tatiana2004
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Topics: 4
Posts: 8
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I took step 3 yesterday. When I did the cases I received three overall messages that after explaining the risks and the benefits of the procedure the patient or his legal guardian refused the procedure. Does it mean that I ordered something absolutely inappropriate? Who knows?
My cases were:Unconcious male, his girlfrend said he was drinking a lot lately, was prescribed anxiolytics and there were empty bottles of those medications next to him. I forgot to send her home to check the names of these medications. He was bradicardic. I did not give him atropine right away. He remained unconcious. After doing everything else finally at the end I decided to do hemodialysis which his relative refused. Then there was 36 yo female with pleural effusion and difficulty breathing, everything else was normal,I did thoracocentesis, checed the fluid, it was yellow with 10000 RBC,1000 lymphocytes, somewhere down the line I wanted to do pleural bipsy which she refused. Then there was 65 yo woman after sigmoid cancer resection with dyspnea,...VQ scan normal, small athelectasis, uncomfortable, tachicardic. After doing the tests I wanted to intubate her. She refused. Were these mistakes very serious? Tell me your opinion. Then 22 mo baby flabby and week, anemic, small for age, I prescribed him iron, ne got his RBC back, but Retics were 1%(it was written that normal - 0.5-1.5%. I did not do anything for it. Probably I missed a neglect or may be I should have biopsied bone marrow? Tell me your opinion.
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| inok
Forum Newbie
Topics: 2
Posts: 8
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Hi tatiana. First, tthank you for posting your experience.
I certainly don't know answers on all of your questions, but i have some thoghts. About unconcious man. 1 ABC, IV , Oxygen, tiamin, naloxon, glucouse. transfer to ICU Temporary pacer. Screen for drugs. If tricycl or SSRIs then bicarbonate. Consult after
F with effusion toracocentesis is fine. Exudate or transudate?
Then we have to think about SLE an tuberc, oncology. Do battery of tests. like ANA, cultures and so on. Any clue?. Fewer? Gyn status? (ovarian cancer?) U/S. PDD?
65 F sigm cancer, postoperative atelectase. ABG, if paO more than 60, no need in intubation Early ambulation, physio therapy, incencive spyro, excesises. Consult
Anemic child. It seems not to be hemolitic or hemorrhagic, because Ret is low. Did your check lead level, iron, transferrin, ferritin. How about electroforesis for talassemia. Then iron is contrindicated. Bone marrow is not first choice at all.
Probably you did okay anyway. CCS count only 25% of exam.
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CCCP
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