Setting: You are a junior doctor based on a surgical firm.
Patient: Kane White (DOB 22/03/1972, Hospital number 723111, Address: 12 Smith Street, Wareham, WR22 2HD) has come in this afternoon for admission prior to his Whipple’s procedure tomorrow.
He has a history of pancreatic cancer, hypertension and peripheral vascular disease.
He does not have any allergies and weighs 81kg.
He brought a list of his medications (click to enlarge):
The patient says he stopped aspirin 6 days ago as advised by an anaesthetist he saw in clinic.
Blood results: Hb 103 g/L (130-180), WCC 4.5 x10^9/L (4-11), Plt 266 x10^9/L (150-500), Na+ 137 mmol/L (133-146), K+ 4.5 mmol/L (3.5-5.4), Ur 4.5 mmol/L (2.5-7.8), Cr 92 mmol/L (59-104), Mg 0.4 mmol/L (0.8-1.0), INR 1.0 (0.8-1.2)
Task: Please complete the patients drug and fluid prescription charts. You have clarified with your consultant and she has specified:
- The patient should have venous thromboembolism prophylaxis this evening but not on the day of the operation
- The patient should have maintenance intravenous fluids overnight as he will be nil by mouth from midnight (please prescribe 2L initially in case of delay in list)
- Aspirin can be resumed on day 5 post-op
- Any antihypertensives should not be given today or on the day of the operation
- Any electrolyte abnormalities must be corrected intravenously
Please also write up an antiemetic and paracetamol in case the patient needs them post-op.
You have 8 minutes and there will be no questions. Your national formulary (e.g. BNF in UK) is available if needed.
Drug chart can be printed here. Fluid chart can be printed here.
