Liver cirrhosis and hip fracture
A few days ago our friendly orthopedic surgeon posted case for IM nail in a hip fracture patient who was 73 years old. Unfortunately, the patient had long standing cirrhosis secondary to hepatitis C,...
View Articleend tidal CO2, what intraoperative role can it play?
Today I had a 64 year old male, with no reported medical history, who presented for L4-5 laminectomy. The patient reported that he walked regularly, up to 2 miles with no history of SOB, chest pain or...
View Articlecysto after laparoscopic surgery to verify ureter patency
A 37 year old female presented for diag laparoscopy for suspected ectopic pregnancy and mass in the left adnexa. The procedure was uneventful, however, the surgeon was unable to visualize the ureters...
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elevated preoperative BNP, what do I do now?
A rather unhealthy and unkept gentleman of about 54 years of age presented to the ER after a 'fall'. He presented to the preop area as an add for intertrochanteric nail by our friendly orthopedic...
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35 year old female with history of alcohol abuse
The other day a 35 year old female presented for surgery for lipoma excision from the posterior neck. She reported a history of severe alcohol abuse in the past for which she was taking naltrexone...
View Articlepreoperative hypokalemia, replace and proceed or cancel?
The other morning, while I was in the middle of my first of three scheduled cases I received a call from a nurse to report that the K+ level was 2.8 mEq/L on my next scheduled patient. The patient...
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Three cases of spinal for c-section; an eval of each one.
Last weekend on call I had three sections during the night. The first case was a young nurse, healthy with excellent anatomy for placing a spinal anesthetic. She was admitted around 4pm and went to...
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WPW syndrome in patient with significant intraoperative hyperthermia
Recently I relieved one of our CRNAs. The patient was undergoing a marathon thyroidectomy which had started at 9:30 that morning. It was now 3pm. The report I received indicated that the patient had...
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63 year old male for shoulder arthroscopy and polycythemia vera
Today I was informed by the orthopedic surgeon that the next patient scheduled for shoulder surgery had a Hgb of 19.4 g/dL. He was 63 and appeared to be in poor health. He was on several medications...
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super obese patient for shoulder surgery
Recently my partner placed an interscalene brachial plexus block with catheter in a patient who had a BMI of greater than 60. The patient was at risk for post operative respiratory insufficiency due...
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26 year old on TPN for major bowel surgery
A 26 year old female with previous bowel surgery for superior mesenteric artery (SMA) syndrome, presents to have a revision of her gastrojejunal anastomossis. SMA syndrome occurs when the aorta and...
View Article34 year old female who is 15 weeks pregnant for cerclage
A 34 year old female required cerclage for incompetent cervix and presented to the OR for the procedure. I discussed the pros and cons of GA vs. regional neuraxial anesthesia and we proceeded with...
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fluid resuscitation in an open bowel resection
61 year old male presents with perforation of sigmoid colon secondary to diverticulitis On my saturday call, a 61 year old male presented after several days on the floor for open sigmoid colectomy...
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5,10 methylenetetrahydrofolate reductase deficiency in my patient
This past month I have suddenly had two teenagers present for surgery claiming to have 5,10 methylenetetrahydrolate reductase deficiency. Ironically, I had just reviewed two articles on this exact...
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Post op MI after lap h/h repair
A 61 year old mail presented for repair of a hiatal hernia for symptomatic GERD via a laparoscopic approach and LINX placement. The patient had a history of HTN, hyperlipidemia and CAD with stents...
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72 year old male with gastric outlet obstruction
On a Saturday call I was called in to take care of a 72 year old gentleman who had undergone a six hour paraesophageal hernia repair and extensive lysis of adhesions 10 days prior. He was now...
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Severe toxic Megacolon secondary to Ischemic Colitis
A 76 Year old male was admitted to the hospital after a syncopal episode during a BM at home. The patient was found to be constipated and admitted for further testing. The patient deteriorated in a...
View ArticlePatient requesting labor epidural and a history of Idiopathic Intracranial...
This morning while watching the news showing the DOW plunging by another 2000 + points in the midst of a panicked public related to the spread of the novel corona virus, I was called up to L and D to...
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HIV + patient for urgent c/s
A 26 year old female diagnosed with HIV for several years was urgently brought to the OR for a c/s for NRFHT. The patient was being treated by quadruple anti viral therapy for her HIV. She was also on...
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ramping up elective cases as COVID-19 ramps up as well
As the Anesthesia Chair at a small community hospital I have been involved in helping to make decisions about how to ramp up elective cases as Government Abbot's decision to cancel elective cases comes...
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