Patient of the week – 2


Another piece for the V&A, this made entirely from cutlery (I am drawing a long bow for today’s post)

Here is another case in this sporadic series

Some months ago I looked after a young patient who had been retrieved following a machete injury near the shoulder, resulting in almost total amputation of the arm. The injury had occurred some hours previously, with the patient left at the side of the road.

He had been intubated by the retrieval team at the scene.

On arrival to the Emergency Department his potassium level was 6.5 mmol/L

BT_GS 1.38

Normal serum potassium rise following an intubating dose of suxamethonium is 1.5mmol/L TRUE/FALSE

BT_PO 1.72

ECG changes associated with hyperkalaemia include tall peaked T waves and a shortened PR interval. TRUE/FALSE

He was taken to theatre to reattach the arm. He was hypovolaemic and anuric.

I set about trying to lower his serum potassium and restore his blood volume.

BT_PO 1.40

Salbutamol may be detected as halothane when nebulised within the circle circuit TRUE/FALSE

BT_PO 1.72

Calcium gluconate is used in the  management of hyperkalaemia as it lowers serum potassium TRUE/FALSE

BT_RT 1.9

Hyperkalaemia and hypercalcaemia are potential metabolic consequences of massive transfusion    TRUE/FALSE

To be honest, nothing I tired (and I tried a lot of everything I could think of, short of starting dialysis) lowered his potassium at all. But at least it didn’t increase any further. He survived the reimplantation  and was transferred to ICU for further management, including some much needed haemodialysis.

BT_PO 1.122 Classify and describe the pharmacology of anti-platelet drugs


Vallecula suggested that the photo from the other day (quite similar to this one) could have been the wall of the operating theatre due to platelet dysfunction. I liked that description and thought it apt for today’s topic….

Here is a link to the BJA education article on antiplatelet agents. The link above will take you to the post with an article on the physiology. Again these agents will be widely covered in the textbooks…

BT_PO 1.122 Classify and describe the pharmacology of anti-platelet drugs

Both clopidogrel and prasugrel are prodrugs and subject to inter-individual differences in activity due to genetic polymorphism of their metabolic pathways       TRUE/FALSE

Both clopidogrel and prasugrel block the ADP receptor and are hence associated with the same risk of bleeding as each other       TRUE/FALSE

Platelet function returns to normal approximately 7 days after ceasing abciximab  TRUE/FALSE

All GP IIb-IIIa receptor antagonists can produce thrombocytopenia TRUE/FALSE

Low dose aspirin (75 100mg/day) is the only drug which selectively inhibits the COX-1 isoenzyme    TRUE/FALSE


BT_PO 1.112 Describe the physiology of haemostasis, including the role of platelets

This photo is from the Yayoi Kusama exhibition I went to in Washington earlier this year. Each visitor was given a sheet of stickers to place in the room. Aggregated platelets???

This topic will be covered in any physiology textbook, but also a nice overview in BJA Education here.

It seems to be quite a popular in the vivas as it lends itself to integtation of physiology and pharmacology (which I will cover on Thursday)

BT_PO 1.112 Describe the physiology of haemostasis, including:

• Coagulation

• The role of platelets

• Fibrinolysis

von Willebrand’s factor is essential for platelet activation  TRUE/FALSE

Fibrinogen and collagen are both ligands for platelet glycoprotein receptors  TRUE/FALSE

Thrombopoeitin is produced by the liver and kidneys in response to thrombocytopenia  TRUE/FALSE

Glycoprotein IIb -IIIa is important for platelet aggregation. TRUE/FALSE

Platelet activation results in release of light and dense granule contents TRUE/FALSE
I noticed that the link in yesterday’s post was broken – it’s fixed now

Bleedy McBleedster

BT_PO 1.121

Describe methods to reverse the effect of warfarin

BT_PO 1.120

Describe the pharmacology of warfarin and other anticoagulant drugs

The metabolic clearance of warfarin is inhibited by amiodarone. TRUE/FALSE

Third generation cephalosporins reduce the anticoagulant effect of warfarin. TRUE/FALSE

Intravenous vitamin K should return the prothrombin time to a normal range within 1 hour. TRUE/FALSE

Skin necrosis is a side effect of warfarin therapy. TRUE/FALSE

Warfarin can be reversed with recombinant factor VIIa TRUE/FALSE

BT_PO 1.116 composition, indications and risks of blood products

These questions relate to Fibrinogen:

Q. Is designated by the Roman numeral II.  TRUE/ FALSE

Q. Is the predominant clotting factor found in Prothrombinex.  TRUE/ FALSE

Q. Is the predominant clotting factor found in the circulation.  TRUE/ FALSE

Q. Has a reduced concentration in the pregnant individual.  TRUE/ FALSE

Q. Is a Vitamin K dependent clotting factor.  TRUE/ FALSE