2012, Hot Cases 1

Prince Charles Hospital
  • 48-year-old male 6 weeks post bilateral sequential lung transplant for end-stage COPD complicated by ARDS secondary to acute rejection, Strep ventilato infection and possible aspiration with multi-organ failure requiring intropes and renal replacement therapy and critical illness weakness. Candidates were asked to identify the reasons tor failure to wean from ventilator support.
  • 28-year-old man 18 weeks+ in ICU with severe necrotizing pancreatitis requiring multiple necrosectomies complicated by SIRS, MOF and a frozen abdomen. Candidates were asked to identify the main clinical issues.
  • 53-year-old man day 2 post MVR for Staph aureus endocarditis complicated by vasoplegic shock, lactic acidosis and right heart dysfunction managed with vasopressors, inotropes, renal replacement therapy and nitric oxide. Candidates were asked to identify the clinical issues and discuss the causes of shock in this patient
  • 42-year-old female day 10 post out of hospital cardiac arrest with hypoxic-ischaemic encephalopathy. Candidates were asked to assess her neurological state, formulate a management plan, discuss a differential diagnosis for the clinical signs and interpret the CT brain and CXR.
  • 43-year-old male post attempted hanging with GCS 3, myoclonus, unreactive pupils and absent oculocephalic reflexes. Candidates were asked to assess the patient and to formulate a management plan.
  • A male patient day 6 post CABG and AVR complicated in the post-operative period by delirium and cardiorespiratory failure requiring re-intubation. Candidates were asked to assess the patient and discuss the main clinical issues and causes of respiratory failure following cardiac surgery.
Princess Alexandra Hospital
  • 18-year-old female day 5 with grade V subarachnoid haemorrhage complicated by intracranial hypertension, management of this including therapeutic hypothermia, and aspiration pneumonia. Candidates were told she had been found unconscious and were directed to assess her neurological status. Discussion included differential diagnosis, aspects of therapeutic hypothermia and DVT prophylaxis
  • 26-year-old motor vehicle crash victim day 10 with fracture/dislocation C6-7 and recent onset fevers and difficulty weaning from ventilation. Candidates were asked to discuss neurological findings and level of spinal injury, fever, ongoing management of spinal cord injury and interpret CXR.
  • 51-year-old male with MSSA endocarditis and ESKD, day 9 post MVR, AVR and aortic root replacement, complicated by bleeding, persisting pneumothorax and ongoing septic shock. Candidates were asked to determine why post-operative progress had been slow, give a differential diagnosis for post-operative hypotension, give a differential diagnosis for the new onset fever and interpret the post-op CXR.
  • 59-year-old female with ESKD day 5 post cardiac surgery complicated by cardiogenic shock, dysrhythmias and ischaemic liver injury, with a cold foot and IABP still in situ. Candidates were asked to identify the major issues and discuss ongoing management.
  • 53-year-old man who fell from a balcony 5 days earlier, sustaining a traumatic brain injury, chest trauma and unstable fracture T12. Candidates were asked to assess him paying particular attention to his neurological state, interpret his CXR and CT chest and discuss which investigations would be helpful in evaluating his neurological state
  • 70-year-old female day 10 with grade III sub-arachnoid haemorrhage complicated by hydrocephalus, seizures, severe vasospasm and extensive right MCA infarction, now febrile to 39 o C. Candidates were asked to assess her neurological status, interpret the CT scan of her head and discuss management of her fever.
Royal Brisbane Hospital
  • 61-year-old day 3 with sub-arachnoid haemorrhage. Candidates were asked to assess her and determine a cause for her presentation with GCS 9. Discussion topics included grading of SAH, underlying causes and prognosis and approach to weaning.
  • 29-year-old female day 23 ICU and 10 weeks post bone marrow transplantation for ALL complicated by engraftment syndrome and GVHD. Admitted to ICU following MET call for respiratory distress, managed with HFOV. Candidates were asked to identify causes for her deterioration and discuss the plan for the next 24-48 hours, her overall prognosis and rescue therapies for ARDS.
  • 65-year-old man post cardiac arrest on induction of anaesthesia for amputation of an infected foot. Candidates were asked to assess him and determine his prognosis.
  • 63-year-old man collapse at home with VF arrest. Candidates were asked to assess his neurological status and discuss his prognosis, determination of brain death and what to say to his family.
  • 63-year-old male day 6 ICU post emergency infrarenal AAA repair, presenting with haemorrhagic shock. Candidates were asked to discuss management of intra-abdominal compartment syndrome and weaning.
  • 18-year-old male day 10 ICU with multi-trauma following pedestrian versus car motor vehicle crash and presentation with haemorrhagic shock. Current issues included new onset fever and failed extubation. Candidates were asked to assess the patient and discuss potential causes of the fever.
  • 43-year-old male day 4 ICU with septic shock and a background of pancreatitis, chronic liver disease and COPD. Candidates were asked to assess the patient and identify the key issues and possible sources of sepsis.

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