Medical Scenarios: Scenario 1

00:01 Okay. Post-op scenario. Some of the trauma scenario, I’m just putting one slide of post-op. Now here I got a AAA, but you can supplement that with total colectomy, total hip replacement, any big operation. Take anything. Essentially, the patient is disoriented and confused. That's the temperature, heart rate and blood pressure. So, classical post-op scenario. Possible causes of confusion in this patient, why is this patient confused? Sepsis, I wouldn't say septic shock. What makes you say septic shock? Sepsis, okay. Anything else? Hypoglycaemia.

00:58 Hypoglycemia. Anything else? Hypoxia.

01:00 Hypoxia, very good. And something, anything else coming up in the history? Alcohol and smoking, so nicotine withdrawal or alcohol withdrawal. Hypoxia, hypoglycaemia, infection, sepsis, urinary tract infection, lower respiratory tract infection, then alcohol, nicotine withdrawal, acute psychosis, acute confusional state, always make sure, elderly patient, if you’re asked in the exam, think about acute confusional state.

01:32 Now this one. In your exam, you'll be surprised how simple some of the questions could be.

01:41 Simple bed test markers. What can you do? What do you really do when you see a patient? You do an oxygen saturation. Do the BM stick, get the capillary blood glucose. You do the urine dip stick, send it for culture. ABG. Chest x-ray. Septic screen. So this is that order. So if at all the question says, what is the next most appropriate thing to do? You have to work around this, you need to make sure that you got that sort of order. Don’t jump into septic screen, ABG. Make sure that if you have an option of answering that, go for that. Oxygen saturation, sorry, yeah.

02:22 Temperature besides sepsis, what is the likely cause? Just urine? Where? Lungs, quite possibly. Lungs. Which one? Wound? Probably not in the first twenty four hours, isn't it? Infection of chest or sepsis from the chest, urinary tract, line infection. Peritoneum would be the last option.

02:50 Okay. Post operative thing, what is the commonest cause of pyrexia postoperatively in our patients normally? Non-inflammatory response? Or little bit of atelectasis. That's the commonest one and a little bit of UTI. These are the commonest things. Always go for the basic tests in your exam. Okay. Slightly different scenario. Twenty nine