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Blood, Fluids and Anaesthesia

Leaders:

James Cormack, MD, FRCPC
Edward T. Crosby, MD, FRCPC

Case 1:

A previously healthy 40 year old male is involved in a motor vehicle accident and presents with multiple orthopaedic injuries. He requires an urgent laparotomy for a brisk intra-abdominal haemorrhage.
Hb 80 g/L, BP 80/50, HR 110

Discussion Goals

1. Assessment of blood loss after trauma
2. Perioperative management of major / massive transfusion.
3. Use of components
4. Role of the laboratory in managing major transfusion

Case 2:

A 70 year old male requires a radical prostatectomy. He is otherwise healthy.
Hb 140 g/L

Discussion Goals

1. Isovolemic hemodilution versus erythropoietin versus preoperative autologous donation.
2. How do you determine a Hb that will trigger a transfusion?

Case 3:

A 26 year old female requires a tonsillectomy. In the preadmission clinic she mentions that she had severe bleeding with prior dental procedures and with the vaginal delivery of her only child.

Discussion Goals

1. The preoperative assessment of a patient with a history of previous, unusual perioperative bleeding - taking a Bleeding History.
2. Treatment and optimization of a patient with a history of previous perioperative bleeding.

Case 4:

A 68 year old male requires a femoral popliteal bypass. He had an anterior wall myocardial infarction two years ago and currently suffers from stable angina. An EKG reveals an old anterior MI, but is otherwise unremarkable. All other lab work is normal. Medications include metoprolol and coated ASA.
Hb 124, BP 130/90

Discussion Goals

1. Acceptable hemoglobin in the patient with cardiac disease.
2. Compensatory mechanisms for anemia.

Case 5:
(Optional)

A 42 year old female requires an elective bowel resection. She has an unremarkable medical history other than chronic glomerulonepinitis x 5 years. She is on no medications.
Hb 105, Creatinine 200, Platelet count 200

Discussion Goals

1. The role of erythropoietin and DDAVP in chronic renal disease.
2. Diuretic and fluid management.