MedBugs: SAQ #377

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Case: Post-tonsillectomy haemorrhage with shock

An 18-year-old male is brought in by ambulance with several episodes of large volume haemoptysis 10 days post tonsillectomy. He is severely agitated, combative and confused with ongoing expectoration of large volumes of blood with clots. He has dislodged his IV access. Observations: GCS 14, BP 78/40 mmHg, HR 160 bpm, RR 24/min, SpO2 85% RA, Temp 37.9°C.

1. Outline your approach to chemically restraining this patient. 4 marks

He has been adequately sedated and moved to the resuscitation bay. Your team has been assembled and large bore IV access has been obtained. VBG: pH 7.2 pCO2 45 HCO3 16 lactate 6 Hb 60

2. Outline your priorities for haemostatic resuscitation in this patient. 4 marks

His parents arrive who state he has von Willebrand factor deficiency. He takes no regular medications and has no known drug allergies.

3. What other medications would you consider in managing this patient’s bleeding? 4 marks

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Case: Post-tonsillectomy haemorrhage with shock

1. Outline your approach to chemically restraining this patient. 4 marks

2. Outline your priorities for haemostatic resuscitation in this patient. 4 marks

3. What other medications would you consider in managing this patient’s bleeding? 4 marks

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