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- Jun 8, 2006
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49 yr old female suffers a mid-femur fracture late saturday night. Ortho schedules her for IM nail sunday morning. Patient has h/o DM2, htn - and is apparently otherwise healthy. Case is quoted as being "urgent" (not emergent).
On admission, her ecg is noted to have LBBB with no previous ecg for comparison. On further questioning, patient states she had an episode of CP and DOE a few weeks ago. Medicine sees the patient and recommends a Dobutamine stress echo prior to going to OR. Ortho, of course, is pushing to proceed with the case. They call you and say they will defer to you... What's the play?
[my thoughts are...this patient could have easily suffered an MI recently and/or still have heart tissue at risk. question is, if you stress her and it's positive, will they place a stent and go on ASA + plavix prior to drilling into her femur?]
On admission, her ecg is noted to have LBBB with no previous ecg for comparison. On further questioning, patient states she had an episode of CP and DOE a few weeks ago. Medicine sees the patient and recommends a Dobutamine stress echo prior to going to OR. Ortho, of course, is pushing to proceed with the case. They call you and say they will defer to you... What's the play?
[my thoughts are...this patient could have easily suffered an MI recently and/or still have heart tissue at risk. question is, if you stress her and it's positive, will they place a stent and go on ASA + plavix prior to drilling into her femur?]