Case discussion: why acidosis?
i did a robot nephrectomy and i kept my patient intubated at the end due to respiratory acidosis. she is elderly with the usual hypertension, DM on insulin, but also with bad pulmonary disease, a component of COPD and severe reduced dlco. on home o2 2L. room air saturation 79-84%
surgery uneventful. 400 ebl. 6 hour case in lateral position. 2.5L fluid.
On emergence, following instructions, having minute ventilation of ~5L, (RR 16, TV ~350-400), with no vent support, thru a 7.0 tube...
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Source: Student Doctor Network - April 11, 2024 Category: Universities & Medical Training Authors: waterbottle10 Tags: Anesthesiology Source Type: forums
Bone pain?
I have a late 30's female patient with a history of leukemia (bone marrow transplant, chemo, nephrectomy), who has lateral hip and thigh pain. Unilateral pain. No obvious exacerbating or alleviating factors. Moderate to severe intensity, constant.
She's got femoral diaphysis infarctions, several of them, and they match up exactly where she hurts. The lateral hip distribution isn't the main focus, it is the proximal and lateral thigh.
She's got buttock pain as well, which was positive on...
Bone pain? (Source: Student Doctor Network)
Source: Student Doctor Network - July 13, 2020 Category: Universities & Medical Training Authors: SommeRiver Tags: Pain Medicine Source Type: forums
Nitrous Oxide during Abdominal Surgery, Yay or Nay?
I've thought about this and I can't seem to get a straight answer out of anyone. Obviously, you don't want to use nitrous in closed noncompliant spaces (middle ear and intracrainal cases), but what about using it during lap appy/choles, robo hys or during wake ups after a exlap/nephrectomy etc. How significant is the expansion effect for exposures less than 1 hour in duration? (Source: Student Doctor Network)
Source: Student Doctor Network - October 2, 2017 Category: Universities & Medical Training Authors: 0kazak1 Source Type: forums
Adjuvant RT after nephrectomy for renal cell carcinoma
Dear colleagues, would you give adjuvant RT after nephrectomy for renal cell carcinoma but with residual disease in a LN that was not resected because of adherence to the vena cava ? (Source: Student Doctor Network)
Source: Student Doctor Network - August 24, 2017 Category: Universities & Medical Training Authors: Kroll2013 Source Type: forums
Question about proceeding w case.
Just curious if you guys would proceed w the case or cancel.
Case is lap radical nephrectomy for cystic neoplasm. 60s years old avg sized, has mild copd , htn , smoker/drinker, had SOB 3 months ago found to have large anterior MI on EKG . tte per cardiologist note said 31% ef and lv aneurysm, etc and cleared him. According to patient he said he had stress test sometime after the MI and he thinks it was normal.. Labs today normal. Does get SOB w some exertion. Got a Aicd placed couple week...
Question about proceeding w case. (Source: Student Doctor Network)
Source: Student Doctor Network - May 26, 2017 Category: Universities & Medical Training Authors: waterbottle10 Source Type: forums
Clinical scenario
Had this case the other day and the nephrectomy case made me want to share this.
GETA for a small palatine tumor removal.
Easy tube everything fine. I step out to get something and the nurse calls me because the patient desats to 74. She was at 98 just a minute ago. Pulse ox wave is very good nothing weird on the vent capnography at 22.
What do you do? (Source: Student Doctor Network)
Source: Student Doctor Network - March 13, 2016 Category: Universities & Medical Training Authors: dhb Source Type: forums
Clinical case: intraop hypoxemia during robot partial nephrectomy
So, doing my CA-3 board runner rotation and got called to a room to help out with this guy.
59yo M, 5'7", 250lb hx HTN, OSA with CPAP, >4 mets, normal EKG, nonsmoker presents for robotic L partial nephrectomy d/t 4x4x4cm mass suspicious for RCC found on CT following c/o hematuria. Normal PE except for distant breath sounds d/t pt's massive truncal obesity. Anticipated difficult airway cause he's got no chin and huge neck. Unable to pass tube with initial glidescope view, long story short he...
Clinical case: intraop hypoxemia during robot partial nephrectomy (Source: Student Doctor Network)
Source: Student Doctor Network - March 10, 2016 Category: Universities & Medical Training Authors: vector2 Source Type: forums
