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It's been a while since I've posted a case. This is from today.
The case first, later I'll tell you what I did ... let's give non-attendings some time to respond and/or heckle me first.
76 year old man scheduled for an elective total hip arthroplasty.
He sacrificed his spleen and the good health of a knee, femur, and hip to the motorcycle gods many years ago. 90 kg guy - not the usual morbidly obese joint patient.
He denies ever having heart problems, has excellent exercise tolerance doing strenuous yard work, all without symptoms. To hear this guy talk, if not for his hip he'd be jumping rope at the gym. An ECG was done at his preop visit a week ago because he's 76. Sinus rhythm, old MI, and per the AHA/ACC guidelines no further cardiac workup.
He is a former smoker, but only a few pack years, and he quit decades ago. CXR is a little hyperexpanded. For some reason somebody got PFTs, which show a minimal obstructive pattern and improvement with bronchodilators. He doesn't use or even have inhalers at home.
Remainder of ROS is negative.
Past surgical history includes a total knee (recent) and tonsils, appendectomy, inguinal hernia, and splenectomy (remote).
(Not sure why coags didn't print out - PT 11.5, PTT 25.4, INR 1.1)
He doesn't want a spinal because he didn't like the one he got for his knee. Definitely wants to go to sleep. Preop nurses are very concerned because he was chewing gum on the way to the hospital.
Pent sux tube?
Make him wait 8 hours post-gum-spit-out?
Talk him into a spinal?
Postpone for repeat PFTs?
Nothing exotic here, just typical old-person community-hospital B&B case.
The case first, later I'll tell you what I did ... let's give non-attendings some time to respond and/or heckle me first.
76 year old man scheduled for an elective total hip arthroplasty.
He sacrificed his spleen and the good health of a knee, femur, and hip to the motorcycle gods many years ago. 90 kg guy - not the usual morbidly obese joint patient.
He denies ever having heart problems, has excellent exercise tolerance doing strenuous yard work, all without symptoms. To hear this guy talk, if not for his hip he'd be jumping rope at the gym. An ECG was done at his preop visit a week ago because he's 76. Sinus rhythm, old MI, and per the AHA/ACC guidelines no further cardiac workup.
He is a former smoker, but only a few pack years, and he quit decades ago. CXR is a little hyperexpanded. For some reason somebody got PFTs, which show a minimal obstructive pattern and improvement with bronchodilators. He doesn't use or even have inhalers at home.
Remainder of ROS is negative.
Past surgical history includes a total knee (recent) and tonsils, appendectomy, inguinal hernia, and splenectomy (remote).
(Not sure why coags didn't print out - PT 11.5, PTT 25.4, INR 1.1)
He doesn't want a spinal because he didn't like the one he got for his knee. Definitely wants to go to sleep. Preop nurses are very concerned because he was chewing gum on the way to the hospital.
Pent sux tube?
Make him wait 8 hours post-gum-spit-out?
Talk him into a spinal?
Postpone for repeat PFTs?
Nothing exotic here, just typical old-person community-hospital B&B case.