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UBP Question 7

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Question 7



(Short Form)


A 68 year old, 145 kg male presents to the operating suite for simultaneous repair of an open fracture of the right radius and an open globe injury of his right eye. Both injuries occurred during a fall while in his kitchen. He recalls finishing supper and standing to take his plate to the sink and then waking up on the floor having broken his arm and injured his eye. His medical history includes hypertension, non-insulin dependent diabetes mellitus, and sick sinus syndrome; his medications include propranolol, HCTZ, and metformin. He is awake and alert with the following vital signs: HR = 76; BP = 154/90 mmHg; T = 36.5 °C

Pre-operative Management

1) What are your concerns when considering this patient for surgery?

UBP Answer: Complete answer is found in the UBP Practice Set #3

2) He tells you that his implanted pacemaker was upgraded to an automatic implantable cardioverter-defibrillator (AICD) 1 year ago when he began to experience episodes of ventricular tachycardia. He hands you a card that identifies this AICD as VVE-DDDRO. What information does this code give you?

UBP Answer: Complete answer is found in the UBP Practice Set #3

3) How would you evaluate the patient’s AICD preoperatively?

UBP Answer: Complete answer is found in the UBP Practice Set #3

4) The orthopedic surgeon says he will need to use electrocautery. Does this concern you?

UBP Answer: Complete answer is found in the UBP Practice Set #3

5) The surgeon says that he will need to use a monopolar electrosurgical unit (ESU). How can you minimize the risk of interference with the AICD?

UBP Answer: Complete answer is found in the UBP Practice Set #3

6) Would you require that the device be interrogated prior to surgery?

UBP Answer: Complete answer is found in the UBP Practice Set #3

7) The surgeon says, “We need to operate. Can’t we just put a magnet over it?”

UBP Answer: Complete answer is found in the UBP Practice Set #3

8) The pacemaker representative sets the device to asynchronous pacing and disables the rate responsiveness function. He recommends using a magnet to disable the antitachycardia shock and pacing capabilities of the AICD. Do you agree with this recommendation to use a magnet in place of reprogramming?

UBP Answer: Complete answer is found in the UBP Practice Set #3

9) Would you administer any preoperative medications?

UBP Answer: Complete answer is found in the UBP Practice Set #3

(Long Form)

A 68 year old male presents to the operating suite for simultaneous repair of an open fracture of the right radius and an open globe injury of his right eye. Both injuries occurred during a fall in his kitchen. He recalls finishing supper and standing to take his plate to the sink and then waking up on the floor having broken his arm and injured his eye.


PMHx: Hypertension
Sick Sinus Syndrome/Tachycardia - AICD 1 year ago (VVE-DDDRO)
Diabetes mellitus – diet controlled

Meds: Propranolol, HCTZ, Metformin

Allergies: NKDA

PE: Vital Signs: HR = 96, BP = 154/90 mmHg, RR = 14, Temp = 36.5 °C, Weight = 145 kg, Height = 72 inches

Airway: Mallampati II

Lungs: clear to auscultation

Cardiovascular: regular rate and rhythm

Labs: Hgb = 13.8 gm/dL, glucose = 156 mg/dL, K+ = 3.1 mEq/L

EKG: Right bundle branch block


Intra-operative Management


1) Where would you place the electrosurgical current-return pad?

UBP Answer: Complete answer is found in the UBP Practice Set #3

2) Could you provide regional anesthesia for these procedures?

UBP Answer: Complete answer is found in the UBP Practice Set #3

3) After consulting with the ophthalmologist, you decide to perform a general anesthetic. How will you induce the patient?

UBP Answer: Complete answer is found in the UBP Practice Set #3

4) Would you use succinylcholine?

UBP Answer: Complete answer is found in the UBP Practice Set #3

5) How would you induce this patient if no succinylcholine were available?

UBP Answer: Complete answer is found in the UBP Practice Set #3

6) Would you place the patient in the trendelenburg position to reduce the risk of aspiration?

UBP Answer: Complete answer is found in the UBP Practice Set #3

7) During laryngoscopy the patient hiccups and about 30 ml of gastric material enters the oropharynx. Would you now place the patient in the trendelenburg position to reduce the risk of aspiration?

UBP Answer: Complete answer is found in the UBP Practice Set #3

8) You secure the airway and surgery is proceeding when the patient’s blood pressure drops to 62/38 mmHg. You note that the heart rate is 43 beats/minute and that not every pacer spikes is followed by a QRS complex. What are you going to do?

UBP Answer: Complete answer is found in the UBP Practice Set #3


Post-operative Management


1) You evaluate and treat the patient and his pacemaker begins to capture appropriately. How would you extubate him?

UBP Answer: Complete answer is found in the UBP Practice Set #3

2) Does the AICD need to be interrogated postoperatively?

UBP Answer: Complete answer is found in the UBP Practice Set #3

3) The pacemaker representative is unable to see the patient until the morning. What will you do?

UBP Answer: Complete answer is found in the UBP Practice Set #3

4) The post-op nurse calls a code because the patient is experiencing ventricular tachycardia. You arrive and note that the patient exhibits a regular wide-complex rhythm (>0.12 sec) with a pulse. What are you going to do?

UBP Answer: Complete answer is found in the UBP Practice Set #3





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