Case 4: A Lack of Communication Leads to a Bad Outcome

Abstract

You have just started your new job as an anesthesiologist. It is Saturday morning, and a 76-year-old man is scheduled for pinning of his fractured left hip. He is an inpatient having been admitted the evening before. You meet the patient (5 ft 11 in. and 75 kg) in the preoperative area. He fell down some stairs the previous afternoon, was taken to the hospital and admitted for surgery this morning. The patient is accompanied by his daughter-in-law and his son. His past medical history tells you that he is being treated for high blood pressure and hyperlipidemia. He has occasional heartburn for which he takes Mylanta. His vital signs are stable. You exam him and find no other injuries and his chest is clear. He has not eaten since lunchtime the previous day. You review the hospitalist note who informs you that he has been vomiting in the night but this was thought to be due to meperidine that had been given to him in the ER. He had been prescribed an antiemetic with good result. The patient says that he does not feel nauseous now and that he has not vomited for hours. His Hct is 36% and the basic metabolic panel is normal. You give him an ASA 2 rating.