MRI Critical Care Teaching PBL Case 2 MRI关键护理教学PBL案例2.pptVIP

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MRI Critical Care Teaching PBL Case 2 MRI关键护理教学PBL案例2.ppt

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MRI Critical Care Teaching PBL Case 2 MRI关键护理教学PBL案例2

MRI Critical Care Teaching - PBL Case 2 Luka Randic PBL Case 2 Week 2: Answers to Scenario 1 Scenario 2 Case 2 A 34 year old man with chronic renal failure as a high dependency bed book for after his elective peritonectomy for sclerosing perotinitis. Throughout surgery he bleeds from his adhesions and friable tissues and requires 16 units of blood preoperatively and 4 bags of FFP. You are asked to arrange a level 3 bed and he arrives on 10mls/hour of “normal” strength noradrenaline and with a blood pressure of 86/40, pulse rate of 114 and CVP of 1. His abdomen is left open with pressure dressings but there is lots of pooling of blood on his bed. Case 2 What would you do? What do you want to know? How are you going to manage him? Case 2 The surgeons are reluctant to take him back to theater until his clotting is corrected. Clotting results: PT 36 APTT 67 Fibrinogen 0.4 FBC: Hb 6.4 Platelets 56 What are your options? Case 2 issues/objectives: Coagulopathy Continuing bleeding Clotting studies - PT/ APTT/ INR/ TEG Blood products - platelets/ ffp/ cryoprecipitate Tranexamnic acid Desmopressin (DDAVP) Aprotinin aFVII (NovoSeven) * * *