2008, Hot Cases 2

 

 

 

Unspecified hospital
  • 65 year old male, 1 day in ICU post resuscitated cardiac arrest and candidates asked to assess neurology, discuss prognostication and management plan over the next few days. Active hypothermia, IABP, no corneals, gag or cough reflexes
  • A 32 yr old lady with vertebral artery dissection and SAH. Candidates were asked to perform a neurological examination.
  • A 77 yr old man admitted headache, blurred vision and left sided weakness. Patient had had a previous prosthetic mitral valve replacement. Candidates were asked to make a neurological assessment and proceed with general examination as required.
  • 42 yr old male post intracerebral hemorrhage due to untreated hypertension. Directed to examine as per normal daily ward round. Findings: EVD, blood stained CSF, hemiparesis, LLL collapse on CXR, morbid obesity and febrile
  • A 42 yr old female following an MVA and chest trauma. Patient presented with hypotension and respiratory difficulty. Candidates asked to assess cardio respiratory system.
  • A 32 yr old lady admitted with isolated head injury and candidates asked to assess neurology.
  • A 58 yr old man – 4 days in ICU, following a perforated sigmoid diverticullum for which he had undergone a Hartmann's procedure. He was on chronic steroid therapy. Issues: AF, gastroparesis, absent BS, globally weak, ongoing temperatures and cushingoid features.
  • A 71 year old man post major abdominal vascular surgery, still ventilated and evidence of impaired gas exchange, renal dysfunction, increased lung water and multi- organ dysfunction.
  • A 50 year old man with a background h/o of Hodgkin's disease for which he received radiation therapy, was admitted following a cardiac arrest. Recently, prior to present admission, he was in ICY for a month following a cardiac surgical procedure. The problem presented was difficulty in weaning. Findings included – poor respiratory complicance, pericardiostomy scar, anuric renal failure, tracheostomy, and pleural effusions evident on CT chest.
  • A 77 year old man with a history of DM and myasthenia gravis was found collapsed at home. He was presented a patient who is now slow to wean. Findings included evidence of global muscle weakness, pulmonary hypertension on a PAC, moderate TR, inotrope requirement, and dialysis dependent renal failure.
  • A 74 year old lady was presented as a failure to wean after admission to ICU following a collapse. Findings included: a prosthetic AVR, Rt. Pleural effusion, and global muscle weakness.
  • 71 yr old admitted 10 days ago admitted with acute respiratory failure. Assess suitability for weaning.
  • A 64 year old male with GB syndrome in ICU for 2 months, ventilator dependant. Candidates were asked to examine and determine diagnosis and problems related to long term ICU stay.
  • A 33 year old man with a history of schizophrenia was found unresponsive at home in a pool of vomit and faeces. He has been slow to wake up. Findings: A ventilated patient, low GCS, pressure areas, biochemical features of rhabdomyolysis and an old infarct on a CT scan.
  • 52 yeard old male, admitted with pneumonia, bilateral infiltrates, worsening respiratory function, empyema, decortication and slow respiratory wean.
  • 64 year old lady with ruptured oesophagus after vomiting. Currently sedated and ventilated. No candidate noted a left thoracotomy wound
  • A 73 year old man with MODS following a recent staphylococcal bacteremia. Other findings included evidence of a septic circulation on a PA catheter, PPM, fluid overload, and evidence of multi-organ dysfunction.
  • A 64 yr old man with cardiogenic shock following a cardiac arrest. Findings included a dilated L.pupil, raised A-a gradient, CRRT and a broad complex rhythm
  • 62 year old male, 5 days in ICU post resuscitated cardiac arrest and candidates asked to assess neurology, discuss prognostication and management plan over the next few days