Preoperative Case Study for 245

Patient C is a high school senior. During the opening drive in the Friday night football game, Patient C is hit from behind. When he falls, he sustains open, comminuted fractures of his left tibia and fibula. Because he is unable to stand, an ambulance is brought onto the field to transport the young player to the hospital for evaluation.

Upon arrival at the emergency department, Patient C’s leg is examined, x-rayed, and evaluated by the orthopedic surgeon on call. It is determined that prompt stabilization and cleansing of the wound would be optimal for the best possible outcome; thus, Patient C is prepared for surgery. His parents, who were at the game, arrive in the emergency department just moments after the ambulance and are available to give permission for the operative procedure. As Patient C has been medicated for pain, a history is obtained from the parents. There are no notable problems; Patient C is a healthy young man in excellent physical condition. He has not had previous operations and no previous exposure to anesthesia. Preoperative Case Study for 245

Patient C is transferred to the operating room. The anesthesiologist gives the patient a number of preoperative medications, including enflurane (Ethrane), a volatile gas. The patient first receives succinylcholine prior to intubation, followed by the anesthetic gas. Within minutes, the anesthesiologist notes that Patient C’s carbon dioxide levels are beginning to rise. Just as the surgeon is to begin, the patient sustains a cardiac arrest.

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The anesthesiologist immediately stops the insufflation of the gas and begins to administer 100% oxygen. A code response is initiated by the remaining members of the operating team. The rescuer performing chest compressions notes that the patient’s skin is warm. While resuscitative efforts continue, blood for laboratory evaluation is obtained. The arterial blood gas results demonstrate a pH of 6.9, partial pressure of oxygen (PaO₂) of 110 mm Hg, and a partial pressure of carbon dioxide (PaCO₂) of 55 mm Hg.

1. What questions should have been asked of patient or significant others prior to surgery regarding anesthesia? Think about all needed pre-op questions and list them.
2. What problem/complication do you think the patient may be experiencing? What medication is the primary treatment to treat the condition you identified?

3. What is missing from the scenario that you feel should have been included for your decision making?

4. Look up Ethrane and Succinylcholine. What are the adverse reactions of these two medications?

5. As a high school senior is the patient treated as a pediatric patient or an adult in the Code Blue?

6. List the H’s and T’s that need to be corrected for a successful resuscitation of this patient? Preoperative Case Study for 245

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