Scenario Mr Sam Speedy is a 35 year old patient who was involved in motor vehicle accident. He was wearing a seat belt and driving at high speed when he lost control of the car and hit a tree. His level of consciousness was normal at the scene of the accident but it has declined slightly while in transit to the hospital. Upon arrival Sam has received 2 L of Normal Saline. Sam’s family history is insignificant, and the only concern with regards to his medical history is his allergy to Penicillin. The patient admits to smoking a pack a day and drinking socially with the guys every weekend. He is currently not taking any medication except for a stress relieving medication bought at the health shop. On admission the hospital, Sam is found lying on a backboard with a cervical collar in place. His vital signs were recorded as follows: BP 90/60 HR 120 bpm SaO2 95% (on oxygen) LOC GCS 14 After a primary survey is completed an acute abdomen is suspected. A blood alcohol reading is found to be 0.04. Sam is taken for a CT scan which reveals a liver laceration. Over the next hour Sam’s abdomen became very firm and distended with hypoactive bowel sounds requiring an immediate admission to the operating suite for an exploratory laparotomy. On admission to the operating suite the following observations are noted for Sam: HR 124 bpm BP 85/60 Temperature 37.9*C Hgb 12.5g.dl Hct 40% WBCs 1200/mm3 LOC GCS 13 1. Discuss the primary data that you would collect in order of priority for Sam. Include in your answer the procedure for admitting Sam to the operating suite, providing a rationale for your answer. Identify assessment findings that would be likely for this patient that would specifically impact on Sam’s anaesthetic management. 10 marks 2. Discuss the implications of obtaining consent for surgery from Sam, taking into consideration in your answer his history on presentation to the unit. 3 marks 3. State the anaesthetic technique that would be required during induction of anaesthesia specific to Sam’s presentation, providing the sequence of events that would occur. Include in your answer the drugs that would be considered as part of the anaesthetic technique discussed. 7 marks 4. Discuss the intraoperative monitoring that would be required for Sam, including a rationale for your answer. 5 marks 5. Describe the position Sam would be placed in and include in your answer the measures that would be implemented to avoid any complications from occurring while in this position. 5 marks 6. Discuss the fluid replacement options that would be considered as an intervention intraoperatively for Sam. 10 marks 7. Discuss the information specific to this patient that would be particularly important to obtain from the anaesthetic handover. Discuss the ongoing management of Sam while in the PARU, including the criteria that would be considered to determine Sam’s discharge from the PARU. 10 marks
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