OS1-136
Tunnel Vision to Code Blue
Oehler J
SUNY Upstate Medical Center, Syracuse, NY, USA
Tunnel Vision into Code Blue-The perils of a consulting provider.
John Oehler, M.D.
SUNY Upstate Medical University, Syracuse NY.
Jan Wong, M.D.
SUNY Upstate Medical University, Syracuse NY.
A 10 year old male was scheduled for a routine Interventional Radiology guided renal biopsy for edema and fatigue following a step throat infection. His Past Medical History included complex partial seizures at the age of 3 years old, and more recently a Streptococcal Pharyngitis infection with ASO positive confirmation 5 months before presentation for biopsy. Two weeks after his Streptococcal Pharyngitis he developed swelling and fatigue presumably due to Post Streptococcal Glomerulonephritis and managed conservatively. He returned to his nephrologist for continued swelling 4 months after his initial symptoms for re-activation of swelling. Workup at this visit included Urine Pr:Cr 2.3, Albumin 3.1 with normal Renal Function and BP. Normal C3C4.Wide Differential Diagnosis of IgA nephropathy vs. RAAS activation from renal failure and Cardiomyopathy vs Vasculitis vs Immuno Complex Mediated MPGN were considered as he was not fitting into any mold perfectly, thus sent for IR guided Renal Biopsy. On day of biopsy, patient was noted to be swollen and lethargic on pre-anesthetic assessment, presumably from his glomerulonephritis. Plan was for General Anesthesia in prone position for renal biopsy. After pre-oxygenation, patient was induced with 80 mg Propofol, 60 mg Succinycholine, intubated with size 5.5 cuffed ETT without difficulty or great variation in vital signs. Upon placing patient in prone position, he was noted to have bradycardia down to 40 BPM, and decrease in his ETCO2. He was immediately turned supine and administered 0.4 mg Atropine without response. Upon absent palpable pulse and asystole- code blue was called. Patient was resuscitated after 5 minutes and three rounds of Epinephrine. He was transported to ICU on dopamine drip 10 mcg/kg/min. Post event he was found to have Cardiomegaly and pulmonary edema with bilateral pleural effusion on CXR; Bi-atrial Hypertrophy, Right Ventricular Hypertrophy and Left Axis deviation on EKG; Dilated Cardiomyopathy, Left Ventricular Enlargement with severely depressed LV systolic function and apical thrombus in Left Ventricle. This presentation and discussion hopes to emphasize our duty as clinicians to consider alternative diagnoses for our patients while facilitating specialists and not allow ourselves as “primary care in the OR†to be tunnel-visioned into one pathologic process.
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