MedBugs: SAQ #25

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Case: Elderly fall off ladder

A 75-year-old man is brought to the Emergency Department following a fall approximately 1.5m off a ladder. He reports hiting the right side of his chest but denies a head strike or loss of consciousness. His vitals signs are :

GCS 15
HR 65
BP 160/90
RR 22
Sats 91% RA
Temp 36.5˚

1. Complete the table, listing (4) classes of medications he might be taking and a complicating factor that may affect his assessment or management. 4 marks

You perform a chest X-ray.

2. List (2) relevant findings. 2 marks

3. Complete the table, listing the advantages and disadvantages of the following imaging modalities for the assessment of thoracic trauma. 3 marks

4. List analgesic options in the table below, with an advantage and disadvantage for each, with particular focus on the geriatric patient. 6 marks

His pain is well-controlled. As part of his further work-up, a CT brain is performed.

5. State (2) relevant findings. 2 marks

You discover he takes dabigatran for atrial fibrillation, having taken the last dose > 12 hours ago. Dabigatran levels cannot be performed at the hospital laboratory.

6. List (2) blood tests you would perform, with your rationale for determining whether a reversal agent is required. 2 marks

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