primary survey is completed an acute abdomen is suspected. A blood
alcohol reading is found to be 0.04. Sam is taken for a CT scan which reveals a
liver laceration. Over the next hour Sam’s abdomen became very firm and
distended with hypoactive bowel sounds requiring an immediate admission to the
operating suite for an exploratory laparotomy.
On admission to the operating suite the following observations are noted for
Sam:
HR 124 bpm
BP 85/60
Temperature 37.9*C
Hgb 12.5g.dl
Hct 40%
WBCs 1200/mm3
LOC GCS 13
1. Discuss the primary data that you would collect in order of priority for Sam.
Include in your answer the procedure for admitting Sam to the operating
suite, providing a rationale for your answer. Identify assessment findings
that would be likely for this patient that would specifically impact on Sam’s
anaesthetic management.
10 marks
2. Discuss the implications of obtaining consent for surgery from Sam, taking
into consideration in your answer his history on presentation to the unit.
3 marks
3. State the anaesthetic technique that would be required during induction of
anaesthesia specific to Sam’s presentation, providing the sequence of
events that would occur. Include in your answer the drugs that would be
considered as part of the anaesthetic technique discussed.
7 marks
4. Discuss the intraoperative monitoring that would be required for Sam,
including a rationale for your answer.
5 marks
5. Describe the position Sam would be placed in and include in your answer
the measures that would be implemented to avoid any complications from
occurring while in this position.
5 marks
6. Discuss the fluid replacement options that would be considered as an
intervention intraoperatively for Sam.
10 marks
7. Discuss the information specific to this patient that would be particularly
important to obtain from the anaesthetic handover. Discuss the ongoing
management of Sam while in the PARU, including the criteria that would
be considered to determine Sam’s discharge from the PARU.
10 marks
Credit:ivythesis.typepad.com
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