would you cancel this case?

[Lizard King]

60yo man with C2 vertebral body mass for CT guided biopsy. Interventional neurorad doc is planning to go through the mouth straight back to get at the sucker. Planning for GA with ETT. Elective procedure, but will need to be done during this hospital admission. We're all set to go, give the dude Versed 2mg, placing monitors, and then notice this guy has a maculopapular rash all over his chest and abdomen. It's a pretty impressive rash, looks like drug reaction or some other allergic reaction. He doesn't know when he got it because he has a c-collar on and is like a fat dude that can't see his package. But he does mention he woke up that day with an itchy back. No recent medication were given (other than the Versed). His morning meds were just his usual home meds. Guy had a bone scan the day revious. No signs of airway compromise and HD stable. Attending cancels the case. While I'm mighty inexperienced, I felt like we should have proceeded. What would you do?

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[urge]

I haven't seen this guy in real life, but from what I hear I wouldn't have cancelled. You can always argue that it's a cancerous tumor which could metastasize any minute. Thus canceling the case could be detrimental. I think the benefit of getting a diagnosis and treating the patient would outweigh the risk of proceeding with presumed current non life threatening allergic reaction.

 

[jetproppilot]

60yo man with C2 vertebral body mass for CT guided biopsy. Interventional neurorad doc is planning to go through the mouth straight back to get at the sucker. Planning for GA with ETT. Elective procedure, but will need to be done during this hospital admission. We're all set to go, give the dude Versed 2mg, placing monitors, and then notice this guy has a maculopapular rash all over his chest and abdomen. It's a pretty impressive rash, looks like drug reaction or some other allergic reaction. He doesn't know when he got it because he has a c-collar on and is like a fat dude that can't see his package. But he does mention he woke up that day with an itchy back. No recent medication were given (other than the Versed). His morning meds were just his usual home meds. Guy had a bone scan the day revious. No signs of airway compromise and HD stable. Attending cancels the case. While I'm mighty inexperienced, I felt like we should have proceeded. What would you do?

HAHAHAHAHAHAHAHAHAHAHAHAHAHAA

I'm waiting for WHAT YOURE GONNA TELL ME

that makes me cancel.

I've gotten open mind.

LETS HEAR IT:

 

[nutmegs]

HAHAHAHAHAHAHAHAHAHAHAHAHAHAA

I'm waiting for WHAT YOURE GONNA TELL ME

that makes me cancel.

I've gotten open mind.

LETS HEAR IT:

I don't think there's a punchline.

 

[militarymd]

*****

 

[urge]

Hey! I couldn't resist. Was your attending an OB anesthesiologist? Be honest.

 

[Lizard King]

No punchline, that's it. First-year attending, very smart, but obviously cautious. The attending even consulted a more senior attending who suggested canceling the case. The airway was their major concern.

 

[isoman2000]

no.

 

[Lizard King]

.

 

[huktonfonix]

is he having trouble breathing or look like hes going into anaphylactic shock? then no.

 

[toughlife]

60yo man with C2 vertebral body mass for CT guided biopsy. Interventional neurorad doc is planning to go through the mouth straight back to get at the sucker. Planning for GA with ETT. Elective procedure, but will need to be done during this hospital admission. We're all set to go, give the dude Versed 2mg, placing monitors, and then notice this guy has a maculopapular rash all over his chest and abdomen. It's a pretty impressive rash, looks like drug reaction or some other allergic reaction. He doesn't know when he got it because he has a c-collar on and is like a fat dude that can't see his package. But he does mention he woke up that day with an itchy back. No recent medication were given (other than the Versed). His morning meds were just his usual home meds. Guy had a bone scan the day revious. No signs of airway compromise and HD stable. Attending cancels the case. While I'm mighty inexperienced, I felt like we should have proceeded. What would you do?

was the patient preoped before taking him into IR suite? That is what the preop is for to look at these issues and determine whether it is old/new and then go from there.

A huge waste of money occurs when these issues are just learned about when pt is on the table.

What was the pt's medical hx?

from what you're saying it sounds like it was not new. I would have proceeded and then consulted IM/derm to evaluate.

 

[SleepIsGood]

If this guy is getting SOB or having trouble breathing and you see all these rashes.....you will have to intubate anyway...

 

[Planktonmd]

Hey! I couldn't resist. Was your attending an OB anesthesiologist? Be honest.

 

[mille125]

Sometimes we just dont understand how cancelling a case can negatively impact a person's health. This patient likely has cancer and needs the biopsy to proceed with appropriate treatment. Your attending was reckless and incorrigible.

 

[Fastrach]

Did he get any contrast on prior scans? Might explain the rash.

No good reason to cancel this one, IMHO...