2007, Hot Cases 2

Unspecified hospital
  • 50 year old female day 10 post-intracranial haemorrhage and EVD insertion. Discussion: Candidates asked to examine looking for the aetiology of a new onset fever.
  • An 81 yr old lady with acute on chronic failure on peritoneal dialysis with signs of sepsis, abdominal pain and encephalopathy. Discussion: on sepsis / renal failure and dialysis
  • A young man with traumatic head injury – cerebral contusions and traumatic subarachnoid hemorrhage, and persistent fevers, Discussion – on ICP management, cause of fevers.
  • 56 year old man with a history of heavy alcohol intake admitted with bilateral leg weakness and community acquired Staph pneumonia. Patient was hypotonic and areflexic with no gag. Discussion: Candidates asked to determine the cause of his leg weakness and his persistent fever.
  • A young man with traumatic head injury, facial fractures, traumatic mydriasis, Discussion: on ICP management, interpretation of CT scans, pupillary signs
  • 22 yr old male with severe head injury after a fall from a horse. Had bifrontal craniectomies. Discussion: on ICP management, neurological prognosis
  • Male in his 60's with traumatic brain injury who had a craniectomy and ICP monitor in situ and was generally hypertonic and hyperreflexic. Discussion: Candidates asked to determine his prognosis
  • A 59 year old man with infective exacerbation of COPD on adrenaline and an aminophylline infusion. Discussion: on weaning difficulties, management of bronchospasm, interpretation of flow time curves, blood gases, ECG and critical illness neuropathy
  • 70 year old male with open cholecystectomy 2 weeks prior complicated by acute renal failure, nosocomial pneumonia and failure to wean (because of ischemic heart disease). Discussion: Candidates asked to examine and determine the cause of failure to wean
  • A 66 year old man with acute pancreatitis and a past history of cardiac transplant. Discussion: on immunosuppression, ongoing renal dysfunction, sepsis with multi- resistant bugs.
    (That's right, the examiners report uses "bugs" to describe the microbiome. )
  • 19 yr old man with severe acute respiratory failure following a MVA with long bone fractures. His bedside therapies included IPPV, NO, ECMO
    Discussion: on causes of respiratory failure, management of refractory hypoxemia. NO and ECMO were considered to be specialized therapies and only were referred to fleetingly in the discussion.
  • 60 year old male admitted with uraemia and sepsis. Discussion: Candidates asked to examine and determine a plan for his renal replacement therapy.
  • A 44 yr old patient admitted with intracranial hemorrhage secondary to an AVM. Currently in ICU, slow wean, and ongoing fevers. Discussion: on neurological assessment, weaning of sedation, approach to management of temperatures in a neurosurgical patient.
  • A 63 yr old man with a subdural hemorrhage after a ruptured AVM. Discussion: on slow neurological recovery, ongoing fevers.