Anaesthesia Viva

Abdominal Gunshot Wounds with Cardiomyopathy

Reading Time

2:00

Clinical Stem

2021.1
A 47-year-old male is brought into the emergency department of a tertiary hospital where you are the anaesthetist on call. He has sustained abdominal gunshot wounds about 2 hours ago with only minor revealed bleeding obvious. He is diaphoretic and agitated requiring restraint. Your help is required to assist keeping him still enough for larger bore intravenous access (he currently has a 20 gauge cannula) and CT angiogram. He is believed to have recently used methamphetamine. BP 100/56 HR 70bpm SaO2 96% He has a background of illicit drug use and a known methamphetamine induced cardiomyopathy (ejection fraction 20-30% on recent echocardiogram). He has extremely poor dentition ("Meth Mouth"). Medications: - telmisartan 40mg daily - carvedilol 25mg (slow release) daily - frusemide (furosemide) 20mg daily

Sections covered in this viva

Assessment of shocked patient with beta blockade and heart failureAirway management and transfer to CT scannerLaparotomy with hypotension: heart failure versus haemorrhage

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