Yep. That's why it's a good case for oral boards simulation. There are some difficult scenarios one should think about. So, residents, why don't you try your best at developing a plan for this, including all the things that may go wrong?
He'll die regardless but if you really what a biopsy it can be done in 10min with minimal sedation
"60yoF BMI 51 COPD with bronchodilator and tiotropium, chronic 5L home O2 and BiPAP at night for sleep, asthma, FEV1 0.6L, recent TTE HFpEF Grade 1 diastolic heart failure, mild concentric LVH, HTN, HLD, NIDDM2"
I'm not a guy to overthink a case but i doubt a BMI 51 living on half a lung on 5L hime O2 with recent hemoptysis is going to do well after a 5h GA with someone dicking around in his lungs.
You are right. But what are you going to do. Delay for pulm clearance-his pulmonologist is bringing him to the OR! For better or worse the decision was made that this procedure is needed for optimal treatment of his cancer. I don't think that any of us is an expert enough in oncology to argue this point. I also don't think that telling the patient that this procedure is necessary but your doc sucks will go over well Best you can do is warn about post-op mechanical ventilation and proceed with GA
There it is. Not much else to do, except do it and be done with it.
This is 100% true, especially for end of life procedures (demented bed bound patients with broken hips come to mind...), but I'm not sure that this patient meets that criteria. He's sick, no doubt. But what about his case really worries you? His BMI? 5L NC? If the nav bronch finds his lesion and they can biopsy appropriately perhaps his treatment is chemo and radiation and not surgery? Doing one lung on this guy for a wedge or lobe would not be fun, but it's also not 100% impossible either.
