AAA Repair Patient Hot Case

GENERAL APPROACH

  • Emergency or Elective
  • End-organ damage
  • Complications
    – brain injury
    – spinal cord ischaemia
    – ileus
    – MI
    – lower limb ischaemia
    – compartment syndromes
    – renal injury

INTRODUCTION

CUBICLE

  • dialysis

INFUSIONS

  • vasoactives
  • fluid boluses
  • sedation
  • analgesia
  • transpyloric feeding: ileus, ischaemia
  • TPN

VENTILATOR

  • mode
  • level of support
  • level of oxygenation: FiO2, PEEP: ARDS, aspiration, nosocomial pneumonia
  • elevated peak AWP: abdominal distension
  • high PEEP: basal atelectasis

MONITOR

  • ECG: arrhythmia
  • CVP: number, waveform
  • arterial trace: MAP, swing, pulsus paradoxus, pulse pressure, avoidance of hypertension
  • temperature: SIRS

EQUIPMENT

  • IDC: oliguria, anuria (multifactorial)
  • dialysis
  • intra-abdominal pressure measurement
  • surgical scars

QUESTION SPECIFIC EXAMINATION

  • hands/arms -> head -> chest -> abdo -> legs/feet -> back

-> general: jaundice (reabsorption of massive haematoma)
-> cardiovascular:
-> respiratory:
-> abdominal: incision, groins (puncture sites)
-> lower limbs: pulses, compartment syndrome

  • neurological (if hypothermic, comment that will effect neurological assessment)

-> paralysed
-> quick
-> unconscious
-> conscious

  • urine output over last 12 hours
  • supra/infra-renal clamping
  • endo-luminal vs open
  • duration of shock prior to clamping
  • cross clamp time
  • mannitol or frusemide given intra-operatively
  • enteral feeding
  • lower limb pulses on Doppler

RELEVANT INVESTIGATIONS

  • FBC: WCC, Hb, platelets
  • CXR
  • recent CT abdomen
  • other organ failures
  • ABG: gas exchange, metabolic state

OPENING STATEMENT

=

  • Emergency/Elective
  • End-organ function
  • Complications

References and Links


CCC 700 6

Critical Care

Compendium

Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also the Innovation Lead for the Australian Centre for Health Innovation at Alfred Health and Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE.  He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.

His one great achievement is being the father of two amazing children.

On Twitter, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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