Westmead Hospital

  • 49-year-old male, day 2 ICU, with mesenteric and retroperitoneal bleed following emergency coronary angiogram and anti-platelet and anticoagulation therapy for inferior STEMI. Clinical findings included a distended tender abdomen and the presence of a right groin arterial puncture site. Candidates were told he had been given multiple anti-platelet agents for ACS and had developed respiratory failure and been intubated and was now oliguric with elevated creatinine. Candidates were asked to determine the reasons for his deterioration. Discussion points included interpretation of the ECG and CT abdomen, cause for his abdominal distension, cause for his renal failure, management of his coagulation status and suitability for extubation.