2013, Hot Cases 1

Flinders Medical Centre
  • 25-year-old man, 3 days post AVR and debridement of aortic root abscess, secondary to MSSA endocarditis following dental work with multiple emboli to brain, kidneys and spleen and low cardiac output state. Candidates were asked to determine the issues affecting his ability to wean.
  • 75-year-old man, 3 days post out of hospital VF cardiac arrest with a recent history of chest trauma following MVA. Candidates were asked to assess his suitability for extubation
  • 74-year-old man with obesity, COPD and sleep apnoea, intubated for respiratory failure associated with abdominal pain and distension. Candidates were asked to assess his suitability for extubation.
  • 73-year-old man, day 3 In ICU with septic shock and severe respiratory failure on a background of urosepsis (previous nephrectomy) and left ventricular failure. Candidates were asked to perform a general examination and present a differential diagnosis.
  • 40-year-old woman, 2 weeks in ICU, with a history of intravenous drug use, presenting with PV bleeding and a septic spontaneous abortion, and now with right- sided endocarditis and lung abscesses and ongoing fever. Candidates were asked to assess her for causes of the fever.
  • 80-year-old woman, with a history of rheumatoid arthritis and colon cancer, admitted with epigastric pain and referred to ICU following clinical deterioration with hypotension, hypoxia and oliguria. Candidates were asked to assess her and provide a differential diagnosis for her deterioration and a management plan.
Queen Elizabeth Hospital
  • 68-year-old woman, one month in ICU with ARDS and fluid overload, with ongoing high ventilatory requirements, heavily sedated with tracheostomy in situ and critical illness weakness with absent reflexes. Candidates were asked to determine the reasons for her failure to wean.
  • 53-year-old man with liver failure admitted with increasing confusion. Candidates were asked to determine the cause of his altered state.
  • 64-year-old woman, day 1 post VAT / decortication of empyema with chest drain in situ, intubated and ventilated with moderate oxygen and PEEP requirements. Candidates were asked to assess her respiratory status.
  • 68-year-old man with Guillain Barre syndrome, with predominantly upper and lower limb motor weakness, ventilated on minimal pressure support and awake and obeying commands. Candidates were asked to assess his neurological function
Royal Adelaide Hospital
  • 55-year-old woman, day 20 in ICU with influenza B infection, complicated by Staphylococcal pneumonia and critical illness weakness. Candidates were asked to identify the reasons for failure to wean.
  • 17-year-old man, day 30 in ICU, following surgical correction of subglottic stenosis (tracheostomy post MVA 2011) complicated by nosocomial pneumonia and failure to wean. Candidates were asked to examine him and determine the cause of his failure to wean.
  • 46-year-old woman, day 47 in ICU, with multi-trauma (severe chest and abdominal injuries) and nosocomial sepsis. Candidates were asked to determine the cause of her failure to wean and to formulate a management plan.
  • 31-year-old woman, day 6 in ICU, with urosepsis and respiratory failure on a background of SLE. Candidates were asked to assess her focussing on possible causes and management of her respiratory failure.
  • 83-year-old man, initially thought to present with respiratory failure secondary to infective exacerbation of chronic airways disease and subsequently developed weakness and diagnosed with Guillain Barre syndrome. Candidates were told that the bedside nurse had noticed the patient was weak and were asked to examine him and determine whether the nurse's concerns were justified.
  • 24-year-old man, day 17 in ICU, multi-trauma and PEA arrest following 20m fall and new-onset sepsis. Injuries included traumatic brain injury, carotid dissection, chest and abdominal trauma. Candidates were asked to examine him and identify the current clinical concerns.
  • 69-year-old man, day 13 in ICU, following multi-trauma with neck and chest injuries, complicated by NSTEMI requiring percutaneous coronary intervention, nosocomial sepsis and failed extubation. Candidates were asked to examine him and suggest a plan for progress.
  • 25-year-old woman, day 10 in ICU, with a severe traumatic brain injury post MVA (GCS 3 at the scene) and a new fever. Candidates were asked to examine her with a view to assessing her prognosis.
  • 57-year-old man, day 16 in ICU post AVR and CABG. Post-operative course complicated by cardiac failure and leg ischaemia. Candidates were asked to identify the nature of surgery, current issues and to formulate a management plan for the day.

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