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    (Original post by birduk)
    I said I'd step out but....

    asprin?
    Good idea, but with her history may be a bad idea. Aspirin is good for pain, but also increases haemorrhagic stroke & bleeds.
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    All you need is :
    -Cane
    -Whiteboard
    -Oversized tennis ball
    -Extremely extended tenuous metaphor
    -3-4 people to bounce ideas off
    -Sudden epiphany

    And for effect maybe a limp as well???
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    (Original post by Just-Some-Guy)
    All you need is :
    -Cane
    -Whiteboard
    -Oversized tennis ball
    -Extremely extended tenuous metaphor
    -3-4 people to bounce ideas off
    -Sudden epiphany

    And for effect maybe a limp as well???
    It's not lupus...
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    (Original post by Subcutaneous)
    It's not lupus...
    Its never lupus!!! (aside from the one time it was......but thats the exception that proves the rule)
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    Could it be hypovolemic shock? In which case you could do a blood transfusion
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    (Original post by ihaveyourcat)
    Could it be hypovolemic shock? In which case you could do a blood transfusion
    You could be on the right lines with shock, although the nurse isn't liking the temperature...

    Good idea to give a fluid, 1 unit of blood is up...
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    (Original post by ihaveyourcat)
    Could it be hypovolemic shock? In which case you could do a blood transfusion
    You could be on the right lines with shock, although the nurse isn't liking the temperature...

    Good idea to give a fluid, 1 unit of blood is up...You're now starting fluid resuscitation, but to ensure you're monitoring this correctly, what would be a good idea to pop in the patient?
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    (Original post by Subcutaneous)
    You could be on the right lines with shock, although the nurse isn't liking the temperature...

    Good idea to give a fluid, 1 unit of blood is up...You're now starting fluid resuscitation, but to ensure you're monitoring this correctly, what would be a good idea to pop in the patient?
    I have no idea what you'd use to monitor them An ECG perhaps? something to monitor their heart in some way.... I'm just guessing now
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    UPDATE:

    56yr old female, 2 days post-op for subdural haematoma following fall. Had become confused, pyrexial, hypotensive, low sats and high resps, tachycardia..gradually worsening.

    1 unit of blood up (suggested by ihaveyourcats), 4l of o2 via nasal cannulas (when says were 93%..review maybe?) 1g of paracetamol given and fan therapy applied. ECG shows tachycardia and sinus rhythm.

    New set of obs..
    HR: 135
    BP: 74/39
    Sats: 88%
    RR: 28
    GCS: 13/15...patient now drowsy only opening eyes to pain/voice and not making sense with words.
    Temp: 39.3

    .....


    HR:
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    (Original post by ihaveyourcat)
    I have no idea what you'd use to monitor them An ECG perhaps? something to monitor their heart in some way.... I'm just guessing now
    Well cardiac monitoring is a fab idea especially with the high heart rate. It shows tachycardia..the nurse is now constantly monitoring patient. She's cool, clammy and pale.

    However you're putting a fluid into this lady, as her BP is low..consider this, all the blood is getting sent to the organs and centrally and perfusion low. Where would the fluid not go if this is happening?

    Consider what happens normally, we drink water..anything that gets excreted...
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    Ohh ok a catheter then to monitor her urine output
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    (Original post by ihaveyourcat)
    Ohh ok a catheter then to monitor her urine output
    Good call! They're always a good idea to put in if giving IV fluids, to help look at urine output.

    Catheter is popped in, 10ml of residual urine is drained...
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    I'm guessing some kind of post-operative nosocomial pneumonia? Now in shock?
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    (Original post by Mushi_master)
    I'm guessing some kind of post-operative nosocomial pneumonia? Now in shock?
    It's some kind of post-op infection leading to septic shock, but from the history so far you can't really say where it is - though the most likely culprits are UTI, pneumonia or a surgical site infection. Either way this lady needs some aggressive sorting-out.
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    Well lumbar puncture, blood gases and cultures and a urine dip if not been done already. IV ABx, although not sure which ones, maybe CXR?
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    (Original post by Mushi_master)
    I'm guessing some kind of post-operative nosocomial pneumonia? Now in shock?
    Close.

    Septic shock from surgical site (hence the swelling, erythema and exudate on wound).

    Oxygen on high flow mask
    Fbc, u&e's, cultures, clotting, toxicology..cross match etc
    Fluid resuscitation and strict monitoring
    Maybe ABG
    Maintain temp
    And ofcourse IV antibiotics
    Hmm not sure on chest xray, maybe one if the medics could clear that up?

    She could need Inotropic therapy, art line/cvp and a bed on ITU...

    Anyone else want a go..
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    Community Assistant
    (Original post by Helenia)
    It's some kind of post-op infection leading to septic shock, but from the history so far you can't really say where it is - though the most likely culprits are UTI, pneumonia or a surgical site infection. Either way this lady needs some aggressive sorting-out.
    Isn't the exudate from the surgical site an answer to that?
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    (Original post by Subcutaneous)
    Close.

    Septic shock from surgical site (hence the swelling, erythema and exudate on wound).

    Oxygen on high flow mask
    Fbc, u&e's, cultures, clotting, toxicology..cross match etc
    Fluid resuscitation and strict monitoring
    Maybe ABG
    Maintain temp
    And ofcourse IV antibiotics

    She could need Inotropic therapy, art line/cvp and a bed on ITU...
    Missed the bit about the septic surgical site I probably should have stated septic shock.
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    (Original post by nexttime)
    Isn't the exudate from the surgical site an answer to that?


    Exudate is a funny thing just exudate alone wouldn't mean it's an infection. So soon post op I'd expect a little bit on the dressing, although wouldn't be happy if it was foul smelling, dodgy colour and literally oozing out. Although along with swelling, and redness it fits an infection perfectly..wound swab could be done too.
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    (Original post by nexttime)
    Isn't the exudate from the surgical site an answer to that?
    Could well be (and apparently is from subcut's post above) - but you'd want to check out the others as well just in case. Then you hit the Surviving Sepsis care bundle and call the bosses.

    I know very little about neurosurgery so have no idea what IVAbx would be appropriate, or how you would tell whether it was a superficial infection only or had penetrated into the skull itself, which would presumably be pretty disastrous. I am also unsure whether an LP would be a good idea in this situation; I am inclined to think not, given the possibility of raised intra-cranial pressure but I don't know for sure.

    CXR is important especially in the context of low sats, though of course you'd have listened to her chest at some point so you'd have some idea of what you might find there.
 
 
 
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