SAQ Stack

Short Answer Questions for ED Fellowship Study

Case: Post-tonsillectomy haemorrhage with shock

An 18-year-old male is brought in by ambulance with several episodes of large volume haemoptysis 10 days post tonsillectomy. He is severely agitated, combative and confused with ongoing expectoration of large volumes of blood with clots. He has dislodged his IV access. Observations: GCS 14, BP 78/40 mmHg, HR 160 bpm, RR 24/min, SpO2 85% RA, Temp 37.9°C.

1. Outline your approach to chemically restraining this patient. 4 marks

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He has been adequately sedated and moved to the resuscitation bay. Your team has been assembled and large bore IV access has been obtained. VBG: pH 7.2 pCO2 45 HCO3 16 lactate 6 Hb 60

2. Outline your priorities for haemostatic resuscitation in this patient. 4 marks

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His parents arrive who state he has von Willebrand factor deficiency. He takes no regular medications and has no known drug allergies.

3. What other medications would you consider in managing this patient’s bleeding? 4 marks

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This case forms part of a collaborative marking project designed to support fellowship preparation. In the week leading up to each tutorial, you can contribute answers to any active case. If you contribute, your answers may be reviewed, marked, and used to refine the model answers during the weekly fellowship teaching sessions.

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Your personal results and updated model answers become available the day after the tutorial.

After the tutorial you can still do the case and self-mark your answers, but your answers will not be included in the group review.