John is 64, and is a committed Jehovah’s Witness admitted to ICU following surgery for colonic bleeding, with an admission Hb of 42g/L.
He has atrial fibrillation, stable on warfarin. Ten days prior, John had an uneventful colonoscopic snare excision of a colonic polyp. Warfarin had been ceased for the procedure, and was re-commenced day 3 post-op.
John presented to the hospital Emergency Department today with massive PR bleeding and hypotension. He has had an emergency R hemicolectomy, with formation of a colostomy. Vitamin K was given for warfarin reversal; the presentation INR was 3.2.
John was transferred to ICU one hour ago, intubated and ventilated with FiO2 of 0.6. His mean arterial pressure is 75 mmHg on 15 mcg/min nor-adrenaline with cool peripheries and urine output 10-20 ml/hr. Haemoglobin = 42 g/L, platelets = 32, INR = 2.6, pH = 7.28, lactate = 2.3 mmol/L. There is fresh blood in the surgical drains and the colostomy.
(Communication and Ethics) - Pass rate ; highest mark .