guayoman
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76 yo man. Operated for strangulated inguinal hernia. 3rd post op day, he falls out of bed. Immediatly after he is responsive but his speech is slurred. and can't explain what happened. VS: PR 120/m. BP 40/0 RR 20/m Lungs are clear to auscultation. Neck veins are distended. ECG: New onset RBBB. Immediate resuscitatin is started, but becomes unresponsive. A little later his pupls become dilated and heart rate falls to 55,
Most likely diagnosis?
A. Hypovolemia
B. Stroke
C. MI
D. post-operative hemorrhage
E. Massive pulmonary throembolism
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| AAAAA
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E
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| powerranger
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MI
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| AAAAA
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Inginal hernia operation is basically an avacular surgery. i had done a few as surgical assistant and there were very few complication except may be in strangulated ones !
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| achilles
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e- PE
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| guayoman
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Answer is E.
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| AAAAA
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The most common post-op complication is atelectasis !!
Massive PE is very rare and I have only seen twice in many years !
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| AAAAA
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UTI is probably second,
Wound infection are also very common !
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| guayoman
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You are right.... I'll explain further.
JVD and RBBB indicate right heart strain. this signs could be due to right MI, bt PE is more likely. Because the pt is older, post op, bed bound. One detail I forgot to post that might have been more leading is the fact that it happened while sitting up. So the clinical scenario is more indicative of PE, rather than MI.
Also notice the fact that the pt has hypotension and distended neck veins.
The options for infectious complications are not likely beacuse there is no fever.
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