Long case #3 for the Final SOE
Information for the candidate
A 59 year old man with a known history of colorectal cancer awaiting surgery is brought in by ambulance to the emergency department after falling from a ladder.
He is diabetic and hypertensive, with a moderate exercise tolerance and can manage a flight of stairs without too much trouble.
The paramedics say he has been complaining of severe neck pain since the fall, but has been moving all four limbs.
Medications
- Losartan
- Bendroflumethiazide
- Omeprazole
- Atorvastatin
- Metformin
Examination
- Temperature - 37.1 °C
- Height - 176 cm
- Weight - 95 kg
- Pulse - 86 bpm regular
- Blood pressure - 140/83 mmHg
- Heart sounds - I + II + ESM
- Respiratory rate - 18 /min
Bloods
- Hb - 102 g/L
- WCC - 15.9 x109/L
- Plts - 234 x109/L
- Sodium - 137 mmol/L
- Potassium - 5.6 mmol/L
- Creatinine - 109 µmol/L
- Albumin - 32 g/L
- LFTs - normal
Arterial blood gas
- pH - 7.32
- PaO2 - 9.8 kPa
- PaCO2 - 5.1 kPa
- HCO3 - 23 mmol/L
- BE - -1.6 mmol/L
ECG
- PR interval - 210 ms
- RSR’ in V1 to V3
- Left axis deviation
- T wave inversion in III and V1
Echocardiogram
- Ejection fraction - 65 - 70%
- Left ventricular hypertrophy
- Dilated left atrium
- Right ventricle function and structure normal
- Aortic valve area - 1.5 cm2
- Peak gradient - 26 mmHg
Questions
Please summarise the case
A 59 year old man with multiple comorbidities awaiting cancer surgery has presented with acute trauma.
- I am concerned about the possibility of a cervical spine injury
- His BMI is 31
- Suspicion of active infection
- He has aortic stenosis and his potassium is high