This was an interesting consult: 75 y/o woman with depression (lost her husband a month ago) and chronic back pain came in for an elective laminectomy. She received rapid induction with Propofol and succinylcholine and was intubated rapidly. She then had sudden bradycardia and hypotension with hypoxemia and her continuous end-tidal CO2 indicator dropped precipitously.
They cancelled the surgery and gave her dopamine and fluids. She had a rebound tachycardia with dopa, was given neosyn. and cardiology and I were consulted.
What other info would you want?
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Actual or former smoker?
Previous medical history?
Drugs for treating depression/other disease (ex. cardiac failure)?
General inspection - Habitus exterior?
ASA/Goldman classification?
Plasma bicarbonate concentration?
Arterial blood gases?
Hemoglobin level prior induction of surgery?
1. Where was the ETT? Maybe she was intubated into the right mainstem.
2. Other alternative: that the end tidal CO2 suddenly went down indicates that tube may never have been in the airway. Perhaps it was in the esophagus....
She was quite obese, not on cardiac or pulmonary meds. Limited performance status because of the back pain and depression. Very remote TOB use. Pre-op EKG had an anterior LFBBB. Normal pre-op CBC. First ABG was 7.24 / 58.8 / 93.9.
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