1. MRI Critical Care Teaching - PBL Case 2 Luka Randic

2. PBL Case 2  Week 2:  Answers to Scenario 1  Scenario 2  Week 2:  Answers to Scenario 1  Scenario 2

3. 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.  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.

4. Case 2  What would you do?  What do you want to know?  How are you going to manage him?  What would you do?  What do you want to know?  How are you going to manage him?

5. 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?  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?

6. 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)  Coagulopathy  Continuing bleeding  Clotting studies - PT/ APTT/ INR/ TEG  Blood products - platelets/ ffp/ cryoprecipitate  Tranexamnic acid  Desmopressin (DDAVP)  Aprotinin  aFVII (NovoSeven)