Don't let anyone tell you PP is boring...
75M for a R anterior total hip arthroplasty. Turns out patient is the father in law of one of our surgeons.
Had a significant R parietal CVA in 1/2013 with L leg weakness. CAD, s/p PTCA 2006. Has had a "negative stress test" 2 months ago. No complaints of angina or dyspnea.
Had a L CEA 2 months ago as well. No issues periop or post op.
You may rightly be asking, "Why the hell are we doing this case?"
Apparently his L leg is weak; R leg is causing pain and thus hampering rehab efforts.
Fair enough. Patient and son in law understand he's at increased risk for periop/postop complications, so let's do this.
Bring him to the OR. No pre medication. For the residents out there, Versed is the most overused drug in anesthesia. Should be reserved for pre-pubescent kids and tearful women. Certainly not needed in geriatric patients. I can't believe how many of my partners slam little old ladies getting their hips pinned with a couple mg's and have em gorked out in the PACU for 2 hours...but I digress.
Awake art line. I notice as soon as I get a flash that the 1cc syringe (I attach a 1cc syringe to a jelco 20g angiocath and use that) fills up immediately.
I transduce. Art BP: 300/90. Transducer is level with heart. Cuff pressure is 275/80 or so. Thousands of Bernanke Bux worth of equipment is open, everyone is ready to operate....
What would you do next???
75M for a R anterior total hip arthroplasty. Turns out patient is the father in law of one of our surgeons.
Had a significant R parietal CVA in 1/2013 with L leg weakness. CAD, s/p PTCA 2006. Has had a "negative stress test" 2 months ago. No complaints of angina or dyspnea.
Had a L CEA 2 months ago as well. No issues periop or post op.
You may rightly be asking, "Why the hell are we doing this case?"
Apparently his L leg is weak; R leg is causing pain and thus hampering rehab efforts.
Fair enough. Patient and son in law understand he's at increased risk for periop/postop complications, so let's do this.
Bring him to the OR. No pre medication. For the residents out there, Versed is the most overused drug in anesthesia. Should be reserved for pre-pubescent kids and tearful women. Certainly not needed in geriatric patients. I can't believe how many of my partners slam little old ladies getting their hips pinned with a couple mg's and have em gorked out in the PACU for 2 hours...but I digress.
Awake art line. I notice as soon as I get a flash that the 1cc syringe (I attach a 1cc syringe to a jelco 20g angiocath and use that) fills up immediately.
I transduce. Art BP: 300/90. Transducer is level with heart. Cuff pressure is 275/80 or so. Thousands of Bernanke Bux worth of equipment is open, everyone is ready to operate....
What would you do next???